Casanova Lisa M, Teal Lisa J, Sickbert-Bennett Emily E, Anderson Deverick J, Sexton Daniel J, Rutala William A, Weber David J
1Division of Environmental Health,School of Public Health,Georgia State University,Atlanta,Georgia.
2Hospital Epidemiology,University of North Carolina Healthcare,Chapel Hill,North Carolina.
Infect Control Hosp Epidemiol. 2016 Oct;37(10):1156-61. doi: 10.1017/ice.2016.169. Epub 2016 Aug 1.
OBJECTIVE Ebola virus disease (EVD) places healthcare personnel (HCP) at high risk for infection during patient care, and personal protective equipment (PPE) is critical. Protocols for EVD PPE doffing have not been validated for prevention of viral self-contamination. Using surrogate viruses (non-enveloped MS2 and enveloped Φ6), we assessed self-contamination of skin and clothes when trained HCP doffed EVD PPE using a standardized protocol. METHODS A total of 15 HCP donned EVD PPE for this study. Virus was applied to PPE, and a trained monitor guided them through the doffing protocol. Of the 15 participants, 10 used alcohol-based hand rub (ABHR) for glove and hand hygiene and 5 used hypochlorite for glove hygiene and ABHR for hand hygiene. Inner gloves, hands, face, and scrubs were sampled after doffing. RESULTS After doffing, MS2 virus was detected on the inner glove worn on the dominant hand for 8 of 15 participants, on the non-dominant inner glove for 6 of 15 participants, and on scrubs for 2 of 15 participants. All MS2 on inner gloves was observed when ABHR was used for glove hygiene; none was observed when hypochlorite was used. When using hypochlorite for glove hygiene, 1 participant had MS2 on hands, and 1 had MS2 on scrubs. CONCLUSIONS A structured doffing protocol using a trained monitor and ABHR protects against enveloped virus self-contamination. Non-enveloped virus (MS2) contamination was detected on inner gloves, possibly due to higher resistance to ABHR. Doffing protocols protective against all viruses need to incorporate highly effective glove and hand hygiene agents. Infect Control Hosp Epidemiol 2016;1-6.
目的 埃博拉病毒病（EVD）使医护人员（HCP）在患者护理期间面临高感染风险，个人防护装备（PPE）至关重要。EVD脱卸PPE的方案尚未经过验证以预防病毒自我污染。我们使用替代病毒（非包膜的MS2和包膜的Φ6），评估了经过培训的医护人员按照标准化方案脱卸EVD PPE时皮肤和衣物的自我污染情况。方法 本研究共有15名医护人员穿戴EVD PPE。将病毒涂抹在PPE上，一名经过培训的监测人员指导他们完成脱卸方案。在15名参与者中，10人使用含酒精洗手液（ABHR）进行手套和手部卫生，5人使用次氯酸盐进行手套卫生并使用ABHR进行手部卫生。脱卸后对内层手套、手部、面部和工作服进行采样。结果 脱卸后，15名参与者中有8名在优势手佩戴的内层手套上检测到MS2病毒，15名参与者中有6名在非优势手内层手套上检测到该病毒，15名参与者中有2名在工作服上检测到该病毒。当使用ABHR进行手套卫生时，在内层手套上均观察到MS2病毒；使用次氯酸盐时未观察到。当使用次氯酸盐进行手套卫生时，1名参与者手部检测到MS2病毒，1名参与者工作服上检测到MS2病毒。结论 使用经过培训的监测人员和ABHR的结构化脱卸方案可防止包膜病毒自我污染。在内层手套上检测到非包膜病毒（MS2）污染，可能是由于其对ABHR的抵抗力较高。预防所有病毒的脱卸方案需要纳入高效的手套和手部卫生剂。《感染控制与医院流行病学》2016年；1 - 6。
