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How to rapidly design and operationalise PPE donning and doffing areas for a COVID-19 care facility: quality improvement initiative
  1. LaxmiTej Wundavalli,
  2. Sheetal Singh,
  3. Angel Rajan Singh,
  4. Sidhartha Satpathy
  1. Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr LaxmiTej Wundavalli; TEJ.WUNDAVALLI{at}GMAIL.COM


Introduction Effective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources.

Aim To rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility.

Methods Literature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian’s structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan–do–study–act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines.

Results Best practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts.

Discussion Challenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility.

Conclusion Our study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.

  • checklists
  • continuous quality improvement
  • healthcare quality improvement
  • infection control
  • PDSA

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  • Contributors LW conceived, designed the work, collected, analysed and interpreted the data, and wrote the draft of the manuscript. SSi analysed and interpreted the data, provided critical feedback on drafts of the manuscript and finally approved the version to be published. ARS and SSi contributed to the analysis of the write up of the study results, provided critical feedback on drafts of the manuscript and finally approved the version to be published. LW, SSa and ARS implemented the planned actions and agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Our quality improvement (QI) was done as part of the institute’s approved plan to set up a COVID-19 care facility. No personal information of any participant was elicited during any part of the study. SQUIRE guidelines were used to report this QI.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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