One size does not protect all

Loreen Herwaldt, MD, professor in Infectious Diseases and of Epidemiology, and Priyadarshini Pennathur, PhD, assistant professor in Industrial and Systems Engineering, presented an invited talk on personal protective equipment (PPE) design problems to a standing committee within the National Academies of Sciences, Engineering, and Medicine.

The committee is tasked with, in part, addressing topics that include identifying state-of-the-art materials and systems in workplaces, laboratories, and field research settings and developing criteria for ensuring safety and best practices. It was formed in response to a request from the National Institute for Occupational Safety and Health (NIOSH).

Members of the committee spotted an article written by Herwaldt and Pennathur in the December issue of the American Journal of Infection Control in which the authors detail 13 different areas where opportunities exist for improving current PPE design. But, as they argue in their article–co-written with Industrial and Systems Engineering PhD students Hamed Salehi, MS, and Jaqueline Pereira Da Silva, MS–if these opportunities are not addressed health care workers (HCWs) will continue to be exposed to infectious agents.

Though she had been invited by the committee to attend the meeting in Washington, DC, and to present in person, clinical responsibilities kept Herwaldt in Iowa. However, that invitation allowed her to include Pennathur in the presentation delivered via video conferencing technology. The two took turns walking the committee through a variety of examples illustrating how current PPE design fell short of HCW-need or even created risks for the user.

Their suggested areas for future research and development ranged from creating PPE with intuitive design to prevent misuse, especially during donning and doffing, packaging PPE in a manner that prevents permanent folds hampering donning and doffing and the buildup of static electricity, considering user strength and mobility when designing access points, and evaluating PPE performance in use scenarios.

“Changes should be supported by data, and should not be made just for cosmetic reasons,” Herwaldt said. They also stressed the importance of considering the entire lifecycle of PPE items, from open through use and disposal and even post-disposal. They cited an example of a discarded gown that billows out of a trash can could pose a risk to HCWs when they discard other PPE or they push the item further into the trash can.

They also provided examples of design ideas that show promise, gloves with tabs for easy removal or gowns with different patterns or textures for exposed and unexposed sides. Herwaldt and Pennathur proposed a potential Grand Challenge-style design competition to identify potential innovative ideas.

Following their presentation, the committee, composed of epidemiologists, engineers, occupational health consultants, industrial hygienists, and other industry consultants, posed a few questions. Cost of design enhancements or new safety features and their implementation were chief concerns, but Herwaldt countered that the costs of PPE failure and infection risks must also be considered.


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  1. […] Part of Chasco’s excitement was because, first at CADRE and then as an assistant research scientist in the Division of General Internal Medicine, she is able to serve as an analyst on multiple projects, exposing her to a variety of investigations. Among a number of projects, she is currently designing a qualitative evaluation for Michael Ohl, MD, and his TelePrEP program, which provides HIV preventive care to rural Iowans, as it expands implementation state-wide. Chasco has also begun to work on a project with psychiatrist Carolyn Turvey, PhD, on patient portal features designed to improve engagement and adherence to treatments for depression. Loreen Herwaldt, MD, has Chasco’s assistance in her work studying safe donning and doffing of personal protective equipment. […]

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