Becoming Don of the Doff: Navigating the Complexity of Donning and Doffing Personal Protective Equipment in the Home

Abstract

Purpose: The safety of care providers and patients is paramount while caring for people with infectious diseases, including those with confirmed or suspected SARS-CoV-2 infection and COVID-19 disease. Existing policies and protocols for donning and doffing personal protective equipment (PPE) are primarily for institutional settings such as hospitals, not for home visits for patient care. We describe a protocol for donning and doffing PPE in home settings. Methods: We used an iterative, rapid-prototyping approach to develop the protocol. A small workgroup created preliminary drafts, drawing on hospital-based protocols and modifying them, whilst undertaking simulations. Wider input was solicited via two webinars; one regional (Hamilton, Ontario) with palliative clinicians, and one national (Canada) with varying professions. We also consulted a group of infectious disease experts. A “how to” video accompanies the protocol. Results: Twelve versions were produced, with major changes occurring within the first six versions. A national webinar mid-development provided further validation and minor modifications. Subsequent versions involved minor changes including the concentration of diluted bleach solution to clean eyewear. The protocol has four phases: 1) Preparing, 2) Entering the Home, 3) Leaving the Home, and 4) After the Visit and Reprocessing. In addition to PPE-related equipment, the protocol requires additional materials including two pails for transporting supplies, plastic bags, hand sanitizer, disinfectant wipes, and printed easy-to-use checklists. Conclusions: This protocol addresses gaps in COVID-19 related guidelines, specifically the process of donning and doffing PPE during home visits while supplementing jurisdictional PPE guidelines and protocols.