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

PURPOSE: The safety of care professionals and patients is paramount while caring for people with infectious diseases, including those with confirmed or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). 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, while undertaking simulations. Wider input was solicited via 2 webinars; 1 regional (Hamilton, Ontario) with palliative clinicians, and 1 national (Canada) with varying professions. We also consulted a group of infectious disease experts. A "how-to" video accompanies the protocol. RESULTS: Twelve versions of the protocol were produced, with major changes occurring within the first 6 versions. A national webinar mid-development provided further validation and minor modifications. Subsequent versions involved minor changes. The protocol has 4 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 2 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.Appeared as Annals "Online First" article.