1
|
Hor SY, Wyer M, Barratt R, Turnbull M, Rogers K, Murphy M, Urwin R, Jorm C, Gilbert GL. Risk assessment and the use of personal protective equipment in an emergency department: Differing perspectives of emergency and infection control clinicians. A video-vignette survey. Am J Infect Control 2024:S0196-6553(24)00557-1. [PMID: 38925501 DOI: 10.1016/j.ajic.2024.06.012] [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: 03/21/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. METHODS An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test. RESULTS Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED. DISCUSSION Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints. CONCLUSIONS To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.
Collapse
Affiliation(s)
- Su-Yin Hor
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
| | - Mary Wyer
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia; NSW Biocontainment Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ruth Barratt
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Margo Turnbull
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kris Rogers
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Margaret Murphy
- Emergency Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Christine Jorm
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
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:S0196-6553(24)00553-4. [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] [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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Gutiérrez-Puertas L, Márquez-Hernández VV, Ortíz-Rodríguez B, Aguilera-Manrique G, Gutiérrez-Puertas V. Effective communication between nursing professionals and patients after the implementation of mask-wearing requirements in the clinical setting: A cross-sectional study. Nurs Health Sci 2023; 25:676-684. [PMID: 37927155 DOI: 10.1111/nhs.13061] [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: 01/31/2023] [Revised: 10/01/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
This study aimed to evaluate staff nurses' perspectives on the use of face masks in effective communication and relationship management skills with patients in the hospital setting. The study surveyed registered nurses (RNs) who work with adult patients in different hospital units. An online survey was completed by RNs who were selected by convenience sampling. RNs' communication with patients was perceived as moderately affected by the use of face masks. Statistically significant differences were found when comparing communication with years of professional experience. Participants who had over 10 years of experience reported having greater difficulty in their communication with patients when using face masks. The effect of provider-patient relationship on effective nurse-patient face-mask communication was statistically significant and negative. This study shows that some participants found face masks used in the clinical setting may affect nurse-patient communication, as well as the nurses' ability to manage their relationships with patients. The findings of this study support the need for targeted research into effective communication strategies when face mask use is needed in the healthcare setting.
Collapse
Affiliation(s)
- Lorena Gutiérrez-Puertas
- Department of Nursing, Physiotherapy and Medicine, Universidad de Almería, Almería, Spain
- Research Group Experimental and Applied Neuropsychology, HUM-061, Health Research Centre, Universidad de Almería, Almería, Spain
| | - Verónica V Márquez-Hernández
- Department of Nursing, Physiotherapy and Medicine, Universidad de Almería, Almería, Spain
- Research Group for Health Sciences CTS-451, Health Research Centre, Universidad de Almería, Almería, Spain
| | | | - Gabriel Aguilera-Manrique
- Department of Nursing, Physiotherapy and Medicine, Universidad de Almería, Almería, Spain
- Research Group for Health Sciences CTS-451, Health Research Centre, Universidad de Almería, Almería, Spain
| | | |
Collapse
|
5
|
Rana K, Poudel P, Chimoriya R. Qualitative Methodology in Translational Health Research: Current Practices and Future Directions. Healthcare (Basel) 2023; 11:2665. [PMID: 37830701 PMCID: PMC10572630 DOI: 10.3390/healthcare11192665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Translational health research is an interdisciplinary field aimed at bridging the gap between basic science studies, preventative studies, and clinical practice to improve health-related outcomes. Qualitative research methods provide a unique perspective on the emotional, social, cultural, and contextual factors that influence health and healthcare and thus are recognized as valuable tools for translational health research. This approach can be embedded within a mixed method design which complements the quantitative findings. This methodological paper aims to provide a comprehensive review of the fundamental concepts and methodologies used in qualitative research, emphasizing their utilization and significance in translational health research. Several approaches to qualitative research methodology are discussed in this review, including ethnography, phenomenology, grounded theory, case study, and action research. Theoretical frameworks such as the social-ecological model, intersectionality, and participatory action research are also examined to provide a structure for understanding and interpreting complex health issues. This methodological paper also reviews commonly used sampling techniques such as purposive, snowball, convenience, theoretical, and maximum variation sampling, along with data collection methods such as in-depth interviews, focus groups, observation, document analysis, and participatory methods. Moreover, data analysis techniques such as thematic analysis, grounded theory, content analysis, narrative analysis, and reflexive analysis, are discussed in the context of translational health. Overall, this review highlights the challenges and opportunities of using qualitative methods in current practice, while also discussing future directions and providing valuable guidance and insights to researchers interested in conducting qualitative research in translational health.
Collapse
Affiliation(s)
- Kritika Rana
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia;
| | - Prakash Poudel
- Office of Research and Education, Canberra Health Services, ACT Government, Garran, ACT 2606, Australia;
| | - Ritesh Chimoriya
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia;
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, NSW 2139, Australia
| |
Collapse
|
6
|
Tsang CC, Holroyd-Leduc JM, Ewa V, Conly JM, Leslie MM, Leal JR. Barriers and Facilitators to the Use of Personal Protective Equipment in Long-Term Care: A Scoping Review. J Am Med Dir Assoc 2023; 24:82-89.e2. [PMID: 36473522 DOI: 10.1016/j.jamda.2022.11.012] [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: 07/14/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review existing literature evaluating barriers and facilitators to the use of personal protective equipment (PPE) by health care workers in long-term care (LTC). DESIGN Scoping review. SETTING AND PARTICIPANTS Health care workers in LTC settings. METHODS Several online databases were searched and a gray literature search was conducted. Study inclusion criteria were (1) conducted in nursing homes or LTC settings, (2) focused on LTC health care workers as the study population, and (3) identified barriers and/or facilitators to PPE use. The Theoretical Domains Framework (TDF), which assesses barriers to implementation across 14 behavioral change domains, was used to extract and organize data about barriers and facilitators to appropriate use of PPE from the included studies. RESULTS A total of 5216 references were screened for eligibility and 10 studies were included in this review. Eight of the 10 studies were conducted during the COVID-19 pandemic. Several barriers and facilitators to PPE use were identified. The most common TDF domain identified was environmental context and resources, which was observed in 9 of the 10 studies. Common barriers to PPE use included supply issues (n = 7 studies), the cost of acquisition (n = 3 studies), unclear guidelines on appropriate use of PPE (n = 2 studies), difficulty providing care (n = 2 studies), and anxiety about frightening patients (n = 2 studies). Having PPE readily available facilitated the use of PPE (n = 2 studies). CONCLUSIONS AND IMPLICATIONS Further research is necessary to identify barriers and facilitators more extensively across behavior change domains to develop effective strategies to improve PPE use and prevent infection transmission within LTC.
Collapse
Affiliation(s)
- Christian C Tsang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Jayna M Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Vivian Ewa
- Department of Family Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - John M Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Myles M Leslie
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jenine R Leal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| |
Collapse
|
7
|
Yehouenou CL, Abedinzadeh A, Houngnihin R, Baxerres C, Dossou FM, Simon A, Dalleur O. Understanding Hand Hygiene Behavior in a Public Hospital in Benin Using the Theoretical Domain Frameworks: The First Step for Designing Appropriate Interventions. Healthcare (Basel) 2022; 10:healthcare10101924. [PMID: 36292370 PMCID: PMC9602033 DOI: 10.3390/healthcare10101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Hand Hygiene (HH) is widely recognized to be one of the most successful and cost-effective measures for reducing the incidence of healthcare-associated infections (HAIs). The hand hygiene behavior of hospital healthcare workers (HCWs) is not well-documented in Benin. Therefore, Theoretical Domains Framework (TDF) was used to identify the behavioral determinants that may impact HCWs’ hand-hygiene compliance in a public hospital. Methods: A qualitative design comprising face-to-face semi-structured interviews with nine HCWs. The interviews included questions on transmission of infections, hand-hygiene practices, problems with their implementation; and ways to improve hand hygiene compliance. Two pharmacists independently coded interviews into behavioral domains using the TDF and then subdivided them into several themes. Interview transcripts were analyzed following 3-steps approach: coding, generation of specific beliefs, and identification of relevant domains. Results: Almost all interviewees have cited the environmental context and resources (such as lack of water) as a barrier to HH practice. They also believed that role models had a significant impact on the good practices of others HCWs. Fortunately, they were confident of their capabilities to perform appropriate HH behaviors. The majority (7/9) reported having the necessary knowledge and skills and believed they could carry out appropriate HH behavior. In all cases, the participants were motivated to carry out HH behavior, and it was recognized that HH remains the cornerstone to reduce health care associated infections. Conclusion: This study identified several behavioral constructs aligned with the TDF that can be targeted and help for the development of new hand-hygiene interventions. These may increase the likelihood of a successful intervention, thereby improving HH compliance and patient safety, especially in hospitals.
Collapse
Affiliation(s)
- Carine Laurence Yehouenou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, 1200 Brussels, Belgium
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou BP 817, Benin
- Faculté des Sciences de la Santé (FSS), Université d’Abomey Calavi (UAC), Cotonou 01 BP 526, Benin
- Correspondence: or
| | - Aynaz Abedinzadeh
- Service de Pharmacie Clinique, Clinique Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
| | - Roch Houngnihin
- Laboratoire d’Anthropologie Médicale Appliquée (LAMA), Université d’Abomey-Calavi, Cotonou 01 BP 188, Benin
| | - Carine Baxerres
- UMR261-MERIT, French National Research Institute for Sustainable Development (IRD), University of Paris, 75006 Paris, France
- UMR151-LPED, IRD, Aix Marseille Université, 13005 Marseille, France
| | - Francis M. Dossou
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, Campus Universitaire, Champs de Foire, Cotonou 01 BP 118, Benin
| | - Anne Simon
- Centres Hospitaliers Jolimont, Prévention et Contrôle des Infections, Groupe Jolimont Asbl, Rue Ferrer, 7100 Haine-Saint-Paul, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, 1200 Brussels, Belgium
- Service de Pharmacie Clinique, Clinique Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
| |
Collapse
|
8
|
Pin M, Somasundaram R, Wrede C, Schwab F, Gastmeier P, Hansen S. Antimicrobial resistance control in the emergency department: a need for concrete improvement. Antimicrob Resist Infect Control 2022; 11:94. [PMID: 35804401 PMCID: PMC9264623 DOI: 10.1186/s13756-022-01135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/29/2022] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Rational use of antibiotics (AB) and infection prevention and control (IPC) are key measures for reducing antimicrobial resistance (AMR) in healthcare. Nonetheless, transferring evidence into clinical practice in emergency medicine has proven difficult. The extent to which structural requirements for implementing AMR control exist in German emergency departments (ED) was determined in a survey. METHODS Aspects of antimicrobial stewardship (AMS) and IPC implementation were surveyed within the German Association for Emergency Medicine (Deutsche Gesellschaft interdisziplinäre Notfall- und Akutmedizin e.V, DGINA) in 2018. Data were collected using an anonymous online questionnaire on ED characteristics, ED-based-link personnel for IPC and AMS, education and training, process monitoring and specific requirements for AMS and IPC as availability of AMR data and alcohol-based hand rub (AHR) consumption data. Data were analysed descriptively. RESULTS 66 EDs with in median [interquartile range (IQR)] of 30,900 [23,000; 40,000] patient visits participated in the survey. EDs' healthcare worker (HCW) received regular training on hand hygiene (HH) in 67% and on AMS in 20% of EDs. Surveillance of AHR consumption was performed by 73% EDs, surveillance of AB consumption by 64%. Regular audits on HH were performed in 39%. Training and audit activities, showed no significant variations according to EDs' organizational characteristics. HCWs received immediate feedback of HH performance in 29%, in 23% a regular structured feedback of HH was provided. ED-based physicians with (1) specific IPC responsibilities and training were available in 61%, with (2) AMS training and responsibility in 15%. 83% had ED based IPC link nurses with precise ICP responsibilities in place. Essentially resistance data existed at the hospital level (74%) rather than at ED- or regional level (15% and 14% respectively). CONCLUSIONS Management of AMR varies in German EDs, especially in accordance to hospital size and level of emergency care. IPC seems to receive more attention than AMS. Our data indicate the need for more implementation of regular IPC and AMS training in connection with monitoring and feedback in German EDs.
Collapse
Affiliation(s)
- Martin Pin
- Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Department of Emergency Medicine, Düsseldorf, Germany
- German Association for Emergency Medicine, (Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), Berlin, Germany
| | - Rajan Somasundaram
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Christian Wrede
- German Association for Emergency Medicine, (Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), Berlin, Germany
- Helios Hospital Berlin-Buch, Department of Emergency Medicine, Berlin, Germany
| | - Frank Schwab
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Petra Gastmeier
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Sonja Hansen
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Rapid development and implementation of a behaviour change strategy to improve COVID-19 personal protective equipment use in a regional Australian emergency department. Australas Emerg Care 2022; 25:273-282. [PMID: 35123929 PMCID: PMC8802564 DOI: 10.1016/j.auec.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/20/2021] [Accepted: 01/23/2022] [Indexed: 01/09/2023]
Abstract
Objective To identify barriers to, describe the development of and evaluate the implementation of a behavioural theory informed strategy to improve staff personal protective equipment (PPE) compliance during COVID-19 in a regional Australian Emergency Department. Methods Barriers to PPE use were identified through staff consultation then categorised using the Theoretical Domains Framework. The Behaviour Change Wheel was used to develop a strategy to address the barriers to PPE compliance. The strategy was refined and endorsed by the site COVID taskforce. Data were collected through direct observation. Descriptive statistics were used to summarise PPE compliance and inductive content analysis for free text data of staff behaviours. Results 73 barriers were identified, mapped to 9 intervention functions and 42 behaviour change techniques. The predominant mechanisms were: (1) Executive communication reinforcing policy and consequences; (2) implementation of a PPE Marshal; (3) face to face reinforcement / modeling; (4) environmental restructuring including electronic medical record modifications. The PPE Marshal observed 281 PPE activities. PPE compliance varied between 47.9% (Buddy check) and 91.8% (Bare below elbow). The PPE Marshal intervened on 121 occasions, predominantly through buddying, explaining and demonstrating correct PPE use, most frequently with medical staff (72%). Conclusion We describe an evidence-based process to overcome barriers to PPE compliance that maximize safe work practice in a time critical situation. Staff require enabling, access to equipment and reinforcement to use PPE correctly.
Collapse
|
11
|
Silverberg SL, Puchalski Ritchie LM, Gobat N, Murthy S. COVID-19 infection prevention and control procedures and institutional trust: Perceptions of Canadian intensive care and emergency department nurses. Can J Anaesth 2021; 68:1165-1175. [PMID: 34046822 PMCID: PMC8158085 DOI: 10.1007/s12630-021-02028-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Healthcare workers must ensure effective infection prevention and control (IPC) to prevent nosocomial spread of SARS-CoV-2, the virus that causes COVID-19. This questionnaire study aims to evaluate Canadian critical care and emergency department nurses' readiness to follow IPC guidelines in their workplace, and to understand their perceptions of trust in organizational preparedness, communication, and infection risk. METHODS We adapted an internationally distributed survey for the Canadian context. This cross-sectional questionnaire, incorporating validated scales for items including institutional trust, was distributed by email to nurses via the Canadian Association of Critical Care Nurses and the Canadian Association of Emergency Physicians networks between 16 March and 25 May 2020. We evaluated intensive care unit and emergency department nurses' adherence to IPC protocols, barriers and facilitators to IPC guideline adherence, and their level of institutitonal trust. RESULTS Three hundred and nineteen nurses responded to the survey. There was higher trust in organizational preparedness among nurses who were older (B = 0.31, P < 0.001) and more experienced (F = 18.09, P < 0.001), and particularly among those with previous experience working in outbreak settings (F = 7.87, P = 0.005). Compared with those without experience working in outbreak settings, respondents with this experience reported higher levels of fear of becoming ill and fear of providing care for COVID-19 patients (χ2 = 21.48, P = 0.002 and χ2 = 12.61, P = 0.05, respectively). Older and more experienced nurses reported greater comfort with IPC skills and easier access to personal protective equipment. While the vast majority (96%) of respondents reported using masks and gloves, only 83% had access to isolation facilities for suspected or confirmed COVID-19 cases. CONCLUSION Canadian nurses had strong self-reported adherence to IPC measures and personal protective equipment use. There were high levels of trust in health system leadership to ensure protective measures are present and reliable. Trust was particularly high among older and more experienced nurses despite these populations reporting higher levels of fear of personal illness.
Collapse
Affiliation(s)
- Sarah L Silverberg
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
- Department of Pediatrics, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
12
|
Ferrari G, Dobrina R, Buchini S, Rudan I, Schreiber S, Bicego L. The impact of personal protective equipment and social distancing on communication and relation between nurses, caregivers and children: a descriptive qualitative study in a maternal and child health hospital. J Clin Nurs 2021. [PMID: 34036654 DOI: 10.1111/jocn.15857] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The main objective was to explore the impact of personal protective equipment and social distancing on nurses, caregivers and children's communication and relationship in a maternal and child health hospital. BACKGROUND The spread of COVID-19 pandemic made it necessary to apply infection prevention and control measures, including interpersonal distancing and the use of personal protective equipment. These measures may impact communication and relationship between nurses, patients and caregivers especially in a complex environment, such as a paediatric setting. DESIGN A qualitative descriptive study design was adopted. Reporting followed the COREQ guidelines. METHODS Semi-structured interviews were conducted in two wards of a maternal and child health hospital in north-east Italy. Data were collected between September and November 2020. Transcripts were analysed using inductive content analysis. RESULTS Seventeen caregivers and 17 nurses were recruited using convenience sampling. Three themes were identified, namely: "Impact on a trustworthy relationship"; "Impact on common communication resources"; and "Strategies to overcome barriers". Participants agreed Covid-19 infection prevention and control measures impacted key elements of family-centred and compassionate care. Communication strategies and play were critical to overcoming the barriers encountered. CONCLUSIONS COVID-19 containment measures impact communication and family-centred care in paediatric hospital settings. There is a need for stakeholders to consider family needs in interventions aimed at controlling pandemics' impact. CLINICAL RELEVANCE While COVID-19 pandemic urgency intensified the use of PPE and social distancing, strategies to overcome issues related to family-centred care should be considered in those wards such as oncology or infectious disease paediatric departments where these measures are continuously adopted. Beyond a greater communication awareness, strategies may comprise the implementation of virtual care to guarantee support, continuity of care and information between the child, the healthcare team and the family members that are not admitted to the hospital for safety reasons.
Collapse
Affiliation(s)
- Giada Ferrari
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Raffaella Dobrina
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Sara Buchini
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Iva Rudan
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Silvana Schreiber
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Livia Bicego
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| |
Collapse
|
13
|
Rio CD, Roseira CE, Perinoti LCSDC, Figueiredo RMD. The use of gloves by the nursing team in a hospital environment. Rev Bras Enferm 2021; 74:e20200972. [PMID: 34037152 DOI: 10.1590/0034-7167-2020-0972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to verify the compliance rate of the use of gloves by the nursing team in a hospital environment. METHODS a descriptive study, carried out in a hospital in the state of Sao Paulo, Brazil, between August and October 2019, through the observation of the nursing team in carrying out a total of 396 procedures. All ethical aspects were considered. RESULTS 32 different types of procedures were observed. The compliance rate with the use of gloves occurred only in one observation (0.25%). Excluding hand hygiene, it was 60.1% (238). In other 158 (39.9%) opportunities, incorrect use varied between reuse (18.43%), unnecessary use (8.33%) and non-use when necessary (13.13%). Hands were cleaned before using gloves in 1.76% of the observations and in 4.54% immediately after their removal. CONCLUSIONS non-conformities were identified in the use of gloves when observing the performance of procedures by the nursing team.
Collapse
Affiliation(s)
- Caroline do Rio
- Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
| | | | | | | |
Collapse
|
14
|
Barratt R, Shaban RZ, Gilbert GL. Characteristics of personal protective equipment training programs in Australia and New Zealand hospitals: A survey. Infect Dis Health 2020; 25:253-261. [PMID: 32600965 PMCID: PMC7318937 DOI: 10.1016/j.idh.2020.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 12/19/2022]
Abstract
Background Using personal protective equipment (PPE) is one of several fundamental measures to prevent the transmission of infection and infectious diseases and is particularly pertinent in the current COVID-19 pandemic. Appropriate use of PPE by healthcare workers is, however, often suboptimal. Training and monitoring of PPE competency are essential components of an infection prevention and control program but there is a paucity of research and data on the content of such training programs across Australasia. This paper reports the results of a survey that characterised the nature of PPE training in Australian and New Zealand hospitals. Methods A population-based online survey was distributed to members of three major Australasian colleges representing infection prevention and control. Results Results indicate that, although training is frequently provided at orientation, many healthcare workers do not receive regular updates. Training programmes combine online and classroom sessions, but over a third do not include a practical component. The frequency of monitoring PPE competency is variable with one third of respondents indicating that no auditing occurs. PPE items used for high-level training are variable, with use of powered air purifying respirators (PAPRs) uncommon. Conclusion The results of this study suggest that HCWs’ confidence, competence and familiarity with PPE are a concern, which in the context of the current global COVID-19 pandemic is problematic. More research is needed into how PPE training programs could be better designed, to prepare HCWs for practice using PPE safely and confidently. Most HCW orientation programmes include PPE training but fewer than half are updated annually. One third of PPE programmes do not include a practical component. Only two thirds of PPE training programmes monitor PPE compliance. Future research should consider the design of PPE training programs to optimise HCW PPE practice.
Collapse
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, Australia; The University of Sydney Westmead Clinical School, Faculty of Medicine and Health, NSW, Australia.
| | - Ramon Z Shaban
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney. Camperdown. NSW, Australia; Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead. NSW, Australia.
| | - Gwendolyn 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, Australia; The University of Sydney Westmead Clinical School, Faculty of Medicine and Health, NSW, Australia.
| |
Collapse
|