1197. The Gloves Are Off: The State of Personal Protective Equipment (PPE) Use in Contact, Droplet, and Standard Precautions at a Major Teaching Hospital

Abstract

BackgroundPPE (gowns, gloves and masks) is used in standard precautions (SP) as well as for contact, droplet or airborne isolation. Improper PPE use can lead to self-contamination and transmission of infectious agents, and at our institution the quality of PPE use has not been well assessed. For quality improvement purposes, we conducted an evaluation of healthcare worker (HCW) PPE use and knowledge of SP.MethodsTwo phases, direct observations and a survey, were completed between December 2018 and February 2019 in inpatient areas. Direct observations of PPE use were done by Infection Prevention nurses (IPs) in contact and droplet isolation rooms during daytime hours using an internally developed observation tool (Figure 1). Observations focused on 3 stages of PPE use: donning, in room clean/dirty activities and doffing. A survey consisting of 15 questions was developed to assess staff knowledge of SP in specific clinical scenarios, perceptions of current practices and barriers to use. The survey was distributed by IPs to HCWs during their regular rounds. Data were recorded and tabulated using RedCap electronic survey tool.Results106 observations and 107 surveys were completed. Observations showed appropriate PPE worn in 84% (n = 83) and hand hygiene (HH) post doffing in 95% (n = 79). Common gaps included no HH pre-donning [33% n = 43], PPE not changed between dirty and clean tasks (29% n = 2), incorrect mask removal (20% n = 16) and doffing gloves post-gowns [19% n = 69]. In the survey, answers to SP questions suggest PPE is overused in patients with diarrhea or respiratory illness but underused in draining wound management (Figure 2). HCW felt more compliant than their colleagues in both HH and PPE (Figure 3). The largest misperception was that gowns should be doffed pre-gloves (40% n = 40). Reasons for not using PPE included time (26%, n = 27), and perception that PPE is unnecessary (16%, n = 10). 75% (n = 80) of HCW felt adequately educated about PPE.ConclusionAt our institution, significant gaps still exist in HCW knowledge and use of PPE. Future QI work should focus on increasing HCW knowledge of standard precautions, HH pre-donning, changing PPE when appropriate in room as well as proper doffing order. The perception that HCW felt adequately educated despite significant gaps may be a barrier. Disclosures All authors: No reported disclosures.