# Analysis of interception problems in donning and doffing personal protective equipment in a large cabin hospital during the COVID-19 pandemic: a real world study

## TL;DR

This study identifies common issues with putting on and taking off PPE in a large hospital during the pandemic, showing that problems with protective clothing and respirators are frequent and need better training.

## Contribution

The study provides a detailed real-world analysis of PPE donning and doffing issues in a large cabin hospital during the 2022 Shanghai COVID-19 outbreak.

## Key findings

- Doffing PPE had a higher problem rate (8.44%) compared to donning (5.29%).
- Protective clothing issues, such as loose fitting and contamination, were most common.
- Respirator problems included seal test failures and shifting during doffing.

## Abstract

Although proper donning and doffing of personal protective equipment (PPE) is critical for infection prevention, detailed characterization of problems encountered during these processes in real-world settings during large-scale infectious disease outbreaks remains insufficient. This study aimed to analyze the characteristics and distribution of interception problems in the process of donning and doffing process in a large cabin hospital during the 2022 COVID-19 pandemic in Shanghai. A prospective, real-world study was designed to collect and analyze data on irregularities observed during personal protective equipment (PPE) donning procedures in cabin hospital operations. The proportion of problems encountered during donning PPE was 5.29% (246/4,652), while during doffing PPE, it was 8.44% (382/4,525) (P < 0.001). The primary problem during donning PPE was related to problems with protective clothing, followed by problems with respirators. There was no significant difference in problem distribution among different posts (P = 0.459). The problems related to protective clothing mainly focused on loose fitting around the head and neck, making them prone to exposure during donning (56.25%, 99/176) and contamination of the inner surface of protective clothing during doffing (46.43%, 91/196). Respirator-related problems included failure of the seal test during donning PPE (61.54%, 24/39) and shifting or loosening of the respirator during PPE doffing (73.68%, 14/19). These findings identify critical gaps in PPE procedures and highlight the need for targeted training to address these issues, thereby reducing the risk of infection among healthcare personnel in mobile cabin hospitals.

The online version contains supplementary material available at 10.1038/s41598-026-39259-z.