Human Factors Risk Analyses of a Doffing Protocol for Ebola-Level Personal Protective Equipment: Mapping Errors to Contamination

Abstract

Background. Dofng protocols for personal protective equipment (PPE) are critical for keeping healthcare workers (HCWs) safe during care of patients with Ebola virus disease. We assessed the relationship between errors and self-contamination during dofng. Methods. Eleven HCWs experienced with dofng Ebola-level PPE participated in simulations in which HCWs donned PPE marked with surrogate viruses (ψ6 and MS2), completed a clinical task, and were assessed for contamination afer dofng. Simulations were video recorded, and a failure modes and effects analysis and fault tree analyses were performed to identify errors during dofng, quantify their risk (risk index), and predict contamination data. Results. Fify-one types of errors were identifed, many having the potential to spread contamination. Hand hygiene and removing the powered air purifying respirator (PAPR) hood had the highest total risk indexes (111 and 70, respectively) and number of types of errors (9 and 13, respectively). ψ6 was detected on 10% of scrubs and the fault tree predicted a 10.4% contamination rate, likely occurring when the PAPR hood inadvertently contacted scrubs during removal. MS2 was detected on 10% of hands, 20% of scrubs, and 70% of inner gloves and the predicted rates were 7.3%, 19.4%, 73.4%, respectively. Fault trees for MS2 and ψ6 contamination suggested similar pathways. Conclusions. Ebola-level PPE can both protect and put HCWs at risk for self-contamination throughout the dofng process, even among experienced HCWs dofng with a trained observer. Human factors methodologies can identify error-prone steps, delineate the relationship between errors and self-contamination, and suggest remediation strategies.