Effectiveness of a multisite personal protective equipment (PPE)–free zone intervention in acute care

AbstractObjective:Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.Design:Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.Setting:All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.Intervention:A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.Results:We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.Conclusions:HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.

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Elimination of Routine Contact Precautions for Endemic Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: A Retrospective Quasi-Experimental Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.156 ◽

2016 ◽

Vol 37 (11) ◽

pp. 1323-1330 ◽

Cited By ~ 36

Author(s):

Elise M. Martin ◽

Dana Russell ◽

Zachary Rubin ◽

Romney Humphries ◽

Tristan R. Grogan ◽

...

Keyword(s):

Experimental Study ◽

Health System ◽

Personal Protective Equipment ◽

Care Delivery ◽

Protective Equipment ◽

Nursing Time ◽

Contact Precautions ◽

Before And After ◽

Quasi Experimental ◽

The Impact

OBJECTIVETo evaluate the impact of discontinuation of contact precautions (CP) for methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system.DESIGNRetrospective, nonrandomized, observational, quasi-experimental study.SETTINGTwo California hospitals.PARTICIPANTSInpatients.METHODSWe compared hospital-wide laboratory-identified clinical culture rates (as a marker of healthcare-associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment was assessed and quantified using time-driven activity-based costing.RESULTSAverage positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (P=.09), and 0.48 and 0.40 cultures/100 admissions for VRE (P=.14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment for MRSA/VRE before the change was 45,277 hours/year (estimated cost, $4.6 million).CONCLUSIONDiscontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery.Infect Control Hosp Epidemiol2016;1–8

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1728. Effectiveness and Healthcare Personnel (HCP) Perceptions of a Multi-Site Personal Protective Equipment (PPE) Free Zone Intervention

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.134 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S55-S56

Author(s):

Lindsay Visnovsky ◽

Diane Mulvey ◽

Yue Zhang ◽

Molly Leecaster ◽

Curtis J Donskey ◽

...

Keyword(s):

Healthcare Personnel ◽

Resistant Bacteria ◽

Post Intervention ◽

Sociotechnical System ◽

Contact Precautions ◽

Free Zone ◽

Before And After ◽

Red Tape ◽

Generalized Linear Mixed Effects ◽

Acute Care Facilities

Abstract Background CDC provides guidelines for using contact precautions (CP) when caring for patients with antibiotic-resistant bacteria or Clostridium difficile. However, HCP frequently report discomfort, difficulty of use, and interrupted workflow with CP. Modifying CP guidelines to balance these issues requires testing to assess benefits and maintenance of safe practices. A promising approach using a “PPE Free Zone” strategy within rooms of patients in CP has not been well-studied. Methods The PPE Free Zone comprised a 3–6 foot area inside door thresholds of CP patient rooms denoted by red tape placed on the floor. Within the zone, HCP were not required to don PPE. HCP were considered compliant if they performed hand hygiene (HH) and donned appropriate PPE before crossing the zone. Observers at 6 acute care facilities (ACF) were trained on observing HCP HH and use of PPE with CP. Observations were made before and after implementation of a PPE Free Zone. Intervention ACF conducted observations on 8 intervention units and 6 nonintervention units. Models of overall compliance and entry HH compliance were constructed using a generalized linear-mixed effects model with a logistic link function. Pre-intervention observations from all 6 ACF and intervention phase observations from the 3 intervention ACF were used in models. Results We observed 4,510 room entries. HH adherence declined over time in both intervention and control units but declined less among intervention units from pre to post intervention (β: 0.71, P = 0.007, Figure 1). Stratified by precautions type, the effect of the PPE Free Zone on HH was only significant for rooms in enteric precautions (P < 0.001). Compliance with PPE use was not significantly different pre- versus postintervention (P = 0.133). When surveyed, HCP had positive views of the PPE Free Zone: 65% (n = 172) agreed or strongly agreed the zone facilitates communication with patients, permits checking on patients more frequently, and saves time [n = 169] (Figure 2). Conclusion Although HCP viewed the zone positively and it had a significant effect on HH in enteric precautions rooms, the zone did not improve PPE compliance. Future interventions in the ACF setting should consider the complex sociotechnical system factors influencing behavior change. Disclosures All authors: No reported disclosures.

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COVID-19 global pandemic planning: Dry heat incubation and ambient temperature fail to consistently inactivate SARS-CoV-2 on N95 respirators

Experimental Biology and Medicine ◽

10.1177/1535370220977819 ◽

2020 ◽

pp. 153537022097781

Author(s):

Douglas J Perkins ◽

Robert A Nofchissey ◽

Chunyan Ye ◽

Nathan Donart ◽

Alison Kell ◽

...

Keyword(s):

Ambient Temperature ◽

Personal Protective Equipment ◽

Healthcare Personnel ◽

Protective Equipment ◽

Experimental Conditions ◽

Dry Heat ◽

Global Pandemic ◽

Individual Site ◽

Pandemic Planning ◽

N95 Respirators

The ongoing pandemic of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed a substantial strain on the supply of personal protective equipment, particularly the availability of N95 respirators for frontline healthcare personnel. These shortages have led to the creation of protocols to disinfect and reuse potentially contaminated personal protective equipment. A simple and inexpensive decontamination procedure that does not rely on the use of consumable supplies is dry heat incubation. Although reprocessing with this method has been shown to maintain the integrity of N95 respirators after multiple decontamination procedures, information on the ability of dry heat incubation to inactivate SARS-CoV-2 is largely unreported. Here, we show that dry heat incubation does not consistently inactivate SARS-CoV-2-contaminated N95 respirators, and that variation in experimental conditions can dramatically affect viability of the virus. Furthermore, we show that SARS-CoV-2 can survive on N95 respirators that remain at room temperature for at least five days. Collectively, our findings demonstrate that dry heat incubation procedures and ambient temperature for five days are not viable methods for inactivating SARS-CoV-2 on N95 respirators for potential reuse. We recommend that decontamination procedures being considered for the reuse of N95 respirators be validated at each individual site and that validation of the process must be thoroughly conducted using a defined protocol.

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Use of Personal Protective Equipment among Healthcare Personnel during COVID-19 Pandemic

Egyptian Journal of Occupational Medicine ◽

10.21608/ejom.2021.193272 ◽

2021 ◽

Vol 45 (3) ◽

pp. 183-198

Author(s):

El-Sallamy R R ◽

Elghazally N

Keyword(s):

Personal Protective Equipment ◽

Healthcare Personnel ◽

Protective Equipment

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Analysis on the Effect of Protective Equipment Training on Hospital Infection Managers

CONVERTER ◽

10.17762/converter.282 ◽

2021 ◽

pp. 211-219

Author(s):

Yongli Zou Et al.

Keyword(s):

Personal Protective Equipment ◽

Protective Clothing ◽

Training Model ◽

Hospital Infection ◽

Protective Equipment ◽

Practical Training ◽

Training Methods ◽

Before And After ◽

Improper Use ◽

Expert Theory

Objectives: To analyze the effect of personal protective equipment training on new hospital infection managers. Methods: Personnel are divided into two batches by region. Adopt a diversified training model to train all personnel, finally conduct practical assessments and issue certificates. Collect information through information technology, analyze questionnaires, and understand trainees’ circumstances before and after the training. Each training batch has uniform teachers and the same training methods. Results: After the training, the trainees' proficiency in putting on and taking off protective equipment increased by 22.85%, and ability to choose protective equipment according to different working environments increased by 22.04%; 78.23% trainees believed that practical exercises should be emphasized. Taking off protective clothing was considered as the most difficult link in practical training (91.13%), followed by putting on protective clothing (70.43%). 96.24% trainees believed that this training is helpful for future work. Conclusions: It is quite necessary to implement personal protective equipment training among new hospital infection managers; where, practical training, assessment, information-based questionnaire survey, expert theory teaching have achieved good results; the training helps reduce occupational exposure-induced hospital infection, and at the same time, avoids improper use of protective materials and waste.

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Self-Contamination While Doffing Personal Protective Equipment

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1020 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s385-s386

Author(s):

Jaqueline Pereira da Silva ◽

Priyadarshini Pennathur ◽

Hugh Salehi ◽

Emily Chasco ◽

Jure Baloh ◽

...

Keyword(s):

Human Factors ◽

Personal Protective Equipment ◽

Demographic Data ◽

Protective Equipment ◽

Human Factors Engineering ◽

Academic Hospital ◽

Training Video ◽

Exposed Skin ◽

Before And After ◽

Trained Staff

Background: Personal protective equipment (PPE) effectiveness can be undermined by inappropriate doffing methods. Objective: We used human factors engineering methods to evaluate self-contamination during PPE doffing. Methods: In this study, 30 participants at a Midwestern academic hospital (A) donned and doffed 3 mask styles (n = 10), 2 gown styles (n = 10), and 2 glove styles (n = 10; the Doffy glove has a tab to facilitate doffing). Also, 30 additional participants at hospital A (residents or fellows, nurses, special isolation trained staff [SITS]) and 10 SITS at academic hospital B doffed a surgical mask, a breakaway neck gown, and exam gloves (PPE ensemble) twice: once while distracted with conversation and once when not distracted. We randomized the order in which participants used different PPE styles or they did the doffing scenario. We collected demographic data. We applied Glo Germ Mist (1.5 dilution in water) with a mucosal atomizer to participants’ PPE before they doffed. We video-recorded participants as they doffed, and we photographed their scrubs and exposed skin before and after each donning and doffing episode. We reviewed videos for doffing errors and photographs for fluorescent spots. We counted fluorescent spots and noted their locations. Results: Overall, 45 (64.3%) participants were women, 31 (44.3%) were nurses, 24 (34.3%) were physicians. Among the participants, 25 (35.7%) had >15 years of experience and 61 (87.1%) had some training in doffing. Participants frequently contaminated their skin or clothing while doffing (Table 1). For all scenarios, hands followed by the torso were contaminated most frequently. Analysis of the videos found that touching the gown front with bare hands was the most common doffing error. Fewer participants self-contaminated when using the Doffy glove without training than when using the standard exam glove. Although most participants in the glove trial indicated that they did not need to watch the Doffy glove training video again, most had difficulty doffing the Doffy glove with the beak method. Many participants stopped doffing to answer questions when they doffed the PPE ensemble during the interruption scenario. Conclusions: Self-contamination was very common with all PPE styles and during all scenarios. Distraction did not increase the risk of contamination. However, participants often stopped doffing to answer questions, which they rarely do in practice. Watching a video was inadequate training for the beak glove-doffing method. The Doffy glove, which decreased contamination compared with the standard glove in the untrained scenario, may have advantages over standard exam gloves and should be evaluated further.Funding: NoneDisclosures: None

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Hand Hygiene and Personal Protective Equipment in Healthcare Settings During COVID-19 Pandemic in Bangladesh

Bangladesh Journal of Medicine ◽

10.3329/bjm.v31i2.48535 ◽

2020 ◽

Vol 31 (2) ◽

pp. 69-75

Author(s):

Md Rezaul Karim ◽

Sushil Kumar Sah ◽

Afsarunnesa Syeda ◽

Muhammad Tanvir Faysol ◽

Aminur Rahman ◽

...

Keyword(s):

Hand Hygiene ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Healthcare Facility ◽

Survey Study ◽

Protective Equipment ◽

Protective Measures ◽

Healthcare Settings ◽

Mandatory Training ◽

Before And After

Objective: This study conducted to implement protective measures in healthcare settings during theCOVID-19 pandemic in the context of Bangladesh. Methods: It is an observational survey study. A pre-designed open questionnaire electronic linkusing google form was used to collect data from 500 healthcare workers within Bangladesh in whichparticipants were observed, and variables were measured. Results: The study findings revealed that among all participants, 70.9% were working in COVID-19dedicated hospitals, and 1.8% were diagnosed with COVID-19 while working. The study showed that69.1% of participants washed hands before and after consulting/handling each patient, 69.1% hadreadily available rubs/sanitizer in their healthcare facility, and 65.5% adhered principals ofhandwashing. The study also revealed that only 76.4% of participants maintained aseptic precautionsfor donning/doffing. Conclusion: The study findings recommend that mandatory training and maintaining asepticprecautions for PPE putting on (donning), and removal (doffing) is equally important. Bangladesh J Medicine July 2020; 31(2) :69-75

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Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/591940 ◽

2008 ◽

Vol 29 (11) ◽

pp. 1035-1041 ◽

Cited By ~ 160

Author(s):

Philip C. Carling ◽

Michael M. Parry ◽

Mark E. Rupp ◽

John L. Po ◽

Brian Dick ◽

...

Keyword(s):

Acute Care ◽

Performance Feedback ◽

Hospital Setting ◽

Acute Care Hospitals ◽

The United States ◽

Multidrug Resistant ◽

Environmental Services ◽

Environmental Surfaces ◽

Before And After ◽

Quasi Experimental

Objective.The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospital project to both evaluate and improve current cleaning practices.Design.Prospective quasi-experimental, before-after, study.Setting.Thirty-six acute care hospitals in the United States ranging in size from 25 to 721 beds.Methods.We used a fluorescent targeting method to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.Results.Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) were cleaned at baseline (95% confidence interval, 43.4-51.8). Thoroughness of cleaning at baseline correlated only with hospital expenditures for environmental services personnel (P = .02). After implementation of interventions and provision of objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal, or staffing parameter but was related to the degree to which cleaning was suboptimal at baseline (P < .001).Conclusions.Significant improvements in disinfection cleaning can be achieved in most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution.

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COVID-19 Pandemisinde Enfeksiyon Kontrol Çalışmaları Çerçevesinde Çocuk Hastalarla Çalışan Sağlık Personeli Eğitimi

Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection ◽

10.5578/ced.70235 ◽

2020 ◽

Vol 54 (4) ◽

pp. 195-200

Author(s):

Pembe Derin Oygar ◽

Ayşe Büyükçam ◽

Zümrüt Şahbudak Bal ◽

Nazan Dalgıç ◽

Şefika Elmas Bozdemir ◽

...

Keyword(s):

Great Risk ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Pediatric Patients ◽

Healthcare Services ◽

Healthcare Personnel ◽

Protective Equipment ◽

Emerging Pathogens ◽

Early Stages ◽

Applied Education

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.

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