Table 1 Risk grading and follow-up action of reportable compliance issues detected through doffing video surveillance
Risk grading | Definition | Component of compliance issue | Follow-up action |
|---|---|---|---|
Green | Minor errors in technique that created no additional risk or compromise to PPE integrity but did not fulfil procedural perfection | Hand hygiene: not performed between each step of the doffing sequence once or twice, or not performed for the required duration (20 s) up to twice between each step of the doffing sequence PPE order: incorrect doffing sequence or incorrect method of removal for one step Mask, glasses, gown, gloves and face shield: standing too close (< 1 m) to the infectious waste bin during doffing Jewellery: wearing of earrings | Analysis of trends and feedback through daily group-level hand hygiene and PPE training |
Blue | Moderate errors in technique that created some risk but did not compromise PPE integrity | Hand hygiene: not performed between each step of the doffing sequence three or more times, or not performed for the required duration (20 s) three or more times between each step of the doffing sequence PPE order: incorrect doffing sequence or incorrect method of removal for two steps Mask, glasses, gown, gloves and face shield: PPE contact with the bin before completing the doffing sequence, glasses not cleaned, touching the front of the mask or the mask/face shield travelling up during doffing Jewellery: wearing of a watch, bracelet, necklace or lanyard | Individual consultation (within 24-h) for retraining, demonstration of the correct procedure and ongoing individual monitoring for improvements |
Red | Major error with compromise to PPE integrity | Hand hygiene: not performed or not performed at the conclusion of doffing PPE order: incorrect doffing sequence for three or more steps or a catastrophic failure of PPE removal resulting in compromise to clothing, skin or membranes Mask, glasses, gown, gloves and face shield: failure to use required PPE, use of unapproved equipment additions or mask travelling over face during removal Jewellery: not applicable to red risk grading | Immediate individual consultation (via phone call or face-to-face, whichever was quicker) with retraining, demonstration of the correct procedure and investigation to determine isolation requirements |