Are health care workers protected? An observational study of selection and removal of personal protective equipment in Canadian acute care hospitals

Abstract

Overall adherence with appropriate PPE use in health care settings involving febrile respiratory illness patients was modest, particularly on pediatric units. Interventions to improve PPE use should be targeted toward the use of recommended precautions (eg, eye protection), HCWs working in pediatric units, the correct sequence of PPE removal, and performing hand hygiene.

Method for investigating nursing behaviors related to isolation care

“…8 These studies have noted the potential for contamination with these processes. Observational studies have commonly investigated PPE by examining the care of isolated patients, 9 care given during resuscitation, 10 and pediatric resuscitation using in situ simulation. 11 All of the studies noted the need to improve performance related to the use of PPE.…”

Variation in health care worker removal of personal protective equipment

“…However, there is a paucity of literature on practices regarding removal of PPE in the setting of routine clinical care. 2,3 It has been shown that breaches in PPE use and removal provide opportunities for transmission of infections to HCWs. 2 A previous study that took place shortly after the severe acute respiratory syndrome outbreak of the early 2000s, concluded that conflicting PPE removal recommendations are available and that few HCWs are familiar with how to avoid contaminating themselves.…”

Clinical Challenges in Isolation Care

“…32 A review of the evidence for standard or universal precautions found an average compliance rate with eye protection of 38%. 22 In a study evaluating clinical behaviors during simulated resuscitations of children with influenza, only 61% of the health care workers used eye shields. 22 In a study evaluating clinical behaviors during simulated resuscitations of children with influenza, only 61% of the health care workers used eye shields.…”

“…Many facilities are now reviewing or establishing protocols to effectively protect nurses and other health care workers. 22 Both studies found a lack of selfprotective behaviors and poor adherence to isolation precautions. 14 In many countries affected by SARS, recommendations varied on the sequence of PPE removal.…”