Cognitive load and performance of health care professionals in donning and doffing PPE before and after a simulation-based educational intervention and its implications during the COVID-19 pandemic for biosafety

Infez Med. 2020 Jun 1;28(suppl 1):111-117.


Introduction: The Personal Protective Equipment (PPE) is essential to avoid the COVID-19 spread to health care workers. Its use can be difficult, posing a high risk of contamination, mainly during doffing, then with the risk of becoming infected.

Methods: We conducted a prospective before-and-after design that used clinical simulation as a research methodology in a clinical simulation center of Colombia. A simulation-based educational intervention with two cases related to COVID-19 was proposed in the emergency room and the intensive care unit. We conducted A workshop for donning and doffing of personal protective equipment (PPE) and a debriefing after the first case.

Results: In the pre-test, 100% of participants failed donning and doffing PPE, 98.4% were contaminated, only one-person did not contaminate out of. The mean cognitive load was high (7.43±0.9 points). In the post-test, 100% were successful in donning the PPE and 94.8% in doffing; only 9.8% were contaminated. The mean of the cognitive load was low (4.1±1.4 points), and the performance was high (7.9±1.1). Of the total, 73.8% of participants reported overload in the doffing. The most difficulties were in gown/overall, and N95 mask removal.

Discussion: The PPE donning and doffing is critical and may be changed significantly by active training. In responding to the current COVID-19 pandemic in 2020, activities of training in donning and doffing PPE would provide a means of training personnel, reducing the cognitive load and maybe the risk of contamination and infection of health care workers.

MeSH terms

  • Adult
  • COVID-19
  • Containment of Biohazards
  • Coronavirus Infections / prevention & control*
  • Emergency Service, Hospital
  • Equipment Contamination
  • Eye Protective Devices
  • Female
  • Gloves, Protective
  • Hand Hygiene
  • Health Personnel / education
  • Health Personnel / psychology*
  • Humans
  • Infection Control / methods
  • Intensive Care Units
  • Male
  • Masks
  • Memory, Short-Term*
  • Occupational Diseases / prevention & control*
  • Pandemics / prevention & control*
  • Personal Protective Equipment*
  • Pneumonia, Viral / prevention & control*
  • Prospective Studies
  • Protective Clothing
  • Simulation Training*
  • Task Performance and Analysis