in 150 - 200 words summarize and rephrase this article, and write one sentence the most takeaway and one-sentence criticism from this article (The effects of trained observers (dofficers) and audits during a facility-wide COVID-19 outbreak: A mixed-methods quality improvement analysis)

Background Since January 3, 2020, the COVID-19 pandemic has affected over 115 million individuals leading to over 2.6 million deaths globally.1 The SARS-CoV-2 virus is highly infectious; causing outbreaks in numerous settings including acute and long-term healthcare facilities. SARS-CoV-2 is transmitted by respiratory droplets, aerosols, and contact (fomites). Public health and infection control measures targeting these mechanisms of transmission may help to stemming the spread of the virus.2 Such steps include appropriate physical distancing, the appropriate use of personal protective equipment (PPE) (including the use of face masks), enhanced environmental cleaning, and hand hygiene.3, 4 However, these relatively simple interventions can be challenging to implement and operationalize. One study demonstrated that training, understanding, and consistency of cleaning in hospitals is often sub-optimal.5 Hospital crowding and aging infrastructure often makes physical distancing in healthcare facilities difficult.6 Staff errors have also commonly been noted during the donning and doffing of PPE.7, 8

Bundled audit tools have been shown to improve practice with regards to many infection prevention measures, as well as improve guideline-compliant practice. To date, however, many bundles have not included trained observers (dofficers) - who can assist in guiding health care workers in the donning and doffing of PPE with the goal of preventing errors leading to self-contamination.9 The trained observer role was first developed in response to viral haemorrhagic fever outbreaks, however, observers may have an important role in the management of COVID-19 as well.10

Results

Trained observers dofficer

All staff who successfully completed training and passed the quiz without remediation became dofficers. In total, 186 dofficers were recruited, trained, and deployed on hospital units to perform audit and feedback. All dofficers completed at least one audit form during the intervention period; some audit forms were completed by more than one dofficer. A total of 962 forms were returned.

Conclusions In conclusion, we implemented a COVID-19 dofficer training program in conjunction with a dofficer-driven audit and feedback tool. Overall, the implementation noted a significant decrease in healthcare worker error rates associated with posting of signage to indicate need for precautions and provision of graphics to provide instruction, PPE provision and station setup, PPE donning and doffing processes, cleaning in patient and staff areas, as well as social distancing of staff and patients when possible. The use of dofficers, aside from helping to decrease donning and doffing errors, may offer additional protection to both staff and patients. Additional research is required to determine if this additional protection is clinically significant and if the model is financially sustainable