Health care workers' action strategies in situations that involve a risk of blood exposure

Perceptions, Knowledge, and Experiences of Using Face Masks among Egyptian Healthcare Workers during the COVID-19 Pandemic: A Cross-Sectional Study

Using face masks appropriately is important for preventing the community spread of respiratory infections. A cross-sectional study was conducted to evaluate the knowledge level and experience of using face masks between healthcare teams to protect them and limit the spread of COVID-19 infection. A structured questionnaire was distributed to 228 healthcare members in July–December 2021. It was divided into two sections and consisted of 29 questions for a total possible score of 0 to 29. The first section was related to perceptions and knowledge about face masks (13 items); the second was related to the experience of using face masks (16 items). The average score of this questionnaire was 23.21/29 with respect to the knowledge about face masks and their proper use techniques. The healthcare team studied had satisfactory knowledge about face mask use techniques, and the study shed light on their unsatisfactory practices. Following instructions is very vital to protecting the person wearing the mask and preventing the spread of infection during health care by blocking droplets produced by speaking or coughing. Providing the healthcare teams with knowledge and experience about how to use face masks during the pandemic is critical to increase their awareness and practice in using face masks and prevent the infection from spreading.

Through Their Eyes: Health Care Worker Compliance With Personal Protective Equipment During the COVID-19 Pandemic

BACKGROUND

Personal protective equipment (PPE) plays a critical role in protecting health care workers (HCWs). During the coronavirus disease-2019 (COVID-19) pandemic, shortages of PPE supplies drastically changed the way PPE was obtained and used by HCWs.

PURPOSE

The objective was to investigate the impact of the COVID-19 pandemic and patient isolation type on PPE compliance.

METHODS

This investigation was a survey of HCWs at a level 1 trauma teaching hospital regarding PPE compliance patterns prior to and during the COVID-19 pandemic.

RESULTS

HCWs reported an increase in PPE compliance during the COVID-19 pandemic. Nearly half (48.6%) of respondents reported that isolation type impacted the decision to wear PPE, of which most were likely to forgo PPE with contact precautions.

CONCLUSIONS

HCWs identified multiple barriers to compliance. The underutilization of PPE with contact precautions suggests that the risk of exposure is interpreted as low, and this could be a future target of education.

Qualitative research: a challenging paradigm for infection control

he importance of high-quality research to address our knowledge deficits in relation to the causes of hospital-acquired infection has been acknowledged by the Department of Health. However, the contribution of nursing research may be restricted by confusion over the use of different paradigms and the discipline's lack of research pedigree. This paper discusses how nursing and infection control has historically favoured quantitative methods as they are associated with rigour, objectivity, generalisation and increased credibility. However, increasingly nurse researchers are turning to qualitative methods as they better explain the complex behavioural issues that affect practice. The paper describes a number of qualitative methods and infection control studies that have adopted these approaches. It concludes by suggesting that infection control nurses, because of their close relationship with practice are well placed to consider the merits of qualitative research as a way of contributing towards the discipline's research agenda.

Safety climate and use of personal protective equipment and safety medical devices among home care and hospice nurses

Use of personal protective equipment (PPE) and safety medical devices is mandated for healthcare workers to reduce the risk of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) from exposure to patients' blood. Research has shown that a strong safety climate may promote increased use of PPE. Therefore, the objective of this study was to examine the association between safety climate and use of PPE among homecare/hospice nurses in North Carolina. To this end, a mail survey was conducted in 2006. The response rate, adjusted on the assumption that the proportion of eligible nurses from among those who did not return the questionnaire or could not be contacted was similar to the proportion among those who did return the questionnaire, was 69% (n=833 eligibles). The percentage of nurses who used the specified PPE was two to three times greater among nurses who had a strong safety climate. Safety climate was only weakly associated with using safety devices. These results suggest that improving safety climate may be a powerful tool for increasing use of PPE.

Student and infection prevention and control nurses’ hand hygiene decision making in simulated clinical scenarios: a qualitative research study of hand washing, gel and glove use choices

Final year nursing students and infection prevention and control nurses were recorded verbalising their hand hygiene decision-making while working through clinical scenarios on a computer, to understand what factors they were taking into account in choosing a decontamination method (hand washing or alcohol based hand rub/gel) or to wear gloves. Results demonstrated an overuse of gloves, and underuse of gel. Three main themes emerged: ‘Experience or expectation’; this was what they had seen on placement, or it was what ‘we’ do. ‘Just in case,’ was characterised by an awareness that what they would do wasn’t actually necessary but they tended to do it anyway. Thirdly, ‘gel doesn’t feel clean,’ was characterised by a feeling that using gel didn’t make the nurses feel clean after ‘dirty’ tasks, even though gel is actually more effective. There was little evidence that participants were making risk assessments based on the individual patient characteristics given, or the tasks, as they had been taught to do. Choice of hand decontamination agent and whether to use gloves appeared to be based on an habitual characterisation of whether the task was ‘clean’ or ‘dirty,’ with a very low threshold for ‘dirty’ based on an excessive perception of risk to the student.

Circumstances surrounding occupational blood exposure events in the National Study to Prevent Blood Exposure in Paramedics

More than 20% of U.S. paramedics are exposed to blood each year. Little is known about the circumstances that lead to these exposures. The objective of this study was to describe blood exposure events among U.S. paramedics. A mail survey was conducted in 2002-2003 among a nationally representative sample of licensed paramedics. Eighty percent of needle/lancet sticks involved non-safety devices. A third of mucous membrane exposures occurred even though the paramedic was wearing eye or face protection; in half of the events, the exposures were caused by the patient vomiting, spitting, or coughing up blood; in a third of the events, the patient was being uncooperative or combative. In 83% of the non-intact skin exposures, the paramedic was wearing disposable gloves; the non-intact skin was covered before the call in a third of the events, but the cover did not prevent exposure; 40% of the events occurred when the patient was being uncooperative or combative. These results suggest that blood exposure among paramedics could be reduced through increased use of safety devices and personal protective equipment, improved engineering and design, and increased compliance with Universal Precautions, and that paramedics need techniques for avoiding blood exposure while treating uncooperative or combative patients.

Gatekeepers of health: a qualitative assessment of child care centre staff's perspectives, practices and challenges to enteric illness prevention and management in child care centres

Background

Enteric outbreaks associated with child care centres (CCC) have been well documented internationally and in Canada. The current literature focuses on identifying potential risk factors for introduction and transmission of enteric disease, but does not examine why these risk factors happen, how the risk is understood and managed by the staff of CCCs, or what challenges they experience responding to enteric illness. The purpose of this study was to explore the understanding, knowledge and actions of CCC staff regarding enteric illness and outbreaks, and to identify challenges that staff encounter while managing them.

Methods

Focus groups were conducted with staff of regulated CCCs in Southern Ontario. Five focus groups were held with 40 participants. An open ended style of interviewing was used. Data were analyzed using content analysis.

Results

CCC staff play an important role in preventing and managing enteric illness. Staff used in-depth knowledge of the children, the centre and their personal experiences to assist in making decisions related to enteric illness. The decisions and actions may differ from guidance provided by public health officials, particularly when faced with challenges related to time, money, staffing and parents.

Conclusion

CCC staff relied on experience and judgment in coordination with public health information to assist decision-making in the management of enteric illness and outbreaks. Advice and guidance from public health officials to CCC staff needs to be consistent yet flexible so that it may be adapted in a variety of situations and meet regulatory and public health requirements.

Patients' conceptions of quality care and barrier care

AIM

To describe patients' conceptions of quality care and barrier care.

METHODS

As this study concerned conceptions of care, a phenomenographic approach was chosen. Fourteen adult orthopaedic patients participated. Data-collection was performed by means of semi-structured interviews. The qualitative data were analysed with two foci, conceptions of quality care and conceptions of barrier care. Different categories of understanding, that is, conceptions, constitute the the essential outcome of phenomenographic analysis. The research was conducted in one county hospital and in one regional hospital situated in different cities in the south of Sweden.

RESULTS AND CONCLUSIONS

Patients' conceptions of quality care resulted in six categories. When comparing the findings with previous research in this field, the findings of the present study confirmed to a large extent the findings from other studies of quality care. Patients' conceptions of barrier care resulted in five categoris. The conceptions of barrier care must be considered as elements in patients' conceptions of quality care, and this must be called atention to in efforts to measure patient satisfaction and in analyses of good care. It also can influence health care workers' compliance to guidelines in infection control procedures.

Blood exposure: factors promoting health care workers' compliance with guidelines in connection with risk

BACKGROUND

Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients' wishes and the presence of competing values and norms are examples of such forces.

AIMS AND OBJECTIVES

The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter.

METHOD

The grounded theory approach. Data were collected through interviews with nurses and assistant nurses.

RESULTS

The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood-exposure incidents and media-coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described.

RELEVANCE TO CLINICAL PRACTICE

The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education.