This study aimed to evaluate practical barriers to personal protective equipment (PPE) use found through health care personnel (HCP) training sessions held during and after the 2015 Middle East respiratory syndrome outbreak in Korea. Difficulties observed were ill-fitting sizes, anxiety, confusion from unstandardized protocols, doubts about PPE quality and effectiveness, and complexity of using several PPE items together. Further research to generate robust evidence and repeated HCP trainings are necessary to ensure HCP and patient safety in future outbreaks.

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Background: Isolation precautions (IPs; ie, patient isolation with transmission-based precautions) are essential in hospital infection control interventions to prevent the transmission of healthcare-associated infections. Because IPs require healthcare personnel (HCP) to use personal protective equipment (PPE; eg, gown, gloves, and mask) to enter patient isolation rooms and perform hand hygiene (HH) frequently, IPs are often regarded as cumbersome tasks and may lead to fewer HCP visits. This observation study examined the time burden of IPs (ie, PPE use and HH) from time spent on HCP tasks, including patient treatment and care, in patient isolation rooms. Methods: With institutional review board approval, participating hospitals were recruited. At each hospital, assigned infection control nurses observed HCP tasks at patient isolation rooms of interest and recorded each task’s duration, using a stopwatch or timer and an observation form. For each observation block (ie, a duty period at 1 observation unit, regardless of the number of observed isolation rooms), unit-related information was collected, including the numbers of hospitalized patients, admission patients, discharge patients, isolation patients, and nurses. For each block, IP proportions were calculated by total time spent on IP divided by the total time spent on all tasks. Descriptive statistics, t test, ANOVA, and regression analyses were conducted using STATA version 16.0 software. Results: Three university-affiliated hospitals (838 average hospital beds, range 811–855) participated from April 2 to May 18, 2019 (for 7–9 days). In total, 2,901 tasks were monitored and the total time spent was 164,973 seconds; most tasks were done by nurses (89.2%) and females (86.8%). Although the most time-intensive task was procedures (eg, intravenous infusion) followed by medication, PPE use was the most frequent task followed by HH (Table 1). Regarding IP proportions, an overall average of 23.6% of total task time was spent on IPs (16.1% for PPE use and 7.5% for HH) in patient isolation rooms (Table 2). Notably, tasks in the tuberculosis isolation room of hospital B showed a greater HH proportion (13.7%) than PPE proportion (13.5%) because HCP usually use N95 masks only. Wards, compared to intensive care units (ICUs), showed higher PPE proportions (19.2%), potentially due to PPE stock in the nurse station and less PPE education compared to ICUs. Conclusions: Our study results demonstrated the substantial amount of time spent on IP compliance among all task durations in patient isolation rooms. To improve IP compliance, this time burden needs to be considered with greater system support, such as more nursing staff.Funding: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (Grant no. 2017R1D1A1B03036377).Disclosures: None