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King EC, Van Belle TA, Zagrodney KAP, McKay SM, Giosa J, Holubiec I, Holness DL, Nichol KA. Factors influencing self-reported facial-protective equipment adherence among home care nurses and personal support workers: A multisite cross-sectional study. Am J Infect Control 2024; 52:1105-1113. [PMID: 38885790 DOI: 10.1016/j.ajic.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/08/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Facial-protective equipment (FPE) use increased during the SARS-CoV-2 pandemic. This study explored factors influencing home care personal support workers' (PSWs) and nurses' self-reported adherence to FPE. METHODS A cross-sectional, electronic, survey was distributed to PSWs and nurses (1,108 complete responses) at 3 home care agencies in Ontario, Canada, in May to June 2022. Descriptive, bivariate, and multivariable analysis were used to assess individual, environmental, and organizational factors influencing adherence. RESULTS Among participants (786 PSWs, 322 nurses), 64% reported being adherent to both respiratory and eye FPE (Respiratory: 96%, Eye: 64%). Higher adherence was associated with facility-based work; better knowledge of FPE; prepandemic FPE use; good availability and convenient access; strong organizational support for health and safety; and Caribbean identity. Lower adherence was found for men; nurses with 2-year diplomas; shorter length of employment; communal transportation; and experiencing negative mental health effects from workplace infectious disease exposure. DISCUSSION Agencies should prioritize increasing providers' knowledge of FPE, supporting mental well-being, fostering a supportive culture, and ensuring availability of FPE. The influences of gender, ethnicity, and role require further exploration. CONCLUSIONS FPE adherence may be improved by addressing modifiable factors and developing population-specific strategies.
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Affiliation(s)
- Emily C King
- VHA Home HealthCare, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | | | - Katherine A P Zagrodney
- VHA Home HealthCare, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Canadian Health Workforce Network, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandra M McKay
- VHA Home HealthCare, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada; The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada; Michener Institute of Education, University Health Network, Toronto, Ontario, Canada; Micheal Garron Hospital, Toronto East Health Network, East York, Ontario, Canada
| | - Justine Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; SE Research Centre, SE Health, Markham, Ontario, Canada
| | | | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kathryn A Nichol
- VHA Home HealthCare, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
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Van Belle TA, King EC, Roy M, Michener M, Hung V, Zagrodney KAP, McKay SM, Holness DL, Nichol KA. Factors influencing nursing professionals' adherence to facial protective equipment usage: A comprehensive review. Am J Infect Control 2024; 52:964-973. [PMID: 38657906 DOI: 10.1016/j.ajic.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Facial protective equipment (FPE) adherence is necessary for the health and safety of nursing professionals. This review was conducted to synthesize predisposing, enabling, and reinforcing factors that influence FPE adherence, and thus inform efforts to promote adherence. METHODS Articles were collected using Cumulated Index to Nursing and Allied Health Literature and MEDLINE and screened for inclusion. Included articles were original studies focused on FPE adherence by nurses to prevent respiratory infection which contained occupation-specific data from at least 10 individuals and were published in English between January 2005 and February 2022. RESULTS Thirty articles were included, 21 of which reported adherence rates. Adherence ranged from 33% to 100% for respiratory protection and 22% to 100% for eye protection. Predisposing demographic factors influencing adherence included tenure and occupation, while modifiable predisposing factors included knowledge and perception of FPE, infection transmission, and risk. Enabling factors included geography, care settings, and FPE availability. Reinforcing factors included organizational support for health and safety, clear policies, and training. CONCLUSIONS The identified demographic factors suggest populations that may benefit from targeted interventions, while modifiable factors suggest opportunities to enhance education as well as operational processes and supports. Interventions that target these areas have the potential to promote adherence and thereby improve the occupational safety of nurses.
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Affiliation(s)
| | - Emily C King
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Meghla Roy
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Mel Michener
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Vivian Hung
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Katherine A P Zagrodney
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Canadian Health Workforce Network, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandra M McKay
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada; The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada; Michener Institute of Education, University Health Network, Toronto, Ontario, Canada; Micheal Garron Hospital, Toronto East Health Network, East York, Ontario, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario Canada
| | - Kathryn A Nichol
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario Canada
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Haas EJ, Furek A, Greenawald LA. Identifying leadership practices to support the uptake of reusable elastomeric half mask respirators in health delivery settings. Healthc Manage Forum 2024; 37:230-236. [PMID: 38243776 PMCID: PMC11273238 DOI: 10.1177/08404704241226698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
An increase in reusable Elastomeric Half Mask Respirators (EHMRs) among healthcare personnel has been documented during pandemic emergencies; however, research has not detailed leadership practices to support their use. Forty-three organizations implemented EHMRs received from the United States federal government which prompted interviews with 73 individuals who managed respirator distribution and fit testing between October 2021 and November 2022. Interview data was qualitatively analyzed. Themes around organizational culture and leadership practices emerged when discussing how elastomeric half mask respirators were integrated into health delivery settings including communication and outreach methods to aid worker support. Example included on-line and hands-on training, peer support, leadership support, and a culture that supports respirator use. To support a shift to reusable respiratory protection being procured and implemented, organizational- and individual-level perspectives are needed. Employee engagement, respirator champions, and updated verbal and written communication mechanisms are important takeaways for leaders to consider during any routine or emergency scenario.
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Affiliation(s)
- Emily J. Haas
- National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, Pennsylvania, USA
| | - Alexa Furek
- National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, Pennsylvania, USA
| | - Lee A. Greenawald
- National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, Pennsylvania, USA
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Barratt R, Gilbert GL. Hospital health care workers' use of facial protective equipment before the COVID-19 pandemic, implications for future policy. Am J Infect Control 2024; 52:502-508. [PMID: 38092070 DOI: 10.1016/j.ajic.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Prepandemic routine use of facial (respiratory and eye) protective equipment (FPE) by health care workers was suboptimal. Understanding factors affecting routine use would facilitate escalation to high level use during infectious disease emergencies. This study explored health care workers FPE-related knowledge, attitudes and behaviors. METHODS Mixed methods were used in a respiratory ward and adult and pediatric emergency departments (EDs), prior to the COVID-19 pandemic. Study design and thematic analysis were based on the theoretical domains framework. Emergent themes were categorized, using the COM-B behavior model, into capability(C), opportunity(O) and motivation(M), which influence behavior(B). RESULTS 22 emergent themes, representing factors influencing FPE use, were mapped to theoretical domains framework domains. Personal experience and departmental cultures influenced motivation. Compared with respiratory ward staff, ED clinicians were less knowledgeable about FPE; the unique ED environment and culture inhibited opportunities and motivation for FPE use. Eye protection was infrequently used. DISCUSSION Optimal FPE use is challenged by ED care models and settings. Changes are needed to translate pandemic-related improvements into routine care of other respiratory infections. CONCLUSIONS This study identified key determinants of FPE behavior. A review of context-specific FPE guidance for ED by infection prevention and control professionals would help to promote practicable, sustainable compliance.
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Affiliation(s)
- Ruth Barratt
- Westmead Clinical School, University of Sydney, Westmead, NSW 2145, Australia.
| | - Gwendolyn L Gilbert
- Westmead Clinical School, University of Sydney, Westmead, NSW 2145, Australia; Sydney Institute for Infectious Diseases, University of Sydney, Westmead, NSW 2145, Australia
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Bryant RA, Smith JM, Tervola NK, Smith C, Hoyt C, Dawud B, Dugan S, St. Hill CA. Use of Elastomeric Half-Mask Respirator in the Clinical Care Environment: Health Care Worker Perceptions. J Nurs Care Qual 2024; 39:37-43. [PMID: 37256675 PMCID: PMC10655906 DOI: 10.1097/ncq.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Elastomeric half-mask respirators (EHMR) reduce health care workers' exposure to airborne hazards including bioaerosols but have primarily been used in the industrial setting. PURPOSE To assess health care workers' perceptions, attitudes, and experiences wearing EHMRs in a clinical environment. METHODS Employees within a single health care system who wore the EHMR continuously during their shift completed an investigator developed survey. Descriptive statistics and thematic analysis were used. RESULTS Of the 8273 EHMR "fit-tested" eligible employees, 1478 met inclusion criteria and participated. Respondents reported that they felt well protected with the EHMR and confident in their care and maintenance of the EHMR. Although skin changes developed, they were primarily managed by adjusting the straps. Clarity of communication was a concern across all respondents and disciplines. CONCLUSIONS The EHMR was preferred over reusing the N95 although clarity in communication was challenging.
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Affiliation(s)
- Ruth A. Bryant
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Justin M. Smith
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Ned K. Tervola
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Claire Smith
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Cecely Hoyt
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Barite Dawud
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Siobhán Dugan
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Catherine A. St. Hill
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
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Edirisooriya M, Haas EJ. Examining the Roles of Training, Fit Testing, and Safety Climate on User Confidence in Respiratory Protection: A Case Example with Reusable Respirators in Health Delivery Settings. SUSTAINABILITY 2023; 15:10.3390/su151712822. [PMID: 39070029 PMCID: PMC11274855 DOI: 10.3390/su151712822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
A lack of confidence in the efficacy of respiratory protection can contribute to uncertainty among workers and cast doubt on workplace safety. To date, no research has been conducted to study and understand the introduction of elastomeric half-mask respirators (EHMRs)-without exhalation valves (EVs) or with exhalation valve filters (EVFs), both representing new designs that address source control-in the workplace. To study this issue, researchers collaborated with partners at 32 health delivery settings that received EHMRs from the Strategic National Stockpile during the COVID-19 pandemic. EHMR users (n = 882) completed an online survey between October 2021 and September 2022. Analyses demonstrated that employees were statistically significantly more confident in the efficacy of EHMRs with no EV/with an EVF (including the efficacy in protecting the user from COVID-19) if they had been fit tested and received training. Respondents were also statistically significantly more confident in the efficacy of their EHMR if they had a more positive perception of their organization's safety climate. The results provide insights for tailored fit testing and training procedures as manufacturers continue to improve respirator models to enhance worker comfort and use. Results also show that, even during a public health emergency, the role of safety climate cannot be ignored as an organizational factor to support worker knowledge, attitudes, and participation in health and safety behaviors specific to respirator use.
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Affiliation(s)
- Mihili Edirisooriya
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA 15236, USA
| | - Emily J. Haas
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA 15236, USA
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King EC, Zagrodney KAP, McKay SM, Holness DL, Nichol KA. Determinants of nurse's and personal support worker's adherence to facial protective equipment in a community setting during the COVID-19 pandemic in Ontario, Canada: A pilot study. Am J Infect Control 2022; 51:490-497. [PMID: 35917934 PMCID: PMC9338445 DOI: 10.1016/j.ajic.2022.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 12/05/2022]
Abstract
Background Appropriate and consistent facial protective equipment (FPE) use is critical for preventing respiratory illness transmission. Little is known about FPE adherence by home care providers. The purpose of this study is to adapt an existing facial protection questionnaire and use it to develop an initial understanding of factors influencing home care providers’ adherence to FPE during the COVID-19 pandemic. Methods A survey was shared with home care providers during Wave 2 of the COVID-19 pandemic in Ontario. Descriptive statistics and logistic regression by FPE adherence were conducted across individual, organizational, and environmental factors. Results Of the 199 respondents (140 personal support workers; 59 nurses), 71% reported that they always used FPE as required, with greater adherence to masks (89%) than eye protection (73%). The always-adherent reported greater perceived FPE efficacy, knowledge of recommended use and perceived occupational risk, lower education, and not experiencing personal barriers (including difficulty seeing, discomfort, communication challenges). Discussion Adherence rates were relatively high. In this context, with participants reporting high levels of organizational support, individual-level factors were the significant predictors of adherence. Conclusions Initiatives addressing perceived FPE efficacy, knowledge of recommended use, perception of at-work risk, and personal barriers to use may improve FPE adherence.
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Kheir O, Watts R, Verlinden J, Jacoby A, Smedts S, Vleugels J, Verwulgen S. Evaluating Filtering Facepiece Respirator Wearing-Comfort of Lebanese Red Cross Healthcare Providers. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:153-161. [PMID: 35677033 PMCID: PMC9169972 DOI: 10.2147/mder.s362198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The COVID-19 pandemic significantly increased the usage of various types of face masks. In addition, it triggered the rapid manufacture of new production lines of masks to cope with the unprecedented demand to overcome worldwide shortages. Such masks, which were previously used mostly by the health care personnel, became a daily necessity to the greater mainstream population. This rapid and sudden increase in their usage and the fact that new masks' innovations are progressively emerging to meet the growing global shortage requires an ongoing analysis on the factors associated with the fit and comfort while using these masks. Methods This paper presents the first translation and validation of the R-COMFI questionnaire to evaluate the comfort of a newly developed filtering face-piece respirator by the research team at the University of Antwerp. The questionnaire, which consists of 3 sections: Discomfort, General wearing experience, and Function, was translated from English to Arabic and involved 43 participants in the Lebanese Red Cross healthcare field based in Lebanon. Results The results showed discomfort factors that are mostly related to breathability and sweating caused by mask usage. Additionally, the results revealed that female respondents found the mask significantly less comfortable than male respondents (p-value with the two-tailed test is 0.0319), which confirmed that future validations should consider the concerns of both genders, and validated the R-COMFI translation exercise detailed in this paper. Discussion The contribution of this paper can be pinned down into three findings. The first finding is related to the discomfort issues. The second finding highlighted a significant difference in comfort experience between females and males. The last finding is the translation validation of the R-COMFI instrument, which confirmed that the questionnaire can be applied among wider geographical locations.
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Affiliation(s)
- Omar Kheir
- Product Development, University of Antwerp, Antwerp, Belgium
| | - Regan Watts
- Product Development, University of Antwerp, Antwerp, Belgium
| | - Jouke Verlinden
- Product Development, University of Antwerp, Antwerp, Belgium
| | - Alexis Jacoby
- Product Development, University of Antwerp, Antwerp, Belgium
| | - Sam Smedts
- Product Development, University of Antwerp, Antwerp, Belgium
| | - Jochen Vleugels
- Product Development, University of Antwerp, Antwerp, Belgium
| | - Stijn Verwulgen
- Product Development, University of Antwerp, Antwerp, Belgium
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George J, Verma R, Shafqat N. Physiological Hazard Assessment While Wielding Personal Protective Equipment (PPE) Among Health Care Workers. Cureus 2022; 14:e23510. [PMID: 35494999 PMCID: PMC9037050 DOI: 10.7759/cureus.23510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Accurate use of personal protective equipment (PPE) is an essential part of infection prevention and control measures to protect health care workers and patients from various hazardous conditions. Health care workers caring for patients with potentially infectious health conditions are using PPE for long periods of time. However, long-term use of PPE can cause many physiological health hazards among health care workers. So, the current study was carried out to assess the general health problems and dermatological problems experienced by health care workers with PPE use. Materials and methods A descriptive cross-sectional survey has been carried out in two selected tertiary care hospitals in central India by recruiting 301 health care workers. Non-probability convenient sampling technique was used to select participants for the study. Sociodemographic Performa and structured questionnaires were used to collect data on demographic characteristics of the participants and various health problems experienced by health care workers with PPE use. Collected data were analyzed using appropriate descriptive and inferential statistics. Results The current study reported excessive sweating (86.4%), difficulty in reading (85%), dry mouth (80.7%), and breathing difficulty (74.1%) as the most common problem associated with PPE use. In addition to this, adverse reactions like headache, restlessness, and dizziness were reported by 70.1%, 64.5%, and 50.8%. Indentation and pain on the back of the ears (76.1%), skin soaking (67.1%), and excessive sweating (76.1%) were identified as the most common problems related to N-95 masks, gloves, and coverall use. Conclusion The current study revealed a higher incidence of various health problems with PPE use among health care workers. The findings of the study highlight the importance of developing various guidelines to reduce the negative impact of PPE use and implementing preventive measures to decrease health problems associated with PPE use.
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Burnell K, Robbins M, Kulali S, Wells EM. Prevalence and predictors of mask use on a large US university campus during the COVID-19 pandemic: A brief report. Am J Infect Control 2022; 50:349-351. [PMID: 34883161 PMCID: PMC8648375 DOI: 10.1016/j.ajic.2021.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 01/16/2023]
Abstract
This observational study was conducted to determine the prevalence and correlates of wearing masks at a large Midwestern US university during the COVID-19 pandemic. A total of 7,237 individuals were observed over 24 hours. Overall mask use prevalence was 90.6% (95% confidence interval: 89.9, 91.2); mask use was significantly associated with being indoors (vs outdoors), female (vs male), and at the athletic center (vs the student union).
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Affiliation(s)
- Kenneth Burnell
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Meredith Robbins
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Sharon Kulali
- Department of Biochemistry, Purdue University, West Lafayette, IN, USA,Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Ellen M. Wells
- School of Health Sciences, Purdue University, West Lafayette, IN, USA,Department of Public Health, Purdue University, West Lafayette, IN, USA,Address correspondence to Ellen M. Wells, PhD, MPH, School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47906, USA
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Sousa RKD, Gonçalves N, Silva TL, Echevarria-Guanilo ME. EQUIPAMENTOS DE PROTEÇÃO INDIVIDUAL NA ASSISTÊNCIA HOSPITALAR DE ENFERMAGEM: REVISÃO DE ESCOPO. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0421pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar a produção científica sobre o uso de equipamento de proteção individual pelos profissionais da enfermagem durante a assistência no âmbito hospitalar. Método: trata-se de uma revisão de escopo, baseada no Manual Institute Joanna Briggs de 2020 e norteado pelo PRISMA-PCR. Utilizou-se como base de dados PUBMED, EMBASE, CINAHL, LILACS, BDENF, SCOPUS e WEB of SCIENCE, sendo o período de busca escolhido nos últimos 20 anos. A coleta de dados ocorreu de setembro a outubro de 2021. Protocolo de estudo disponível em Framework: https://osf.io/7d8q9/files/. Foram incluídos estudos sobre o uso dos Equipamentos de Proteção Individual na assistência direta da equipe de enfermagem nos hospitais e excluídos aqueles que abordassem em outros cenários, revisões, teses, dissertações e estudos não disponíveis na íntegra. Resultados: a amostra foi composta por 26 documentos. O equipamento mais citado e com maior adesão nos estudos foram as luvas de procedimento, enquanto que o uso dos óculos foi o menor. Dos fatores que facilitam o uso dos EPIs pelos enfermeiros destacam-se as relações interpessoais, conhecimento, carga de trabalho, padronização das diretrizes e participação da equipe assistencial nas decisões gerenciais. Conclusão: a necessidade de educação dos profissionais utilizando como estratégia o conhecimento comportamental, a manutenção da comunicação nos setores para evitar a contaminação, a influência da carga de trabalho, a padronização das diretrizes são necessárias nos serviços de saúde hospitalar para aumentar o engajamento dos profissionais de saúde às práticas de biossegurança.
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Sousa RKD, Gonçalves N, Silva TL, Echevarria-Guanilo ME. PERSONAL PROTECTIVE EQUIPMENT IN HOSPITAL NURSING CARE: A SCOPING REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0421en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze the scientific production on the use of Personal Protective Equipment by Nursing professionals during the care provided in the hospital environment. Method: this is a scoping review, based on the 2020 Joanna Briggs Institute Manual and guided by PRISMA-PCR. PUBMED, EMBASE, CINAHL, LILACS, BDENF, SCOPUS and WEB of SCIENCE were used as databases, choosing a search period corresponding to the last 20 years. Data collection took place from September to October 2021. The study protocol is available in the Open Science Framework: https://osf.io/7d8q9/files/. Studies on the use of Personal Protective Equipment in direct care provided by the Nursing team in hospitals were included; and those that addressed reviews, theses and dissertations in other settings were excluded, as well as studies not available in full. Results: the sample consisted of 26 documents. The items most cited and with the highest adherence in the studies were procedure gloves, while use of goggles was the least mentioned. The following stand out among the factors that facilitate PPE use by nurses: interpersonal relationships, knowledge, workload, standardization of guidelines, and participation of the care team in management decisions. Conclusion: the need to educate the professionals using behavioral knowledge as a strategy, as well as maintenance of communication in the sectors to avoid contamination, the influence of workload and the standardization of guidelines are necessary in the hospital health services to increase health professionals' engagement towards the biosafety practices.
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Trinkoff AM, Baldwin CM, Chasens ER, Dunbar-Jacob J, Geiger-Brown J, Imes CC, Landis CA, Patrician PA, Redeker NS, Rogers AE, Scott LD, Todero CM, Tucker SJ, Weinstein SM. CE: Nurses Are More Exhausted Than Ever: What Should We Do About It? Am J Nurs 2021; 121:18-28. [PMID: 34743129 DOI: 10.1097/01.naj.0000802688.16426.8d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.
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Affiliation(s)
- Alison M Trinkoff
- Alison M. Trinkoff is a professor at the University of Maryland School of Nursing, Baltimore. Carol M. Baldwin is professor emeritus and a Southwest Borderlands Scholar at Arizona State University's Edson College of Nursing and Health Innovation, Phoenix. Eileen R. Chasens is a professor and chair of the Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, where Jacqueline Dunbar-Jacob is dean and a distinguished service professor and Christopher C. Imes is an assistant professor. Now retired, at the time of this writing Jeanne Geiger-Brown was a professor and associate dean for research at the George Washington University School of Nursing, Washington, DC. Carol A. Landis is a professor emeritus at the University of Washington School of Nursing, Seattle. Patricia A. Patrician is a professor and the Rachel Z. Booth Endowed Chair at the University of Alabama at Birmingham School of Nursing, and a retired U.S. Army colonel. Nancy S. Redeker is the Beatrice Renfield Term Professor of Nursing at the Yale University School of Nursing, New Haven, CT. Ann E. Rogers is a professor at the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta. Linda D. Scott is a professor and dean of the University of Wisconsin-Madison School of Nursing. Catherine M. Todero is dean of the College of Nursing and vice provost of Health Sciences at Creighton University, Omaha, NE, and Phoenix, AZ. Sharon J. Tucker is the Grayce Sills Endowed Professor in Psychiatric-Mental Health Nursing and director of the Translational/Implementation Research Core at the Ohio State University College of Nursing, Columbus. Sharon M. Weinstein is chief executive officer of the Global Education Development Institute, and SMW Group LLC, North Bethesda, MD, and a clinical assistant professor at the College of Nursing, University of Illinois, Chicago. This article was a collaborative effort by the Fatigue Subgroup of the Health Behavior Expert Panel, American Academy of Nursing. The authors acknowledge Claire C. Caruso, PhD, RN, a research health scientist at the National Institute for Occupational Safety and Health, for her help in reviewing the manuscript. Contact author: Alison M. Trinkoff, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com
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van Gulik N, Bouchoucha S, Apivanich S, Lucas J, Hutchinson A. Factors influencing self-reported adherence to standard precautions among Thai nursing students: A cross sectional study. Nurse Educ Pract 2021; 57:103232. [PMID: 34700259 DOI: 10.1016/j.nepr.2021.103232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
AIM This study explored nursing students' compliance with standard precautions (SPs) and attitudes to SPs in Thailand, to identify factors that may increase adherence to SPs and infection prevention and control best practice. BACKGROUND In the context of high rates of healthcare associated infections as in Thailand, effective strategies to promote high levels of clinician adherence to SPs is a priority. Nursing students are one group of healthcare workers who play a vital role in caring for patients and constitute the future nursing workforce. DESIGN A cross-sectional survey design was used. METHODS A self-reported survey comprising the Compliance with Standard Precautions Scale and the Factors Influencing Adherence to Standard Precautions Scale were distributed to nursing students as a Thai paper-based survey. RESULTS A total of '533 second' to fourth year nursing students from a tertiary nursing school in Bangkok, Thailand completed the survey. The average nursing student compliance to SPs was 68.5%. Most (91.2%) reported only using water for handwashing and 57.2% reported reuse of surgical masks. The fourth-year students had higher compliance (M=3.90, SD=1.12) on the 'prevention of cross infection from person-to-person' dimension while second-year students reported higher compliance on the 'disposal of sharps' (M=2.67, SD=0.57) dimension. 'Contextual Cues' was identified as the factor (M=3.41, SD=0.40) that had the greatest influence on adherence and 'Practice Culture' (M=1.84, SD=0.66) and 'Justification' (M = 1.35, SD.68 had the lowest influence. Fourth year students identified 'Leadership' (M=2.90, SD=0.49) as an important influence on adherence to SPs. CONCLUSIONS To increase nursing students' adherence there needs to be greater emphasis on the importance of SPs in theoretical sessions and regular monitoring and feedback on hand hygiene performance and personal protective equipment use while students are on placements. More visible organizational leadership and promotion of high levels of adherence to SPs may assist students to translate their theoretical knowledge into practice.
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Affiliation(s)
- Nantanit van Gulik
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
| | - Stéphane Bouchoucha
- School of Nursing & Midwifery & Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia
| | - Siriluk Apivanich
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - James Lucas
- Deakin University Geelong, School of Health & Soc. Dev., VIC 3220, Australia
| | - Anastasia Hutchinson
- School of Nursing & Midwifery & Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Epworth Health Care Richmond, VIC 3121, Australia
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15
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Herstein JJ, Gibbs SG, Kupzyk KA, Beam EL. Using a Critical Safety Behavior Scoring Tool for Just-in-Time Training for N95 Respirator Use. Workplace Health Saf 2021; 70:31-36. [PMID: 34425725 DOI: 10.1177/21650799211031169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Historically, health care workers (HCWs) have exhibited marginal adherence to proper N95 respirator use. During the COVID-19 pandemic, HCWs with little to no prior training on N95 respirator use are relying on N95s as their primary respiratory protection. There is a need for simple, effective, and easily implementable just-in-time training (JITT) interventions to improve N95 respirator-related safety behavior. This study investigated two JITT interventions. METHODS A pilot experimental pretest posttest study design was used to evaluate two training interventions for N95 respirator donning/doffing performance at a Midwestern hospital system. HCW participants were randomly assigned to an intervention: one used a 4-minute instructional video alone, while the other used the same video but added a video reflection intervention (participant watched and scored a video of their own performance). All performances were scored using a 10-point Critical Safety Behavior Scoring Tool (CSBST). FINDINGS Sixty-two HCWs participated (32 video alone, 30 video reflection). The two groups' CSBST scores were not significantly different at pretest. Averaged participant scores on the CSBST improved immediately following both interventions. Scores were significantly higher on the posttest for the reflective practice intervention (p<.05). Years of experience and frequency of N95 respirator use did not predict pre or post scores. CONCLUSIONS/APPLICATIONS TO PRACTICE We provide evidence to support the use of a time-efficient JITT intervention to improve HCW N95 respirator donning/doffing practices during the COVID-19 pandemic and beyond. Hospital safety professionals should consider this type of training for HCWs required to wear respiratory protection.
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Healthcare Workers' Experiences and Views of Using Surgical Masks and Respirators, and Their Attitudes on the Sustainability: A Semi-Structured Survey Study during COVID-19. NURSING REPORTS 2021; 11:615-628. [PMID: 34968337 PMCID: PMC8608101 DOI: 10.3390/nursrep11030059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
A universal mask use was instituted in healthcare during COVID-19 pandemic in 2020. The extensive growth in the consumption of surgical masks and respirators brought new challenges. Healthcare workers had to get accustomed to wearing the facemasks continuously, raising concerns on the patient, occupational, and environmental safety. The aim of this study is to describe frontline healthcare workers and other authorities’ views and experiences on continuous use of surgical masks and respirators (facemasks) and their attitudes towards environmental and sustainability issues. A cross-sectional web-based survey was conducted in Finland during the COVID-19 pandemic in autumn 2020. The respondents(N = 120) were recruited via social media, and the data were collected using a purpose-designed questionnaire. Descriptive statistics and inductive content analysis were used to analyze the quantitative data and qualitative data, respectively. The healthcare workers perceived their own and patient safety, and comfortability of facemasks as important, but according to their experiences, these properties were not evident with the current facemasks. They considered protection properties more important than environmental values. However, biodegradability and biobased material were seen as desired properties in facemasks. Based on the results, the current facemasks do not meet users’ expectations well enough. Especially the design, breathability, and sustainability issues should be taken more into account.
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Yang Q, Wang X, Zhou Q, Tan L, Zhang X, Lai X. Healthcare workers' behaviors on infection prevention and control and their determinants during the COVID-19 pandemic: a cross-sectional study based on the theoretical domains framework in Wuhan, China. Arch Public Health 2021; 79:118. [PMID: 34193306 PMCID: PMC8242273 DOI: 10.1186/s13690-021-00641-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infection prevention and control (IPC) measures are crucial to combat the COVID-19 pandemic. This study aimed to explore the levels and determinants of HCWs' IPC behaviors based on the theoretical domains framework (TDF), which has been shown to be effective in guiding behavior change. METHODS A cross-sectional survey was conducted in Wuhan, China in January 2020. Self-reported hand hygiene and droplet isolation behaviors (including the use of masks, gloves, goggles and gowns) were set as dependent variables. TDF domains and HCWs' characteristics were independent variables. Negative binomial regression analyses were performed to explore their relationships. RESULTS HCWs reported good IPC behaviors, while the compliance with goggle and gown use was relatively low (below 85%). Environmental context and resources domain was significantly related to hand hygiene (β = 0.018, p = 0.026), overall droplet isolation behaviors (β = 0.056, p = 0.001), goggle (β = 0.098, p = 0.001) and gown use (β = 0.101. p < 0.001). Knowledge domain was significantly related to goggle (β = 0.081, p = 0.005) and gown use (β = 0.053, p = 0.013). Emotion domain was a predictor of overall droplet isolation behaviors (β = 0.043, p = 0.016), goggle (β = 0.074, p = 0.026) and gown use (β = 0.106, p < 0.001). Social influences domain was a predictor of overall droplet isolation behaviors (β = 0.031, p = 0.029) and gown use (β = 0.039, p = 0.035). HCWs in high-risk departments had better behaviors of gown use (β = 0.158, p = 0.032). HCWs who had encountered confirmed or suspected patients reported worse behaviors of goggle (β = - 0.127, p = 0.050) and gown use (β = - 0.153, p = 0.003). CONCLUSIONS Adequate personal protective materials and human resources, education and training, as well as supervision and role model setting are necessary to improve IPC behaviors regarding the COVID-19 pandemic.
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Affiliation(s)
- Qiuxia Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei Province, China
| | - Xuemei Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei Province, China
| | - Qian Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei Province, China
| | - Li Tan
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei Province, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei Province, China.
| | - Xiaoquan Lai
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei Province, China.
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Abuduxike G, Acar Vaizoglu S, Asut O, Cali S. An Assessment of the Knowledge, Attitude, and Practice Toward Standard Precautions Among Health Workers From a Hospital in Northern Cyprus. Saf Health Work 2021; 12:66-73. [PMID: 33732531 PMCID: PMC7940130 DOI: 10.1016/j.shaw.2020.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The objective was to assess the knowledge level, attitude, and practice of health care workers towards standard precautions, and to identify the related factors. Furthermore, it was attempted to identify the proportion of having the experience of needle stick injuries (NSIs) and associated factors among participants. METHODS A cross-sectional study was conducted in a teaching hospital among 233 health workers using a self-administrated questionnaire. The questionnaire included eight knowledge items, seven practice items, and five attitude items. Based on the mean score of each category, responses were grouped into "satisfactory" and "unsatisfactory". Univariate, bivariate, and multivariable logistic regression analyses were done. RESULTS The mean age of the participants 32.95 (SD ± 9.70) and 62.2% of them were women. 57.5% of the staff had a satisfactory level of correct knowledge (>5 correct answers), 37.3% had a satisfactory positive attitude (>3 correct answers), and 30.9% had a satisfactory practice (>3 correct answers) towards standard precautions. The occupation was one of the predictors as doctors were less likely to have satisfactory knowledge and practice compared to nurses (OR = 0.269, 95% CI: 0.10-0.70 and OR = 0.248, 95% CI: 0.08-0.77, respectively). Out of 174 participants, 31.6% of them reported experiencing NSIs and support staff were 71% less likely to experience NSIs compared to nurses & paramedics. CONCLUSION The findings revealed a substandard adherence of standard precautions among participants, which highlighted the necessity of the provision of a periodic, tailored training program based on the occupation and risk exposure.
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Affiliation(s)
- Gulifeiya Abuduxike
- Department of Public Health, Faculty of Medicine, Near East University, Cyprus
| | | | - Ozen Asut
- Department of Public Health, Faculty of Medicine, Near East University, Cyprus
| | - Sanda Cali
- Department of Public Health, Faculty of Medicine, Near East University, Cyprus
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19
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Burton C, Coles B, Adisesh A, Smith S, Toomey E, Chan XHS, Ross L, Greenhalgh T. Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review. Occup Environ Med 2021; 78:679-690. [PMID: 33504624 DOI: 10.1136/oemed-2020-107058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
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Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Briana Coles
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | - Anil Adisesh
- Occupational Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Simon Smith
- Canadian Standards Biological Aerosols Group, Canadian Standards Association, Toronto, Ontario, Canada
| | - Elaine Toomey
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | - Lawrence Ross
- Infectious Diseases, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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20
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Triemstra S, Liang H, Gooder M, Livings N, Spencer A, Beavers L, Brooks D, Miller E. Updating the Evidence: Suctioning Practices of Physiotherapists in Ontario. Physiother Can 2021; 73:147-156. [PMID: 34456425 PMCID: PMC8370724 DOI: 10.3138/ptc-2019-0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this article is to describe current tracheal suctioning practices of physiotherapists in the province of Ontario and to determine what factors influence these practices. Method: A cross-sectional online survey was conducted. An online survey link and quick response code were mailed to Ontario physiotherapists who were actively providing patient care and were authorized to perform tracheal suctioning as identified by the College of Physiotherapists of Ontario. Results: Ninety physiotherapists participated in the survey (23% response rate). Most (66%) suctioned in an intensive care setting, and many (41%) reported frequently using a closed endotracheal suctioning system. Hyperoxygenation was frequently performed before suctioning by 48% of participants, and only 18% frequently hyperoxygenated after suctioning. Most participants reported infrequently performing saline instillation (52%) and infrequently hyperinflating before suctioning (79%). Clean gloves were reported as the personal protective equipment most frequently worn across all suctioning approaches, and goggles and sterile gloves were least often worn while suctioning. Previous suctioning experience had the most influence on suctioning practices, and limited access to equipment had the least influence. Conclusions: Some of the tracheal suctioning practices of physiotherapists in Ontario vary from evidence-based clinical guidelines.
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Affiliation(s)
| | | | | | | | | | | | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto
- School of Rehabilitation Science, McMaster University, Hamilton, Ont
| | - Erin Miller
- Department of Physical Therapy
- Rehabilitation Sciences Institute, University of Toronto
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21
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A novel perspective approach to explore pros and cons of face mask in prevention the spread of SARS-CoV-2 and other pathogens. Saudi Pharm J 2020; 29:121-133. [PMID: 33398228 PMCID: PMC7773545 DOI: 10.1016/j.jsps.2020.12.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022] Open
Abstract
Corona virus disease 2019 (COVID-19) outbreak has become a severe community health threat across the world. Covid-19 is a major illness, presently there is no as such any medicine and vaccine those can claim for complete treatment. It is spreading particularly in a feeble immune people and casualties are expanding abruptly and put the health system under strain. Among the strategic measures face mask is one of the most used measures to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Wearing a face mask possibly create a false sense of security lead to decline others measures. Face mask could be risk for the people of under lying medical conditions, old age group, outdoor exercise, acute and chronic respiratory disorders and feeble innate immune. Restrictive airflow due to face mask is the main cause of retention of CO2 called hypercapnia that can lead to respiratory failure with symptoms of tachycardia, flushed skin, dizziness, papilledema, seizure and depression. According to latest updates face shield and social distancing could be better substitute of face mask.
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22
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Cohen J, Rodgers YVDM. Contributing factors to personal protective equipment shortages during the COVID-19 pandemic. Prev Med 2020; 141:106263. [PMID: 33017601 PMCID: PMC7531934 DOI: 10.1016/j.ypmed.2020.106263] [Citation(s) in RCA: 243] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 01/01/2023]
Abstract
This study investigates the forces that contributed to severe shortages in personal protective equipment in the US during the COVID-19 crisis. Problems from a dysfunctional costing model in hospital operating systems were magnified by a very large demand shock triggered by acute need in healthcare and panicked marketplace behavior that depleted domestic PPE inventories. The lack of effective action on the part of the federal government to maintain and distribute domestic inventories, as well as severe disruptions to the PPE global supply chain, amplified the problem. Analysis of trade data shows that the US is the world's largest importer of face masks, eye protection, and medical gloves, making it highly vulnerable to disruptions in exports of medical supplies. We conclude that market prices are not appropriate mechanisms for rationing inputs to health because health is a public good. Removing the profit motive for purchasing PPE in hospital costing models, strengthening government capacity to maintain and distribute stockpiles, developing and enforcing regulations, and pursuing strategic industrial policy to reduce US dependence on imported PPE will help to better protect healthcare workers with adequate supplies of PPE.
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Affiliation(s)
- Jennifer Cohen
- Department of Global and Intercultural Studies, Miami University, 501 E. High St. Oxford, OH 45056, USA; Ezintsha, Wits Reproductive Health and HIV Institute, Department of Medicine, Faculty of Health Sciences, 32 Princess of Wales Terr., Sunnyside Office Park, Block D, Floor 5, University of the Witwatersrand, Johannesburg 2193, South Africa.
| | - Yana van der Meulen Rodgers
- Department of Labor Studies & Employment Relations, and Department of Women's, Gender, & Sexuality Studies, Rutgers University, 94 Rockafeller Road, Piscataway, NJ 08854, USA
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23
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Webster C, Wordsworth M, Marsden M, Navaratne L, Bowley D, Chaloner E, O'Brien B, Schilling R. C4: 'Command, control, coordination and communication' at NHS Nightingale, London: introducing the tactical commander. J R Soc Med 2020; 113:299-301. [PMID: 32780977 PMCID: PMC7539096 DOI: 10.1177/0141076820945286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Claire Webster
- Royal Centre for Defence Medicine, Birmingham B15 2WB, UK
| | | | - Max Marsden
- Royal Centre for Defence Medicine, Birmingham B15 2WB, UK
| | | | - Doug Bowley
- Royal Centre for Defence Medicine, Birmingham B15 2WB, UK
| | - Eddie Chaloner
- Royal Centre for Defence Medicine, Birmingham B15 2WB, UK
| | - Ben O'Brien
- Royal Centre for Defence Medicine, Birmingham B15 2WB, UK
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Clarke B, Haze N, Sly J, Thomas A, Ponte PR, Jurgens CY. Just-in-time safety training for N95 respirators: A virtual approach. Nurs Manag (Harrow) 2020; 51:17-22. [PMID: 33116046 DOI: 10.1097/01.numa.0000719392.56384.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Beth Clarke
- At Boston College William F. Connell School of Nursing in Chestnut Hill, Mass., Beth Clarke is a clinical instructor, Nanci Haze is a clinical assistant professor, Jacqueline Sly is a clinical instructor, Allan Thomas is a clinical instructor, Patricia Reid Ponte is an associate clinical professor, and Corrine Y. Jurgens is an associate professor
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25
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Martin GP, Hanna E, McCartney M, Dingwall R. Science, society, and policy in the face of uncertainty: reflections on the debate around face coverings for the public during COVID-19. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1797997] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Graham P. Martin
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Esmée Hanna
- School of Allied Health Sciences, De Montfort University, Leicester, UK
| | | | - Robert Dingwall
- Dingwall Enterprises Ltd and School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Parush A, Wacht O, Gomes R, Frenkel A. Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study. J Med Internet Res 2020; 22:e19947. [PMID: 32511099 PMCID: PMC7301688 DOI: 10.2196/19947] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 01/07/2023] Open
Abstract
Background Full level 1 personal protective equipment (PPE) is used in various domains and contexts. Prior research has shown influences of such equipment on performance, comfort, and contamination levels. The coronavirus disease (COVID-19) pandemic forced a pervasive requirement of PPE, with little preparation, rushed deployment, inadequate time for training, and massive use by personnel who are inexperienced or not qualified in its effective use. Objective This study aims to examine the key human factors (physical and ergonomic, perceptual and cognitive) that influence the use of level 1 PPE when attending to patients with suspected or confirmed COVID-19. Methods The research approach consisted of a short survey disseminated to health care professionals in two countries, Israel and Portugal, with similar demographics and health care systems. The survey included 10 items with a 5-point Likert scale regarding the key human factors involved in level 1 PPE, as identified in prior research. Results A total of 722 respondents from Israel and 301 respondents from Portugal were included in the analysis. All the respondents reported using level 1 PPE with patients with COVID-19 in the range of several hours daily to several hours weekly. The Cronbach α was .73 for Israel and .75 for Portugal. Responses showed high levels of difficulty, with medians of 4 for items related to discomfort (n=539/688, 78% in Israel; n=328/377, 87% in Portugal), hearing (n=236/370, 64% in Portugal; n=321/642, 50% in Israel), seeing (n=697/763, 89% in Israel; n=317/376, 84% in Portugal), and doffing (n=290/374, 77% in Portugal; n=315/713, 44% in Israel). A factor analysis showed a set of strongly related variables consisting of hearing, understanding speech, and understanding the situation. This suggests that degradation in communication was strongly associated with degradation in situational awareness. A subsequent mediation analysis showed a direct effect of PPE discomfort on situational awareness (P<.001); this was also influenced (mediated) by difficulties in communicating, namely in hearing and understanding speech. Conclusions In 2020, the COVID-19 pandemic is paving the way for updating PPE design. The use of already deployed technology affords ample opportunities to improve, adapt, and overcome caveats. The findings here suggest that the use of level 1 PPE with patients with COVID-19 has perceptual and cognitive effects, in addition to physical and ergonomic influences. Efforts should be taken to mitigate the harmful effects of such influences, both regarding the performance of medical actions and the risk of contamination to health care workers. Such efforts involve the design of PPE; the introduction of technologies to enhance vision, hearing, and communicating during the use of PPE; and training staff in using the equipment and in effective communication and teamwork protocols.
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Affiliation(s)
- Avi Parush
- Israel Institute of Technology, Haifa, Israel
| | - Oren Wacht
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ricardo Gomes
- Department of Operational Medicine, Clinical Center of Guarda Nacional Republicana, Lisboa, Portugal
| | - Amit Frenkel
- Intensive Care Unit, Soroka University Medical Center, Beer Sheva, Israel
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Affiliation(s)
- Graham P Martin
- Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge CB2 0AH, UK
| | - Esmée Hanna
- Institute of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Robert Dingwall
- Dingwall Enterprises and Nottingham Trent University, Nottingham, UK
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Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P, Parker A, Wall P, Spinelli A, Torkington J. Safe management of surgical smoke in the age of COVID-19. Br J Surg 2020; 107:1406-1413. [PMID: 32363596 PMCID: PMC7267397 DOI: 10.1002/bjs.11679] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/21/2022]
Abstract
Background The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. Methods The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Results Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail. Conclusion There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.
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Affiliation(s)
- N G Mowbray
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Ansell
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Horwood
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Cornish
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - P Rizkallah
- School of Medicine, Cardiff University, Cardiff, UK
| | - A Parker
- School of Medicine, Cardiff University, Cardiff, UK
| | - P Wall
- Isca Healthcare Research, Caerleon, UK
| | - A Spinelli
- Department of General and Minimally Invasive Surgery, Istituto Clinico Humanitas, Rozzano, Italy
| | - J Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
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Chughtai AA, Seale H, Rawlinson WD, Kunasekaran M, Macintyre CR. Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings. Ann Work Expo Health 2020; 64:368-377. [DOI: 10.1093/annweh/wxaa020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Infection control policies and guidelines recommend using facemasks and respirators to protect healthcare workers (HCWs) from respiratory infections. Common types of respirators used in healthcare settings are filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). Aims of this study were to examine the current attitudes and practices of HCWs regarding the selection and use of respiratory protection and determine the acceptability of a novel PAPR.
Methods
In-depth interviews were undertaken with 20 HCWs from a large tertiary hospital in Sydney, Australia. Participants were fit tested with a lightweight tight-fitting half-facepiece PAPR (CleanSpace2™ Power Unit, PAF-0034, by CleanSpace Technology®) using the TSI™ Portacount quantitative fit test method.
Results
Interview results showed that HCWs had a limited role in the selection and use of facemasks and respirators and had been using the devices provided by the hospital. The majority of subjects had no knowledge of hospital policy for the use of facemasks and respirators, had not been trained on the use of respirators, and had not been fit tested previously. Compliance with the use of facemasks and respirators was perceived as being low and facemasks and respirators were typically used only for short periods of time.
All 20 participants were successfully fit tested to the CleanSpace2™ PAPR (overall geometric mean fit factor—6768). According to the exit surveys, CleanSpace2™ PAPRs were easy to don (14/20) and doff (15/20) and comfortable to wear (14/20). Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations.
Conclusions
HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs.
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Affiliation(s)
- Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, The University of New South Wales, , Sydney, NSW, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, The University of New South Wales, , Sydney, NSW, Australia
| | - William D Rawlinson
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C Raina Macintyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USA
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Barratt R, Gilbert GL, Shaban RZ, Wyer M, Hor SY. Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians. Australas Emerg Care 2019; 23:105-113. [PMID: 31810897 PMCID: PMC7104090 DOI: 10.1016/j.auec.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 12/27/2022]
Abstract
Background The risk of healthcare-acquired infection increases during outbreaks of novel infectious diseases. Emergency department (ED) clinicians are at high risk of exposure to both these and common communicable diseases. Personal protective equipment (PPE) is recommended to protect clinicians from acquiring, or becoming vectors of, infection, yet compliance is typically sub-optimal. Little is known about factors that influence use of PPE—specifically gloves and masks—during routine care in the ED. Methods This was an ethnographic study, incorporating documentation review, field observations and interviews. The theoretical domains framework (TDF) was used to aid thematic analysis and identify relevant enablers of and barriers to optimal PPE use. Results Thirty-one behavioural themes were identified that influenced participants’ use of masks and gloves. There were significant differences, namely: more reported enablers of glove use vs more barriers to mask use. Reasons included more positive unit culture towards glove use, and lower perception of risk via facial contamination. Conclusion Emerging infectious diseases, spread (among other routes) by respiratory droplets, have caused global outbreaks. Emergency clinicians should ensure that, as with gloves, the use of masks is incorporated into routine cares where appropriate. Further research which examines items of PPE independently is warranted.
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Affiliation(s)
- Ruth Barratt
- University of Sydney, Faculty of Medicine and Health, Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead, NSW 2145, Australia.
| | - Gwendolyn L Gilbert
- University of Sydney, Faculty of Medicine and Health, Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead, NSW 2145, Australia; University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; University of Sydney, Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW, Australia
| | - Ramon Z Shaban
- University of Sydney, Faculty of Medicine and Health, Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead, NSW 2145, Australia; University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Australia; University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead, NSW 2145, Australia
| | - Mary Wyer
- University of Sydney, Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; University of Sydney, Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW, Australia
| | - Su-Yin Hor
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; University of Sydney, Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW, Australia; Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, Australia
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Ngo CQ, Manabe T, Vu GV, Chu HT, Vu TTT, Tran TT, Doan LTP, Takasaki J, Kudo K. Difficulties in tuberculosis infection control in a general hospital of Vietnam: a knowledge, attitude, and practice survey and screening for latent tuberculosis infection among health professionals. BMC Infect Dis 2019; 19:951. [PMID: 31703561 PMCID: PMC6842132 DOI: 10.1186/s12879-019-4593-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/24/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In Vietnam, a country with a high tuberculosis (TB) burden, health professionals in both TB-specialized and non-TB-specialized general hospitals have a high risk of acquiring TB. The aims of the present study were to clarify the difficulties in TB infection control at non-TB specialized hospitals and whether any associated risks of latent TB infection exist among health professionals in Vietnam. METHODS We conducted a cross-sectional study in a national tertiary and general hospital of Hanoi, Vietnam. Participants were health professionals, including physicians, nurses, and other health professionals. We assessed difficulties in TB infection control by conducting a knowledge, attitude, and practice (KAP) survey. We also collected data on the results of tuberculin skin tests (TSTs) conducted during health check-ups for hospital staff to determine whether health professionals had latent TB infection or TB disease. KAP scores were compared among health professional groups (physicians vs. nurses vs. other health professionals). Factors influencing knowledge scores were evaluated using multiple regression analysis. RESULTS A total 440 health professionals at the study site participated in the KAP survey, and we collected the results of TSTs from a total of 299 health professionals. We observed a high prevalence of latent TB infection (74.2%), especially among participants in the emergency department. Although participants had high KAP scores, some topics were less understood, such as symptoms and risks of TB, proper use of protective equipment such as N95 respirators, and preventing transmission by patients with confirmed or suspected TB. Factors influencing knowledge scores associated with TB were age, a belief that TB is the most important infectious disease, being a medical professional, having previously attended workshops or seminars, and knowing that Vietnam has a high burden of TB. CONCLUSION In a non-TB specialized hospital of Vietnam, we observed a risk of TB infection among health professionals and difficulties in properly controlling TB infection. Early awareness regarding patients with suspected TB, to apply proper measures and prevent transmission, and education regarding obtaining updated knowledge through scientific information are crucial to enhancing TB infection control in general hospitals of Vietnam.
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Affiliation(s)
| | - Toshie Manabe
- Jichi Medical University, Center for Community Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | | | | | | | | | | | - Jin Takasaki
- National Center for Global Health and Medicine, Division of Pulmonary Medicine, Tokyo, Japan
| | - Koichiro Kudo
- Waseda University Organization for Regional and Inter-Regional Studies, Tokyo, Japan
- Yurin Hospital, Tokyo, Japan
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Fix GM, Reisinger HS, Etchin A, McDannold S, Eagan A, Findley K, Gifford AL, Gupta K, McInnes DK. Health care workers' perceptions and reported use of respiratory protective equipment: A qualitative analysis. Am J Infect Control 2019; 47:1162-1166. [PMID: 31182235 PMCID: PMC7115305 DOI: 10.1016/j.ajic.2019.04.174] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about health care workers' (HCW) perceptions of, or experiences using, respiratory protective equipment (RPE). We sought to characterize their perceptions and identify reasons underlying inappropriate use. METHODS We conducted 12 focus groups with nurses and nursing assistants at 4 medical centers. We analyzed the thematic content of 73 discrete "stories" told by focus group participants. RESULTS We identified 5 story types surrounding RPE use: 1) policies are known and seen during work routines; 2) during protocol lapses, use is reinforced through social norms; 3) clinical experiences sometimes supersede protocol adherence; 4) when risk perception is high, we found concern regarding accessing RPE; and 5) HCWs in emergency departments were viewed as not following protocol because risk was ever-present. DISCUSSION HCWs were aware of the importance of RPE and protocols for using it, and these supported use when protocol lapses occurred. However, protocol adherence was undermined by clinical experience, perceived risk, and the distinct context of the emergency department where patients continually arrive with incomplete or delayed diagnoses. CONCLUSIONS Protocols, visual cues, and social norms contribute to a culture of safety. This culture can be undermined when HCWs experience diagnostic uncertainty or they mistrust the protocol and instead rely on their clinical experiences.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Boston University School of Public Health, Boston, MA.
| | - Heather Schacht Reisinger
- Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - Anna Etchin
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA
| | - Sarah McDannold
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA
| | - Aaron Eagan
- VHA Office of Public Health, National Center for Occupational Health and Infection Control, Gainesville, FL
| | - Kimberly Findley
- VHA Office of Public Health, National Center for Occupational Health and Infection Control, Gainesville, FL
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA; Boston University School of Public Health, Boston, MA
| | - Kalpana Gupta
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VA Hospital, Bedford, MA; Center for Healthcare Organization and Implementation Research (CHOIR), Boston University School of Medicine, VA Boston Healthcare System, Boston, MA; Boston University School of Public Health, Boston, MA
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Barratt R, Shaban RZ, Gilbert GL. Clinician perceptions of respiratory infection risk; a rationale for research into mask use in routine practice. Infect Dis Health 2019; 24:169-176. [PMID: 30799181 PMCID: PMC7129171 DOI: 10.1016/j.idh.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/18/2022]
Abstract
Outbreaks of emerging and re-emerging infectious diseases are global threats to society. Planning for, and responses to, such events must include healthcare and other measures based on current evidence. An important area of infection prevention and control (IPC) is the optimal use of personal protective equipment (PPE) by healthcare workers (HCWs), including masks for protection against respiratory pathogens. Appropriate mask use during routine care is a forerunner to best practice in the event of an outbreak. However, little is known about the influences on decisions and behaviours of HCWs with respect to protective mask use when providing routine care. In this paper we argue that there is a need for more research to provide a better understanding of the decision-making and risk-taking behaviours of HCWs in respect of their use of masks for infectious disease prevention. Our argument is based on the ongoing threat of emerging infectious diseases; a need to strengthen workforce capability, capacity and education; the financial costs of healthcare and outbreaks; and the importance of social responsibility and supportive legislation in planning for global security. Future research should examine HCWs' practices and constructs of risk to provide new information to inform policy and pandemic planning.
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Affiliation(s)
- Ruth Barratt
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW 2050, Australia; The Westmead Clinical School, University of Sydney, NSW 2145, Australia.
| | - Ramon Z Shaban
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW 2050, Australia; Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW 2050, Australia; Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead, NSW 2145, Australia.
| | - Gwendoline L Gilbert
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW 2050, Australia.
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Liu Y, Song Y, Hu X, Yan L, Zhu X. Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists. J Cancer 2019; 10:2788-2799. [PMID: 31258787 PMCID: PMC6584931 DOI: 10.7150/jca.31464] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/29/2019] [Indexed: 12/31/2022] Open
Abstract
Surgical smoke is the gaseous by-product produced by heat generating devices in various surgical operations including laser conization and loop electrosurgical procedures that often are performed by gynecologists. Surgical smoke contains chemicals, blood and tissue particles, bacteria, and viruses, which has been shown to exhibit potential risks for surgeons, nurses, anesthesiologists, and technicians in the operation room due to long term exposure of smoke. In this review, we describe the detailed information of the components of surgical smoke. Moreover, we highlight the effects of surgical smoke on carcinogenesis, mutagenesis, and infection in gynecologists. Furthermore, we discussed how to prevent the surgical smoke via using high-filtration masks and smoke evacuation systems as well as legal guidelines for protection measures among the gynecologists.
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Affiliation(s)
- Yi Liu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yizuo Song
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoli Hu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linzhi Yan
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqiong Zhu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Wizner K, Nasarwanji M, Fisher E, Steege AL, Boiano JM. Exploring respiratory protection practices for prominent hazards in healthcare settings. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:588-597. [PMID: 29750600 PMCID: PMC6201744 DOI: 10.1080/15459624.2018.1473581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/12/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
The use of respiratory protection, an important component of personal protective equipment (PPE) in healthcare, is dependent on the hazard and environmental conditions in the workplace. This requires the employer and healthcare worker (HCW) to be knowledgeable about potential exposures and their respective protective measures. However, the use of respirators is inconsistent in healthcare settings, potentially putting HCWs at risk for illness or injury. To better understand respirator use, barriers, and influences, the National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers provided an opportunity to examine self-reported use of respirators and surgical masks for targeted hazards. The hazards of interest included aerosolized medications, antineoplastic drugs, chemical sterilants, high-level disinfectants, influenza-like illness (ILI), and surgical smoke. Of the 10,383 HCWs who reported respiratory protection behaviors, 1,904 (18%) reported wearing a respirator for at least one hazard. Hazard type, job duties, site characteristics, and organizational factors played a greater role in the likelihood of respirator use than individual factors. The proportion of respirator users was highest for aerosolized medications and lowest for chemical sterilants. Most respondents reported using a surgical mask for at least one of the hazards, with highest use for surgical smoke generated by electrosurgical techniques and ILI. The high proportion of respirator non-users who used surgical masks is concerning because HCWs may be using a surgical mask in situations that require a respirator, specifically for surgical smoke. Improved guidance on hazard recognition, risk evaluation, and appropriate respirator selection could potentially help HCWs better understand how to protect themselves at work.
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Affiliation(s)
- Kerri Wizner
- National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
- Association of Schools and Programs of Public Health, Washington, D.C., USA
| | - Mahiyar Nasarwanji
- National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Edward Fisher
- National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Andrea L. Steege
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - James M. Boiano
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Evaluation of 9 health care organizations' respiratory protection programs and respiratory protective device practices: Implications for adoption of elastomerics. Am J Infect Control 2018; 46:350-352. [PMID: 29079137 DOI: 10.1016/j.ajic.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/21/2022]
Abstract
Interview, observational, and discussion group data at 9 health care organizations (HCOs) were collected to better understand elastomeric half-facepiece respirators' (EHFRs) use. We found that HCOs do not routinely use EHFRs as a respiratory protection device (RPD) for health care workers; compliance with other respirator types was less than expected. This finding has important training implications for proper use of all RPDs and EHFRs as an alternative RPD stockpiled for use during a respiratory infectious outbreak.
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LaVela SL, Kostovich C, Locatelli S, Gosch M, Eagan A, Radonovich L. Development and initial validation of the Respirator Comfort, Wearing Experience, and Function Instrument [R-COMFI]. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:135-147. [PMID: 27636378 DOI: 10.1080/15459624.2016.1237025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Filtering face-piece respirators (FFRs) are worn to protect health care personnel from airborne particles; however, clinical studies have demonstrated that FFR adherence is relatively low in some settings, in part, due to discomfort and intolerance. The objective of this study was to develop and initially evaluate the psychometric properties of an instrument designed to measure the comfort and tolerability of FFRs. Instrument items were developed through literature reviews, focus groups, and several iterations of ranking and refining by experts. Psychometric evaluation of the instrument was conducted using Rasch partial credit model (PCM) analysis. Pivot anchoring was used to specify the threshold defining item difficulty; in our analyses, this was the point that participants moved from possessing none of the trait to some of the trait. The final instrument was completed by 165 health care personnel from 3 Veterans Health Administration facilities, and data were analyzed using Rasch PCM. Seven items were removed because they: (1) violated the assumption of independence; (2) were mis-fitting; and/or (3) were deemed not relevant. Category function analysis demonstrated that all categories progressed monotonically. Principal components analysis demonstrated the existence of three subscales (Discomfort, General Wearing Experience, and Function). Final reliability analyses showed that the scale had moderate to high person reliability and high item reliability. The final instrument contained 21 items. Until now, to our knowledge no instrument with evidence supporting its reliability and validity to assess discomfort and tolerance of FFRs among health care personnel has been published. A 21-item psychometrically sound measure of comfort and tolerability of FFRs, Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), was developed. The significance of developing such an instrument is that it will help identify respirators that are likely to have better adherence in practice settings. The R-COMFI may be used within and beyond the VA healthcare system as a psychometrically sound instrument to evaluate the comfort and tolerability of respirators, including developmental prototypes.
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Affiliation(s)
- Sherri L LaVela
- a Department of Veterans Affairs , VA Health Services Research and Development , Hines , Illinois
- b Department of Physical Medicine and Rehabilitation , Feinberg School of Medicine, Northwestern University , Chicago , Illinois
| | - Carol Kostovich
- a Department of Veterans Affairs , VA Health Services Research and Development , Hines , Illinois
- c Marcella Niehoff School of Nursing , Loyola University Chicago , Chicago , Illinois
| | - Sara Locatelli
- a Department of Veterans Affairs , VA Health Services Research and Development , Hines , Illinois
| | - Megan Gosch
- d National Center for Occupational Health and Infection Control, Office of Public Health, Veterans Health Administration , Department of Veterans Affairs , Washington , DC
| | - Aaron Eagan
- d National Center for Occupational Health and Infection Control, Office of Public Health, Veterans Health Administration , Department of Veterans Affairs , Washington , DC
| | - Lewis Radonovich
- d National Center for Occupational Health and Infection Control, Office of Public Health, Veterans Health Administration , Department of Veterans Affairs , Washington , DC
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Weng YH, Bhembe PT, Chiou HY, Yang CY, Chiu YW. Perceived risk of tuberculosis infection among healthcare workers in Swaziland. BMC Infect Dis 2016; 16:697. [PMID: 27881088 PMCID: PMC5122014 DOI: 10.1186/s12879-016-2029-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of tuberculosis (TB) in the Kingdom of Swaziland is extremely high. How healthcare workers (HCWs) in Swaziland perceive infection control (IC) measures for preventing TB transmission is unclear. This study aimed to determine perceived risk of TB infection in relation to IC measures among HCWs in three institutions of Swaziland. METHODS A cross-sectional questionnaire survey was conducted in 2014. Demographic data and IC measures were collected from main and allied HCWs. RESULTS In total, 186 HCWs (19 doctors, 99 nurses, and 68 allied HCWs) were enrolled. The multivariate logistic regression analyses revealed that nurses (OR = 39.87, 95% CI = 2.721-584.3) and other HCWs (OR =99.34, 95% CI = 7.469-1321) perceived a higher TB infection risk than did doctors. Moreover, HCWs working for <4 years at the TB department perceived a lower TB infection risk (OR = 0.099, 95% CI = 0.022-0.453). Availability of N95 respirator masks (OR = 0.055, 95% CI = 0.005-0.586) and a designated sputum collection area (OR = 0.142, 95% CI = 0.037-0.545) also carried lower TB infection risks. CONCLUSION This study depicts the current status of IC measures for TB infection in a high prevalence country. The results suggest that HCWs perceived a greater TB infection risk at inadequate environmental IC measures.
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Affiliation(s)
- Yi-Hao Weng
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Patience Thulile Bhembe
- Department of Nursing, Faculty of Health Sciences, Southern Africa Nazarene University, Manzini, Swaziland.,Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Health Policy and Care Research Center, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Wen Chiu
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan. .,Health Policy and Care Research Center, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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Chen SL, Chen KL, Lee LH, Yang CI. Working in a danger zone: A qualitative study of Taiwanese nurses' work experiences in a negative pressure isolation ward. Am J Infect Control 2016; 44:809-14. [PMID: 26944003 DOI: 10.1016/j.ajic.2016.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/31/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospital nurses are frontline health care workers in controlling the spread of infectious diseases. It is not known if nurses working in negative pressure isolation wards (NPIWs) are better prepared than before to safely care for patients with common infectious diseases. METHODS For this qualitative descriptive study, 10 nurses were interviewed in depth about their experiences caring for patients in an NPIW. Tape recordings were transcribed verbatim and analyzed by qualitative content analysis. RESULTS The following 5 themes were identified: (1) complexity of patient care, (2) dissatisfaction with the quantity and quality of protective equipment, (3) shortage of nursing staff, (4) continued worries about being infected, and (5) sensitivity to self-protection. Our participants' anxiety and uncertainty about being infected in the NPIW were increased by the complexity of patients' health problems and organizational factors. To protect themselves against infection before and during patient care, participants also developed sensitivity to, concepts about, and strategies to improve self-protection. CONCLUSIONS NPIW administrators should pay more attention to nurses' concerns about improving the NPIW working environment, supply good quality protective equipment, and provide appropriate psychologic support and ongoing education to ensure that nurses feel safe while working. This ongoing education should refresh and update nurses' knowledge about disease transmission, therefore decreasing unnecessary anxiety based on misunderstandings about becoming infected.
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Affiliation(s)
- Shu-Ling Chen
- Department of Nursing, HungKuang University, Taichung, Taiwan
| | - Kuei-Ling Chen
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Hung Lee
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Cheng-I Yang
- Department of Nursing, HungKuang University, Taichung, Taiwan.
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van Cutsem G, Isaakidis P, Farley J, Nardell E, Volchenkov G, Cox H. Infection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment Is the Key. Clin Infect Dis 2016; 62 Suppl 3:S238-43. [PMID: 27118853 PMCID: PMC4845888 DOI: 10.1093/cid/ciw012] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Multidrug-resistant (MDR) tuberculosis, "Ebola with wings," is a significant threat to tuberculosis control efforts. Previous prevailing views that resistance was mainly acquired through poor treatment led to decades of focus on drug-sensitive rather than drug-resistant (DR) tuberculosis, driven by the World Health Organization's directly observed therapy, short course strategy. The paradigm has shifted toward recognition that most DR tuberculosis is transmitted and that there is a need for increased efforts to control DR tuberculosis. Yet most people with DR tuberculosis are untested and untreated, driving transmission in the community and in health systems in high-burden settings. The risk of nosocomial transmission is high for patients and staff alike. Lowering transmission risk for MDR tuberculosis requires a combination approach centered on rapid identification of active tuberculosis disease and tuberculosis drug resistance, followed by rapid initiation of appropriate treatment and adherence support, complemented by universal tuberculosis infection control measures in healthcare facilities. It also requires a second paradigm shift, from the classic infection control hierarchy to a novel, decentralized approach across the continuum from early diagnosis and treatment to community awareness and support. A massive scale-up of rapid diagnosis and treatment is necessary to control the MDR tuberculosis epidemic. This will not be possible without intense efforts toward the implementation of decentralized, ambulatory models of care. Increasing political will and resources need to be accompanied by a paradigm shift. Instead of focusing on diagnosed cases, recognition that transmission is driven largely by undiagnosed, untreated cases, both in the community and in healthcare settings, is necessary. This article discusses this comprehensive approach, strategies available, and associated challenges.
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Affiliation(s)
- Gilles van Cutsem
- Médecins Sans Frontières Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | | | - Jason Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Ed Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Grigory Volchenkov
- Department of Tuberculosis Control, Vladimir Oblast Tuberculosis Dispensary, Russian Federation
| | - Helen Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
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Barasheed O, Alfelali M, Mushta S, Bokhary H, Alshehri J, Attar AA, Booy R, Rashid H. Uptake and effectiveness of facemask against respiratory infections at mass gatherings: a systematic review. Int J Infect Dis 2016; 47:105-11. [PMID: 27044522 PMCID: PMC7110449 DOI: 10.1016/j.ijid.2016.03.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/18/2016] [Accepted: 03/24/2016] [Indexed: 11/25/2022] Open
Abstract
Approximately half of the attendees of mass gatherings use facemask Facemask seems to be effective against respiratory infections at Hajj Effectiveness of facemask against specific respiratory infections is not proven
Objectives The risk of acquisition and transmission of respiratory infections is high among attendees of mass gatherings (MGs). Currently used interventions have limitations yet the role of facemask in preventing those infections at MG has not been systematically reviewed. We have conducted a systematic review to synthesise evidence about the uptake and effectiveness of facemask against respiratory infections in MGs. Methods A comprehensive literature search was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using major electronic databases such as, Medline, EMBASE, SCOPUS and CINAHL. Results Of 25 studies included, the pooled sample size was 12710 participants from 55 countries aged 11 to 89 years, 37% were female. The overall uptake of facemask ranged from 0.02% to 92.8% with an average of about 50%. Only 13 studies examined the effectiveness of facemask, and their pooled estimate revealed significant protectiveness against respiratory infections (relative risk [RR] = 0.89, 95% CI: 0.84-0.94, p < 0.01), but the study end points varied widely. Conclusion A modest proportion of attendees of MGs use facemask, the practice is more widespread among health care workers. Facemask use seems to be beneficial against certain respiratory infections at MGs but its effectiveness against specific infection remains unproven.
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Affiliation(s)
- Osamah Barasheed
- Research Center, King Abdullah Medical City (KAMC), Makkah, P.O. Box: 57657, Saudi Arabia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia.
| | - Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | | | - Hamid Bokhary
- Umm Al-Qura University Medical Center, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jassir Alshehri
- Research Center, King Abdullah Medical City (KAMC), Makkah, P.O. Box: 57657, Saudi Arabia
| | - Ammar A Attar
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; Science and technology Unit, General Presidency for the Holy Mosque & Prophet Holy Mosque affairs, Makkah, Saudi Arabia; Department of Innovation & Corporate Integration, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Australia
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Chughtai AA, Seale H, Dung TC, Hayen A, Rahman B, Raina MacIntyre C. Compliance with the Use of Medical and Cloth Masks Among Healthcare Workers in Vietnam. ANNALS OF OCCUPATIONAL HYGIENE 2016; 60:619-30. [PMID: 26980847 DOI: 10.1093/annhyg/mew008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 01/19/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Masks are often worn in healthcare settings to prevent the spread of infection from healthcare workers (HCWs) to patients. Masks are also used to protect the employee from patient-generated infectious organisms but poor compliance can reduce efficacy. The aim of this study was to examine the factors influencing compliance with the use of medical and cloth masks amongst hospital HCWs. METHODS HCWs compliance with the use of medical and cloth masks was measured over a 4-week period in a randomized controlled trial in Vietnam. HCWs were instructed to record their daily activities in diary cards. Demographic, clinical, and diary card data were used to determine the predictors of compliance and the relationship of compliance with infection outcomes. RESULTS Compliance rates for both medical and cloth masks decreased during the 4 weeks: medical mask use decreased from 77 to 68% (P < 0.001) and cloth masks from 78 to 69% (P < 0.001). The presence of adverse events (adjusted RR 0.90, 95% CI 0.85-0.95), and performing aerosol-generating procedures (adjusted RR 0.78, 95% CI 0.73-0.82) were negatively associated with compliance, while contact with febrile respiratory illness patients was positively associated (adjusted RR 1.14, 95% CI 1.07-1.20). Being compliant with medical or cloth masks use (average use ≥70% of working time) was not associated with clinical respiratory illness, influenza-like illness, and laboratory-confirmed viral infection. CONCLUSION Understanding the factors that affect compliance is important for the occupational health and safety of HCWs. New strategies and tools should be developed to increase compliance of HCWs. The presence of adverse events such as discomfort and breathing problems may be the main reasons for the low compliance with mask use and further studies should be conducted to improve the design/material of masks to improve comfort for the wearer.
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Affiliation(s)
- Abrar Ahmad Chughtai
- 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia;
| | - Holly Seale
- 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Tham Chi Dung
- 2.National Institute of Hygiene and Epidemiology (NIHE), Hanoi, Vietnam
| | - Andrew Hayen
- 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Bayzidur Rahman
- 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - C Raina MacIntyre
- 1.School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
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Perceived versus Observed Patient Safety Measures in a Critical Care Unit from a Teaching Hospital in Southern Colombia. Crit Care Res Pract 2016; 2016:2175436. [PMID: 26989508 PMCID: PMC4775773 DOI: 10.1155/2016/2175436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 01/24/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Patient safety is an important topic. The purpose of this study is to evaluate the perceived versus observed patient safety measures (PSM) in critically ill patients in a teaching hospital in Latin America. Materials and Methods. The level of perceived patient safety was evaluated with the patient safety hospital survey. Three months later, a qualitative study was conducted, including video recording of procedures, graded according to adherence to PSM. Levels of adherence were scored during patient mobilization (PM), placement of central catheters (PCC), other invasive procedures (OIP), infection control (IC), and endotracheal intubation (ETI). Results. The perceived adherence of PSM in the prestudy survey was considered fair by 89.1% of the ICU staff. After the survey, 829 ICU procedures were video-recorded. Mean observed adherence for fair patient safety measures was 20.8%. Perceived adherence was higher than the real patient safety protocol measures observed in the videos. Conclusion. Perception of PSM was higher than observed in the management of critically ill patients in a teaching hospital in southern Colombia.
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Steelman ED, Alexander JL. Laboratory Animal Workers' Attitudes and Perceptions Concerning Occupational Risk and Injury. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2016; 55:419-425. [PMID: 27423148 PMCID: PMC4943612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/02/2015] [Accepted: 01/26/2016] [Indexed: 06/06/2023]
Abstract
Little is known regarding the risk perceptions and attitudes of laboratory animal care workers toward biologic safety. The purpose of this descriptive study was to assess the attitudes and perceptions of laboratory animal workers toward occupational and injury risk. Subscribers to the CompMed and TechLink listservs (n = 4808) were surveyed electronically, and 5.3% responded; data from 215 respondents were included in the final analysis. Primary variables of interest included AALAS certifications status, level of education, and responses to Likert-scale questions related to attitudes and perceptions of occupational risk and injury. Nonparametric (χ(2)) testing and measures of central tendency and dispersion were used to analyze and describe the data. According to 88.6% of respondents, biologic safety training is provided with information about zoonotic diseases of laboratory animals. Level of education was significantly related to perception of importance regarding wearing personal protective equipment. Participants indicated that appropriate support from coworkers and management staff is received, especially when performance and perception are hindered due to stress and fatigue. Laboratory animal staff are susceptible to injury and exposure to dangerous organisms and toxic substances. For this reason, to maximize safety, yearly biologic safety training should be provided, the importance of protective equipment adherence strengthened, and the culture of safety made a priority within the institution.
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Affiliation(s)
- Eric D Steelman
- College of Graduate Health Studies, Arizona Campus, A.T. Still University, Mesa, Arizona, USA.
| | - Jeffrey L Alexander
- College of Graduate Health Studies, Arizona Campus, A.T. Still University, Mesa, Arizona, USA
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Ebola virus disease in nonendemic countries. J Formos Med Assoc 2015; 114:384-98. [PMID: 25882189 PMCID: PMC7135111 DOI: 10.1016/j.jfma.2015.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 12/20/2022] Open
Abstract
The 2014 West African outbreak of Ebola virus disease was unprecedented in its scale and has resulted in transmissions outside endemic countries. Clinicians in nonendemic countries will most likely face the disease in returning travelers, either among healthcare workers, expatriates, or visiting friends and relatives. Clinical suspicion for the disease must be heightened for travelers or contacts presenting with compatible clinical syndromes, and strict infection control measures must be promptly implemented to minimize the risk of secondary transmission within healthcare settings or in the community. We present a concise review on human filoviral disease with an emphasis on issues that are pertinent to clinicians practicing in nonendemic countries.
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Locatelli SM, LaVela SL, Gosch M. Health care workers' reported discomfort while wearing filtering face-piece respirators. Workplace Health Saf 2015; 62:362-8. [PMID: 25102476 DOI: 10.3928/21650799-20140804-03] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 06/25/2014] [Indexed: 11/20/2022]
Abstract
Filtering face-piece respirators (FFRs) are one method of protecting health care workers from airborne particles; however,research suggests adherence is poor, perhaps due to worker discomfort. Three separate focus groups were conducted at two Veterans Affairs health care facilities. Seventeen health care workers who reported using FFRs as part of their job duties were in the focus groups. Focus group transcripts were coded using qualitative descriptive coding techniques. Participants described experiences of discomfort and physical mask features they believed ,contributed to discomfort. Participants believed FFRs influenced patient care because some patients felt uneasy and changed healthcare workers' behaviors (e.g., doffing procedures, loss of concentration, rushed patient care, and avoidance of patients in isolation resulting from FFR discomfort). Assessment of comfort and tolerability should occur during fit-testing. These factors should also be taken into account by management when training employees on the proper use of FFRs, as well as in future research to improve comfort and tolerability.
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Barriers to the use of face protection for standard precautions by health care providers. Am J Infect Control 2015; 43:169-70. [PMID: 25516218 DOI: 10.1016/j.ajic.2014.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/30/2014] [Accepted: 11/03/2014] [Indexed: 11/21/2022]
Abstract
Health care providers sometimes choose not to use face protection even when indicated as part of standard precautions. We performed a survey of pediatric health care providers to determine barriers to the routine use of face protection. Lack of availability at the point of care and a perceived lack of need were the most commonly cited issues. Continuing education is needed regarding situations in which face protection is indicated for standard precautions.
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Rozenbojm MD, Nichol K, Spielmann S, Holness DL. Hospital unit safety climate: relationship with nurses' adherence to recommended use of facial protective equipment. Am J Infect Control 2015; 43:115-20. [PMID: 25530554 PMCID: PMC7132698 DOI: 10.1016/j.ajic.2014.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 11/30/2022]
Abstract
Background Despite the existence of formal guidelines for the acute health care sector, nurses' adherence to recommended use of facial protective equipment (FPE) to prevent occupational transmission of communicable respiratory disease remains suboptimal. In addition to individual factors such as knowledge and education, group factors such as shared perceptions of organizational support for safety may influence adherence. These group safety climate perceptions can differ depending on the pace and type of work, local leadership, and organizational structure of each unit. Methods An analysis of a data set from a cross-sectional survey of 1,074 nurses in 45 units of 6 acute care hospitals was conducted. Variance components analysis was performed to examine the variance in perceptions of safety climate and adherence between units. Hierarchical linear modeling using unit-level safety climate dimensions was conducted to determine if unit-level safety climate dimensions were predictors of nurses' adherence to FPE. Results Findings revealed statistically significant unit variances in adherence and 5 of the 6 unit-level safety climate dimensions (P < .05). Furthermore, a hierarchical model suggested that tenure and unit-level communication were significantly associated with increased adherence to FPE (P < .05). Conclusion Unit-level safety climate measures varied significantly between units. Strategies to improve unit-level communication regarding safety should assist in improving adherence to FPE.
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Affiliation(s)
- Michael Diamant Rozenbojm
- Department of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Kathryn Nichol
- Department of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Collaborative Academic Practice, University Health Network, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
| | | | - D Linn Holness
- Centre for Research Expertise in Occupational Disease, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Occupational and Environmental Health, St Michael Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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