PPE donning and doffing checklists – creating clarity in a time of uncertainty

Tsun, Jonathan Haseeb Muhammad Kent Harriet Su Vern Lim Browning Timothy Ka-Wing Ng Paran Kiritharamohan Tambe Anagha

Coronavirus 2019 (Covid-19) poses a new hazard for healthcare professionals. Infection prevention relies on donning and doffing (D&D) personal protective equipment (PPE) safely. Studies have suggested the importance of clear D&D instructions in reducing the risk of self-contamination.1 Guidance on Covid-19 PPE from Public Health England (PHE) was sparse and ambiguous, leaving many operating department (OD) and ICU staff feeling unprotected.2 In view of this, anaesthetic trainees devised D&D checklists to improve staff confidence and safety.A survey was created asking OD and ICU staff to rate their confidence in D&D following PHE’s guidance on a 10-point Likert scale (1 - low;10 - high), if PHE guidance provided sufficient detail, and how it could be improved upon. New D&D checklists were devised based on existing guidelines and scientific evidence. Final checklists were approved and disseminated by Trust management. Same staff completed a post-intervention survey, asking to rate their confidence using new checklists on the same scale, if the new checklists improved upon PHE’s, whether sufficient checklists were displayed, and if not, where else they should be displayed. Data was tested using Wilcoxon matched pairs test.37 staff completed both surveys. The most common suggestion was for detailed checklists. 97% of participants said PPE guidance was not available where required. Median confidence improved from 4 to 9 after using our new checklists (p<0.0001). All participants reported the checklists significantly improved upon PHE guidance. After dissemination, 95% of participants commented that sufficient checklists were displayed, but suggested displaying on resuscitation trolleys and COVID wards.The results of our study demonstrate significantly improved confidence in D&D using our checklists. Through collaboration with the multidisciplinary team, anaesthetic trainees produced checklists that provided clarity on PPE procedures for staff across the Trust.Kwon J, Burnham C, Reske K, et al. Assessments of healthcare worker protocol deviations and self-contamination during personal protective equipment donning and doffing. Infection Control and Hospital Epidemiology 2017;38(9):1077–1083.Rimmer A. Covid-19: doctors still do not have #properPPE. BMJ 2020;369:m1423.