Table 1.

Care escalation strategies for donning and doffing procedure

Donning and doffing	Action	Example safety statements
Prior to rounding	Assign roles, including the clinical assessor and the personal protective equipment (PPE) spotter. This sets expectations and provides role clarity.	Both physicians: “When we round today, let's agree that during donning and doffing, that no other tasks will be completed so that we can maintain our focus.”
Predonning	Review tasks that need to be completed inside the patient's room before the assessor pauses to don PPE. Signal this with a safety statement.	Assessor: “Please spot me when I'm donning my PPE. Do not hesitate to correct errors to ensure my safety and the safety of our team.”
Donning	Employ silence during application of PPE to ensure the assessor focuses on the task and the spotter actively observes.	Assessor: “I have now put on my PPE. Am I safe to enter the patient's room?”
Predoffing	Assessor announces exit from patient's room. This cues the spotter to observe the doffing of PPE and to be alert for lapses to create situational awareness.	Assessor: “All eyes on me. I am leaving the patient's room and I will be removing my PPE.”
Doffing	Assessor focuses on the task of doffing while the spotter actively observes. If focus is broken, or an impending error occurs, use a safety statement for correction.	Spotter: “Stop! You are about to touch your face. Please perform hand hygiene before removing your mask”.
After patient assessment	Debrief any safety issues and lapses in infection control procedures. This normalizes the shared responsibility for safety.	Spotter: “You were speaking while you were doffing your PPE. I believe this lead to your distraction and subconscious attempt to touch your face. Let's agree that we will remain silent during doffing so that you can focus on removal of PPE while I spot you.”