Study shows SARS protective clothing systems and procedures need improvement

Kingston, ON – Health-care workers who don protective clothing to stave-off infection from threats such as SARS, other emerging infectious diseases, and bio-terrorism are still vulnerable to contamination, a Queens University study has found.

The strengths and limitations of each protective system need to be considered when recommendations are made about which choice of system, donning and removal procedures and decontamination procedures are optimal, says Dr Jorge E Zamora, a Queens University anesthesiologist and lead author of the study.

Released today in the Canadian Medical Association Journal (CMAJ) in early August, the study compares two kinds of recommended protective clothing systems and found that one kind of protective gear leaves health-care workers prone to contamination at their forearms, wrists, hands and necks. Another more elaborate ensemble, while proving more protective, was time-consuming for these workers to don and remove without making procedural errors – an important consideration, as workers must change after performing specific procedures on patients.

The studied protective gear is recommended by the Ontario Ministry of Health and Long-Term Care and the US Centre for Disease Control and Prevention to protect health-care workers performing high-risk procedures in patients affected by diseases, such as SARS, that are transmitted via aerosols or respiratory droplets.

This study provides us with a valuable first step in the examination of the relative effectiveness of protective clothing systems used by health-care workers. Future attempts to optimize health-care workers protective clothing should involve efforts to find a solution to the different levels of protection associated with specific systems and to improve decontamination procedures, says Dr Zamora.

He and fellow Queens researchers John Murdoch, Brian Simchison, and Andrew G Day, had the studys 50 participants from Kingston General Hospital put on the respective outfits and then contaminated them with an ultraviolet light-detectable spray and paste. The participants were timed and video-taped as they put on and removed their gear and any procedural violations were noted.

The enhanced respiratory and contact precautions (E-RCP) outfit, consisting of hair cover, goggles, face-shield, breathing mask, gloves and surgical gown, left participants more vulnerable to contamination particularly on the front of their necks, hands and wrists, but was easier to put on and take off. All but two of the participants donning the E-RCP experienced some contamination.

An outfit incorporating a powered air-purifying respirator (PAPR), included two protective layers adding a hood, more gloves, hooded coveralls, and boot covers to the ensemble. This outfit did offer superior protection but required more time and more procedural steps to don. Although participants were coached through both donning and removing this outfit, 15 participants made violations during the more than six minutes it took to put it on.

The study, funded by the Physicians Services Incorporated Foundation and the Clinical Teachers Association of Queens University, also proved to be an excellent training exercise for the participants and drove home the importance of thoroughly washing their hands, wrists, forearms and even their necks after removing the clothing.