Timing and type of personal protective equipment adherence lapses in pediatric trauma resuscitation: A retrospective video study.

Abstract

Background: Although personal protective equipment (PPE) reduces the transmission of infectious diseases, adherence among health care providers remains inconsistent. Developing strategies to improve PPE use requires understanding the factors associated with adherence lapses, defined as the partial undoing or removal of PPE, leading to nonadherence.

Methods: We performed a retrospective video review of 10 pediatric trauma resuscitations from March 2023 to July 2024. We recorded the number of lapses, the time from adherence to lapse (time-to-lapse), and the timing of lapses during resuscitation. We observed provider actions before and after a lapse to understand situational factors.

Results: We observed 292 lapses among 120 providers. The median time-to-lapse was 7.7 minutes (interquartile range [IQR] 3.8-15.1) for gloves, 1.5 minutes (IQR 0.3-6.8) for masks, and 13.4 minutes (IQR 6.6-26.6) for gowns. Lapses in masks (estimate -0.4, 95% confidence interval -0.6 to -0.3, P < .001) occurred earlier in the resuscitations. Of 292 lapses, 105 (36.0%) were corrected. The most common provider action before a lapse included "observing" (n = 109/292, 37.3%).

Conclusions: PPE lapses were frequent in the postpandemic setting. The time-to-lapse and lapse timing varied by PPE type. Aligning PPE monitoring with lapse patterns may optimize nonadherence detection and correction.