Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self-Contamination During Donning and Doffing

J Emerg Med. 2022 Mar;62(3):337-341. doi: 10.1016/j.jemermed.2021.12.010. Epub 2022 Feb 4.


Background: At least 115,000 health and care workers (HCWs) are estimated to have lost their lives to COVID-19, according to the the chief of the World Health Organization (WHO). Personal protective equipment (PPE) is the first line of defense for HCWs against infectious diseases. At the height of the pandemic, PPE supplies became scarce, necessitating reuse, which increased the occupational COVID-19 risks to HCWs. Currently, there are few robust studies addressing PPE reuse and practice variability, leaving HCWs vulnerable to accidental contamination and harm.

Objective: The objective of this study was to assess potential HCW contamination during PPE donning, doffing, and reuse.

Methods: The study included 28 active acute care physicians, nurses, and nurse practitioners that evaluated 5 simulated patients with COVID-like symptoms while donning and doffing PPE between each patient encounter. An N95 mask was contaminated with a transparent fluorescent gel applied to the outside of the N95 mask to simulate contamination that might occur during reuse. Participants were evaluated after PPE doffing for each encounter using a black light to assess for face and body contamination.

Results: All participants had multiple sites of contamination, predominantly on their head and neck. None of the participants were able to don and doff PPE without contaminating themselves during five consecutive simulation cycles.

Conclusions: The current Centers for Disease Control and Prevention PPE guidelines for donning and doffing fall short in protecting HCWs. They do not adequately protect HCWs from contamination. There is an urgent need for PPE and workflow redesign.

Keywords: PPE; PPE reuse; doffing; donning; occupational risks; personal protective equipment.

MeSH terms

  • COVID-19* / prevention & control
  • Fluorescence
  • Health Personnel
  • Humans
  • Pandemics / prevention & control
  • Personal Protective Equipment*