COVID-19 Personal Protective Equipment in the Home: Navigating the Complexity of Donning and Doffing

Brian Kerley; Lana Tan; Denise Marshall; Cindy O’Neill; Anne Bialachowski; José Pereira

doi:10.1370/afm.2667

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RE: Thank you, Dr. Yan
Brian K. Kerley

Published on: 26 January 2022
RE: In Support of the COVID-19 Home PPE Protocol
Allison P Yan

Published on: 21 October 2021

Published on: (26 January 2022)
Page navigation anchor for RE: Thank you, Dr. Yan
RE: Thank you, Dr. Yan
Brian K. Kerley, B.Sc., M.D., C.C.F.P(PC)., F.C.F.P., Niagara North Family Health Team
We thank our colleague Allison Yan for her helpful letter and are pleased she has found our protocol both useful and practical.  Indeed, the protocol described in our article was developed in the very early months of the pandemic, in the spring of 2020.  At that time, high emphasis was placed on the possibility of fomite transmission and droplet transmission (vs. aerosol transmission) of Covid-19, and our original protocol reflected this.  Both of these premises, however, have been called into question as the pandemic has evolved.  Fomite transmission has been de-emphasized[1][2], and many authors have theorized that airborne transmission via aerosol is more common than originally thought. [3][4]This has implications for both the procedures in the protocol and the type of PPE needing to be worn.  In light of this, we have revised our protocol (see Table linked in article).

Brian Kerley, Lana Tan, Denise Marshall, Cindy O’Neill, Anne Bialachowski and José Pereira

...
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We thank our colleague Allison Yan for her helpful letter and are pleased she has found our protocol both useful and practical.  Indeed, the protocol described in our article was developed in the very early months of the pandemic, in the spring of 2020.  At that time, high emphasis was placed on the possibility of fomite transmission and droplet transmission (vs. aerosol transmission) of Covid-19, and our original protocol reflected this.  Both of these premises, however, have been called into question as the pandemic has evolved.  Fomite transmission has been de-emphasized[1][2], and many authors have theorized that airborne transmission via aerosol is more common than originally thought. [3][4]This has implications for both the procedures in the protocol and the type of PPE needing to be worn.  In light of this, we have revised our protocol (see Table linked in article).

Brian Kerley, Lana Tan, Denise Marshall, Cindy O’Neill, Anne Bialachowski and José Pereira

[1]Onakpoya, I et al:  SARS-CoV-2 and the role of fomite transmission: a systematic review.

F1000Res. 2021 Mar 24;10:233. doi: 10.12688/f1000research.51590.3. eCollection 2021.PMID: 34136133

[2]Goldman, E:  Exaggerated risk of transmission of COVID-19 by fomites.Lancet Infect Dis. 2020 Aug;20(8):892-893. doi: 10.1016/S1473-3099(20)30561-2. Epub 2020 Jul 3.PMID: 32628907

[3]Tang, JW et al: Dismantling Myths on the Airborne Transmission of Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2).  J Hosp. Infect. 2021 Apr;110:89-96.

doi: 10.1016/j.jhin.2020.12.022.Epub 2021 Jan 13.

[4]https://www.canada.ca/en/public-health/news/2021/11/statement-from-the-chief-public-health-officer-of-canada-on-november-12-2021.html

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Competing Interests: None declared.
Published on: (21 October 2021)
Page navigation anchor for RE: In Support of the COVID-19 Home PPE Protocol
RE: In Support of the COVID-19 Home PPE Protocol
Allison P Yan, Medical Student, The Ohio State University College of Medicine
I was extremely impressed by the protocol for donning and doffing personal protective equipment (PPE) in the home setting as described by Kerley and colleagues. While the robust PPE in home settings protocol fills an urgent need in the authors’ community of Southern Ontario, it has far-reaching applications to home healthcare settings throughout the world.

As a current medical student, my clinical experiences have been limited to either the hospital or outpatient clinic setting. As such, ready access to PPE equipment and proper PPE disposal can be often taken for granted. Prior to the onset of the COVID-19 pandemic, I was able to easily discard gowns, gloves, and N95 masks between every patient while working in various inpatient and outpatient locations. However, careful review of Kerley et al.’s step-by-step protocol clearly outlines unique challenges pertaining to care of patients with respiratory illnesses in a home environment. As the ongoing COVID-19 pandemic has reduced available hospital bed space and healthcare-related resources, home visits provide the opportunity to care for patients outside of a formal clinical setting. This PPE protocol provides an avenue to ensure that home visits are conducted as safely and efficiently as possible.

It is my understanding that this protocol was developed in spring and summer 2020, and made public in July 2020, before more information about the transmission and infectiousness of coronavirus was fully known. I wo...
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I was extremely impressed by the protocol for donning and doffing personal protective equipment (PPE) in the home setting as described by Kerley and colleagues. While the robust PPE in home settings protocol fills an urgent need in the authors’ community of Southern Ontario, it has far-reaching applications to home healthcare settings throughout the world.

As a current medical student, my clinical experiences have been limited to either the hospital or outpatient clinic setting. As such, ready access to PPE equipment and proper PPE disposal can be often taken for granted. Prior to the onset of the COVID-19 pandemic, I was able to easily discard gowns, gloves, and N95 masks between every patient while working in various inpatient and outpatient locations. However, careful review of Kerley et al.’s step-by-step protocol clearly outlines unique challenges pertaining to care of patients with respiratory illnesses in a home environment. As the ongoing COVID-19 pandemic has reduced available hospital bed space and healthcare-related resources, home visits provide the opportunity to care for patients outside of a formal clinical setting. This PPE protocol provides an avenue to ensure that home visits are conducted as safely and efficiently as possible.

It is my understanding that this protocol was developed in spring and summer 2020, and made public in July 2020, before more information about the transmission and infectiousness of coronavirus was fully known. I wonder if the procedure has been revised since its original publication? One part of the procedure that potentially merits updating was in Phase 2, “Entering the Home,” where it stipulates that the healthcare professional could not offer their own alcohol-based hand rub to the patient they were seeing. This home PPE protocol must continually be updated to ensure its most effective use.

All in all, I am glad that the authors were able to establish such a robust protocol regarding PPE use in the home environment, and I hope their procedure receives widespread use and recognition during these unprecedented times.
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Competing Interests: None declared.