Under ARMOUR - Donning and doffing of Personal Protective Equipment for simulated CPR of COVID-19 patients

Abstract

Abstract Background Personal protective equipment (PPE) protects healthcare workers and patients. Data on guideline compliance on how to dress (donning) or remove (doffing) PPE and the effect of monitoring (buddying) are limited. This study assesses the quality of donning, doffing, and buddying of PPE in a simulated medical emergency. Method Physicians handling a simulated cardiac arrest of a COVID-19 patient. Adjacent to the victim, PPE (FFP2 masks, gowns, caps, protective eyewear, gloves) was available. Data analysis was performed on video recordings. The primary outcome was the number and timing of participants being appropriately protected, defined as both wearing a) all PPE items provided, and b) all PPE items correctly at the time of first patient contact (FPC). Secondary outcomes included compliance with doffing and buddying. Statistical analysis was performed using SPSS (version 28). Mann–Whitney test, Chi-square test, and linear regression analysis were performed as appropriate. Results At first patient contact 91/437 (21%) were correctly protected while 306/437 (70%) were partially incorrectly protected. One or more PPE items were missing in 62/437 (15%). Overall donning time was 63 (52–74) seconds, the time interval between donning start and FPC was 66 (55–78) sec. Time to FPC was longer in correctly than in incorrectly protected participants (77 [66–87] vs 64 [54–75] sec; P < 0.0001) and decreased by 7 ± 2 seconds per PPE item omitted (P = 0.002). Correct doffing was observed in 192/345 (56%), buddying in 120 participants (27%). Conclusions Our findings imply a need for education in correct and timely PPE donning and doffing. Donning PPE as intended delayed FPC. This and the influence of buddying needs further investigation (German study register number DRKS00023184).