Assessing PPE donning and doffing competence in healthcare workers: A utility-based structured narrative review.

Abstract

Background: Healthcare workers remain at high risk of infection when performing personal protective equipment (PPE) donning and doffing, particularly when procedures are executed incorrectly. Despite their importance, assessment methods vary substantially, and few have been evaluated. This review synthesised and examined published hospital-based PPE assessment methods and evaluated their educational utility using van der Vleuten's framework, encompassing validity, reliability, educational impact, acceptability, and cost.

Method: A structured narrative review was undertaken to capture heterogeneous study designs related to the topic area. Searches across CINAHL, PubMed, Scopus and Google Scholar (February-April 2026) were conducted. Inclusion criteria consisted of empirical studies assessing donning and doffing performance among hospital-based healthcare workers (2014 - 2026). A best-fit framework approach was used to map each assessment method to van der Vleuten's utility framework.

Results: Twenty-two studies met inclusion criteria, representing five assessment approaches: checklists (n = 15), video review (n = 6), fluorescent marker contamination (n = 7), MS2 bacteriophage (n = 1), and artificial intelligence-assisted (AI) assessment (n = 1). Checklist-based assessment demonstrated the strongest overall utility due to feasibility, low cost, and broad acceptability, though evidence for validity and reliability was limited. Fluorescent markers provided high educational impact through visible contamination feedback but had reduced ecological validity. Video review and bacteriophage methods showed moderate utility, while AI-assisted approaches offered emerging promise. Methodological inconsistencies across studies limited comparability.

Conclusion: No single optimal method exists for assessing PPE competence in hospital settings. Checklists remain the most feasible option for routine infection-control practice but require stronger validation. Multimodal approaches incorporating real-time contamination-feedback tools may enhance educational impact and overall utility.