• LaxmiTej Wundavalli, Sheetal Singh, Angel Rajan Singh, and Sidhartha Satpathy.
• Hospital Administration, All India Institute of Medical Sciences, New Delhi, India TEJ.WUNDAVALLI@GMAIL.COM.
• BMJ Open Qual. 2020 Sep 1; 9 (3).

IntroductionEffective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources.AimTo rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility.MethodsLiterature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian's structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan-do-study-act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines.ResultsBest practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts.DiscussionChallenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility.ConclusionOur study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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