FARGO — For doctors, nurses and technicians who treat patients infected with the highly contagious coronavirus, the key to remaining safe can hinge on a seemingly mundane task: getting dressed properly.

The proper use of personal protective equipment — the gowns, gloves, masks and face shields that health care workers wear — is critical in avoiding infection when in close contact with infectious patients.

But the protective garments are ineffective if they’re not properly worn and removed — a painstaking process called donning and doffing that must be undertaken each time health care workers come in contact with a patient who is infected or possibly contagious.

“When putting it on and taking it off you want to make sure you’re doing it correctly,” said Brenda Puffrey, an infection prevention specialist at Sanford Health. Improperly donning or doffing protective garments can defeat the purpose, allowing the person to become infected, she said.

“Any of the PPE is only as good as we use it,” Puffrey added. “We want to be diligent in our PPE use.”

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Health care workers are an obvious high risk group during the pandemic. In North Dakota, health care workers accounted for 15.44% of coronavirus infections as of June 30. In Minnesota, 6.8% of COVID-19 infections were acquired in health care settings.

Both Essentia Health and Sanford Health employ a “buddy system” in which a colleague watches to ensure that protective wear is properly donned and doffed.

The protocol can vary depending upon the risk posed by a patient, including whether the patient has symptoms of COVID-19, such as a headache or respiratory symptoms, said Tiffany Anderson, a registered nurse at Essentia’s emergency department and “dofficer.”

“It’s very complex depending on what the patient has going on with them,” she said.

All of that doffing and donning between patient checks is time-consuming, Anderson and Puffrey said.

“We often say it takes twice as long to take care of a patient” that has or is suspected of having COVID-19, Anderson said. “We certainly spend time putting stuff on and off all day.”


To conserve supplies, nurses and others who go into the room of a COVID-19 patient must make each visit as productive as possible, accomplishing multiple tasks to reduce the number of times they must enter a room and discard the protective wear, Puffrey said.

“It takes planning,” she said. “You need to plan ahead.”

After each use, the protective garments are disposed of, except for eye goggles and face shields, which are cleaned before reuse, Anderson and Puffrey said.

Use of the personal protective equipment definitely helps to prevent infections, Anderson and Puffrey said.

Anderson said she has personally treated several patients who were infected with COVID-19 but has not become infected.

Sanford has reported that 165 employees have tested positive for the virus, but none of the infections was traced back to caring for a patient.

“I’m aware of no instance here at Sanford where we’ve had cross-contamination,” Puffrey said.

Essentia declines to disclose the number of employees who have tested positive, citing patient privacy protections.

The practice of donning and doffing protective wear to prevent infection has become so ingrained during the pandemic that the precaution might continue after the public health crisis subsides, Anderson said.

“We wonder if we’ll ever come to work and not wear a mask,” she said.