Modelling the risk of SARS-CoV-2 infection through PPE doffing in a hospital environment

Abstract

AbstractSelf-contamination during doffing of personal protective equipment (PPE) is a concern for healthcare workers (HCW) following SARS-CoV-2 positive patient care. Staff may subconsciously become contaminated through improper glove removal, so quantifying this risk is critical for safe working procedures. HCW surface contact sequences on a respiratory ward were modelled using a discrete-time Markov chin for: IV-drip care, blood pressure monitoring and doctors’ rounds. Accretion of viral RNA on gloves during care was modelled using a stochastic recurrence relation. The HCW then doffed PPE and contaminated themselves in a fraction of cases based on increasing case load. The risk of infection from this exposure was quantified using a dose-response methodology. A parametric study was conducted to analyse the effect of: 1a) increasing patient numbers on the ward, 1b) the proportion of COVID-19 cases, 2) the length of a shift and 3) the probability of touching contaminated PPE. The driving factors for infection risk were surface contamination and number of surface contacts. HCWs on a 100% COVID-19 ward were less than 2-fold more at risk than on a 50% COVID ward (1.6% vs 1%), whilst on a 5% COVID-19 ward, the risk dropped to 0.1% per shift (sd=0.6%). IV-drip care resulted in higher risk than blood pressure monitoring (1.1% vs 1% p<0.0001), whilst doctors’ rounds produced a 0.6% risk (sd=0.8%). Recommendations include supervised PPE doffing procedures such as the “doffing buddy” scheme, maximising hand hygiene compliance post-doffing and targeted surface cleaning for surfaces away from the patient vicinity.ImportanceInfection risk from self-contamination during doffing PPE is an important concern in healthcare settings, especially on a COVID-19 ward. Fatigue during high workload shifts may result in increased frequency of mistakes and hence risk of exposure. Length of staff shift and number of COVID-19 patients on a ward correlate positively with the risk to staff through self-contamination after doffing. Cleaning of far-patient surfaces is equally important as cleaning traditional “high-touch surfaces”, given that there is an additional risk from bioaerosol deposition outside the patient zone(1).