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. 2020 Nov 5;49(6):713–720. doi: 10.1016/j.ajic.2020.11.002

Table 2.

Visual summary of observation results in simulations and suggested recommendations

Related pictures Descriptions and comments
Image, table 2 From previous PPE donning/doffing experience, healthcare personnel (HCP) developed their own knowhow to avoid the cumbersome issue of shoes getting stuck inside of the coverall (left picture). HCP wore coveralls half on their shoes (middle picture) and removed them by stepping on the coveralls with the other foot (right picture). This method effectively made HCP take less time and avoid bending down to hold the coveralls to extract their foot in our observation. Worthy of being considered for the recommendations, when the coverall without combined foot-covers is used with additional shoe covers.
Image, table 2 The string type of finger rings which was attached at the end of coverall sleeves were not enough to hold the sleeve covers’ inner gloves; often, the string was too long and wrist skin can be exposed despite the string (left picture). Instead, trained HCP made a thumbhole on a sleeve as a thumb finger ring using scissors; it was more stable and fully covers the gap between inner gloves and sleeves (right picture).
Image, table 2 Most of the inner glove contaminations occurred during the coveralls doffing process by touching contaminated brackets. After opening the front zipper (left picture), then bending down to untie the shoe ties (middle picture) caused the contaminated outer bracket to touch the HCP's inner shirt (right picture). It would be better to untie the shoe cover strings before opening the front zipper of the coveralls.
Image, table 2 The corner of the untucked inner shirt touched the contaminated surface of the coveralls (middle picture) during the doffing process and became contaminated (right picture). The inner shirt needs to be tucked in the inner pant.
Image, table 2 After doffing the hood of the coveralls (left pictures), the sliding down front surface of the hood touched the back hair (middle picture), because it was not folded over easily due to the thick material. It would be better to make sure that the hood part is completely turned down or folded over. In addition, managing hair in a compact way (eg, in a disposable inner hat) would be recommended.
Image, table 2 Leaving the sagging coveralls without rolling them down (left and middle pictures) to put the contaminated surface inside caused contamination on the arm (right picture) while bending down to take the shoes off. It is recommended to make sure the contaminated surface inside by rolling the coveralls down.
Image, table 2 The contaminated stethoscope caused contamination around the ear, hair, mask, and the collar of the shirt. Disinfection of the stethoscope's surface is necessary every time before use. However, it may be better not to use the stethoscope, because it would not be easy to disinfect the full surface of the stethoscope thoroughly.
Image, table 2 While a hood was being removed (left picture), the front end of the hood, which was contaminated by touching the contaminated front surface of the coverall, contaminated the touched hair part (right picture). The end of the hood needs to be carefully folded so as not to touch any part of the body when it is removed.
Image, table 2 Loosely wearing goggles that had a front-head gap (left picture) and loosely wearing an N95 respirator that had a mid-nasal gap (middle picture) caused a collection of fluorescent powder on the curved sides of the participant's nose (right picture). As generally recommended, HCP need to ensure the sealing of an N95 respirator along with their face shape.