Use of personal protective equipment in Canadian pediatric emergency departments

Abstract

Objective: Numerous barriers to maintaining infection control practices through the use of personal protective equipment (PPE) exist in the emergency department (ED). This study examined the knowledge, self-reported behaviours, and barriers to compliance with infection control practices and the use of PPE in Canadian pediatric EDs. Methods: A self-administered survey instrument consisting of 21 questions was developed and piloted for this study. The survey was mailed to all individuals listed in the Pediatric Emergency Research Canada database of physicians practicing pediatric emergency medicine in Canada. Results: A total of 186 physicians were surveyed, and 123 (66%) participated. Twenty-two percent of participants reported that they had never received PPE training and 32% had not been trained in the previous 2 years. Fifty-three percent reported being very or somewhat comfortable with their knowledge of transmission-based isolation practices. Participants were correct on a mean of 4.9 of 11 knowledge-based questions (SD 1.7). For scenarios assessing self-reported use of PPE, participants selected answers that reflected PPE use in accordance with national infection control standards in a mean of 1.0 of 6 scenarios (SD 1.0). Participants reported that they would be more likely to use PPE if patients were clearly identified prior to physician assessment, equipment was accessible, and PPE use was made a priority in their ED. Conclusions: Knowledge and self-reported adherence to recommended infection control practices among Canadian pediatric emergency physicians is suboptimal. Early identification of patients requiring PPE, convenient access to PPE, and improved education regarding isolation and PPE practices may improve adherence.

Infection Prevention in the Emergency Department

“…[47][48][49][50][51] In some cases, HCP also report uncertainty of which protective barriers to use and when, reflecting inadequate training or knowledge retention. 52,53 Several intervention studies have sought to improve HCP adherence to standard precautions in the ED (Table 2). 44,[54][55][56][57][58] Educational programs have employed in-service lectures, smallgroup discussions, and written materials highlighting the risks posed by bloodborne pathogens.…”

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

“…They are also exposed to both seasonal and emerging respiratory infectious diseases. In one paediatric ED setting, only 1-12% of clinicians reported that they always or usually wore a mask or eye protection, while assessing febrile respiratory patients during winter [28]. Although gloves are worn frequently, patient safety may be compromised by misuse, such as not changing them between dirty and clean tasks on the same patient or between different patients and/or failing to comply with hand hygiene before and after use, which often contaminates the clinician's hands [29][30][31].…”

“…Commonly cited factors contributing to sub-optimal compliance with PPE in healthcare include inadequate knowledge and training, perception of risk, organisational culture and environmental barriers [32,33]. Reid et al [28] identified knowledge, access to PPE, patient diagnosis and unit culture, in the ED context, as factors influencing PPE compliance.…”

Hospital unit safety climate: Relationship with nurses' adherence to recommended use of facial protective equipment

“…4 Two studies from Canada found 44% of nurses in 6 hospitals 5 and 11% of doctors in 14 hospitals reported they properly adhered to FPE. 6 Such suboptimal adherence rates are of great concern because it is estimated that 1 in 4 health care workers contract a communicable respiratory illness through work. 7 Furthermore, FPE has been cited as the most uncomfortable and problematic of all types of personal protective equipment, and is often more poorly adhered to than other components of standard precautions such as hand washing and glove use.…”