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coronavirus, COVID-19, personal protective equipment, warm zone



  1. Omess, Sarah MSN, APRN, AGCNS-BC, AGPCNP-BC
  2. Kaplow, Roberta PhD, APRN-CCNS, AOCNS, CCRN
  3. Green, Alyson MS, APRN, AGCNS-BC, OCN
  4. Kingsley-Mota, William MSN, RN, NEA-BC
  5. Mota, Sergio MSN, RN, CCRN-CSC, NE-BC
  7. Wilson, Keisa MSN, RN, RN-BC


ABSTRACT: In March 2020, in response to the coronavirus disease 2019 (COVID-19) pandemic, the executive leadership of an academic medical center in Atlanta tasked an interprofessional quality improvement (QI) team with identifying ways to improve staff and patient safety while caring for patients with suspected or confirmed COVID-19 infection. Additional goals of the initiative were to improve workflow efficiency by reducing the amount of time spent donning and doffing personal protective equipment (PPE) and to conserve PPE, which could be in short supply in a prolonged pandemic. The QI team developed a "warm zone model" that allowed staff members to wear the same mask, eye protection, and gown while moving between the rooms of patients who had tested positive for COVID-19. The risk of self-contamination while doffing PPE is well documented. Staff members were trained to conserve PPE and to properly change gloves and perform hand hygiene between exiting and entering patients' rooms. The warm zone model allowed multidisciplinary team members to reduce the times they donned and doffed PPE per shift while maintaining or increasing the times they entered and exited patients' rooms. Staff members believed that the model improved workflow and teamwork while maintaining staff members' personal safety. Daily gown use decreased on the acute care unit where the model was employed, helping to preserve PPE supplies. Once the model was proven successful in acute care, it was modified and instituted on several critical care COVID-19 cohort units.