When protection becomes the risk for healthcare workers

As flu season ramps up and back to school means kids coming home green and vomiting from norovirus or the “stomach bug,” we are reminded that even the pros can get this infectious disease stuff wrong.

A new study shows that healthcare workers are contaminating themselves taking off their personal protective equipment (PPE). This is counterintuitive to most. PPE, when worn and taken off correctly, is supposed to protect and prevent and not to create harm.

{mosads}Gloves and gowns are common examples of PPE. Healthcare workers wear them when caring for patients with known or suspected infectious diseases, like flu, norovirus or drug resistant organisms like MRSA. These barriers are in place to protect the healthcare worker from acquiring whatever the patient has. They are also integral to protecting the next patient the nurse or doctor sees.

The practice goes like this: Put on PPE, attend to patient, take off PPE, throw it away, put on new PPE, attend to next patient and so on for a 12-hour shift.

What most don’t know is that the take-off-PPE step has to be done properly. If not, the bugs that have been transferred from the patient’s skin or body fluid to the worker’s gloves or gown can easily contaminate the practitioner’s skin or clothing. From there, those bugs can be transmitted to the next patient, to the next healthcare worker, and potentially onto every surface that worker has touched.

A new study shows — in bright fluorescent colors — that this matters.

In a recently published study in JAMA Internal Medicine (part of the Journal of the American Medical Association network) conducted by Dr. Myreen Tomas and a team based in Cleveland, it is shown that almost half of the time (46 percent), healthcare workers are contaminating their own skin or clothing when they take off contaminated PPE.

The researchers mimicked what might happen with real bugs and real patients by using fluorescent lotion and a fake bug to see how this can happen. They put the fluorescent marker just on the PPE (gloves and gown) and asked healthcare workers to take them off.

The researchers looked under a black light to see if the fluorescent color remained on the worker. They found it on the workers’ hands, forearms, neck and face, as well as in their hair and on their clothing. It was essentially everywhere the contaminated PPE touched the healthcare worker when they took it off.

If the fluorescent color were an actual microorganism instead, it could easily be passed on: a microscopic, infectious hitchhiker left on their “clean” hands, skin, hair, scrubs, lab coat or clothing.

Published studies like this conducted in simulated research environments remind us that what we do in actual life matters.

Most of us do not have access to gloves or gowns or other PPE in our regular lives. We definitely do not know if everyone we touch has an infectious microorganism. We do know that bugs that cause illness or infection (like viruses and bacteria) can be rubbed off from one surface to the next and even when we are protected, that we need to pay attention. We need to wash our hands, limit how much we touch our noses and mouths with those bare hands, and be an active contributor to public health.

With drug resistance on the rise from practices like over-prescribing and overuse of antibiotics in both humans and animals, this becomes increasingly important. This is especially true for children and the elderly, or those whose bodies are compromised from illness, disease or disability.

Mitchell, DrPH, M.P.H., C.P.H. is the president and executive director of the International Safety Center and the Public’s Health.