Personal Protective Equipment Practices Research Articles

Knowledge, attitude and practice among healthcare professionals regarding the use of personal protective equipment at tertiary care hospitals in Peshawar

Background: Personal protective equipment is designed to safeguard healthcare workers and patients from potential risks during healthcare activities. The proper utilization of PPE serves as a crucial strategy for mitigating the transmission of infections within healthcare settings, thereby minimizing the risk of both healthcare-associated infections and community spread. In this study we tried to explore and assess the knowledge, attitude and practice of healthcare professionals regarding use of Personal protective equipment (PPE). Methods: A cross-sectional study was conducted at Northwest General Hospital (a private sector tertiary healthcare hospital) and Hayatabad Medical Complex (a public sector tertiary care hospital) from March to August 2023. Data was collected from 260 healthcare workers i.e. Doctors and Nurses from both institutions through a preformed questionnaire containing a total of 27 questions. Results: There was a slight positive correlation between increasing years of practice and knowledge regarding PPE (Pearson correlation = 0.017). There was a slight positive correlation between increasing years of practice and attitude (Pearson correlation = 0.035). There was a positive correlation between increasing years of practice and practice of PPE (Pearson correlation=0.147), and there was also a significant association (0.018) between increasing years of practice and practice of PPE Conclusion: Study shows that the healthcare professionals have good knowledge and attitude regarding use of PPE, but there are still gaps in practicing PPE.

Applied qualitative methods for social life cycle assessment: a case study of Canadian beef

PurposeThis paper presents a transparent and rigorous methodological approach to conducting a case study of social performance (SP) within the conventional life cycle of Canadian beef. The objective was to explore the potential benefits and risks (or hotspots) of practices on Canadian beef farm businesses (BFBs) and slaughter operations (BSOs) to establish valid benchmarks and a social sustainability roadmap for decision-makers to improve SP.MethodsThis study undertook a novel and participatory approach to social life cycle assessment (S-LCA). Respondents from both within and at-arms-length to the beef value chain were engaged to identify SP practices and perceptions and develop the life cycle inventory. The goal and scope, inventory, assessment, and interpretation were conducted in a three-phased approach: (i) scoping; (ii) practice-based assessment; and (iii) deep-dive assessment. Data collected through mixed methods, including Q method, interviews, surveys, and literature review, were assessed using a type I (reference scale) approach and interpreted through critical interpretive synthesis. Organizational SP was explored at BFBs and BSOs, considering the following stakeholders: value chain actors, farmers, employees, and cattle.Results and discussionOutcomes from the applied approach explore the interrelations between organizations and stakeholders along the value chain. Impact categories concerning labour management, people’s health and safety, and animal care were prioritized for deep-dive assessment. Subcategories included novel topics, like recruitment and retention and access to mental health resources. A range of potential benefits and areas for improving SP were identified at BFBs and BSOs. Potential risks from SP were identified for stakeholders from working hours, communication and dispute resolution, animal transport, and personal protective equipment practice areas. Results informed strategic activities for the National Beef Sustainability Strategy.ConclusionThis study contributes to the social sustainability discourse in livestock systems by demonstrating a qualitative approach to S-LCA that can be replicated by practitioners to explore valid and locally specific social dimensions of sustainability. Practitioners may consider the approach and results in future studies to better capture and manage the complex and dynamic nature of livestock systems, leading to more effective social sustainability decisions that incorporate diverse stakeholder perspectives.

Knowledge, attitudes and practices regarding respirable silica exposure and personal protective equipment use among brick kiln workers in Nepal

ObjectivesBrick kiln workers in Nepal are a neglected population who are exposed to high respirable silica concentrations, and few use interventions to reduce exposure. We aimed to characterise the prevalence...

Adherence to Personal Protective Equipment practices during the COVID-19 pandemic: A pilot study

A direct observational pilot project of healthcare personnel (HCP) was conducted to validate a tool that measures personal protective equipment (PPE) adherence at a large pediatric institution. Overall unit PPE adherence for all moments ranged from 50-61%. Masking was the most adhered to PPE moment (100%); hand hygiene prior to donning PPE had the lowest adherence (13%). Using data from this standardized tool, researchers can evolve PPE standards to maximize their adherence, effectiveness, and ease of utilization.

Knowledge, Attitudes, and Practices of Dental Students from Romania Regarding Self-Perceived Risk and Prevention of Infectious Diseases.

University education is a leading source of information for dental practitioners. Particular emphasis should be given to determining the extent to which students acquire positive knowledge, attitudes, and practices (KAP) and positive metacompetences beyond the scope of each studied dental discipline. We performed a cross-sectional questionnaire-based study among dentistry students from Romania to assess self-perceived risk of infectious diseases and their KAP on topics related to infectious disease prevention. The surveyed students presented good knowledge regarding personal protective equipment (PPE), and their PPE practices significantly correlated with the perceived usefulness of PPE. Only 45.1% correctly recognized all vaccine-preventable diseases (VPDs), but knowledge regarding VPDs significantly improved with increasing year of study (τb = 0.298, p = 0.001), confirming a positive education effect. Awareness regarding the need for screening for bloodborne viruses is poor; the majority of students had never performed a test for hepatitis C virus infection (HCV) (59.4%) or for human immunodeficiency virus (HIV) infection (60.4%). Furthermore, most respondents incorrectly considered themselves at high or very high risk of acquiring BBV, and perceived risk was inversely correlated with willingness to treat patients with hepatitis B virus (HBV) infection (τb = -0.214, p = 0.018), HCV infection (τb = -0.234, p = 0.013), or HIV infection (τb = -0.242, p = 0.006). This led to 3.0% of respondents stating that they would hypothetically deny dental treatment to a patient with HBV infection, 5.0% for HCV infection, and 10.9% for HIV infection, the proportion being significantly higher for HIV (z = -2.2, p = 0.026). In conclusion, better knowledge is needed among dental students regarding their own vaccination history, screening for bloodborne viruses, accurate estimates for their risk of acquiring bloodborne viruses during routine dental practice, and the existence of post-exposure measures following occupational exposure. Improving student knowledge and awareness could translate into a higher willingness to treat patients with chronic viral infections and into a safer and more inclusive dental practice. We propose an adaptation to the university curriculum to cover these key areas for targeted focus to empower future dental practitioners and to facilitate the improvement of across-discipline metacompetences for infection prevention and control.

Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey

BackgroundIt is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities.MethodsWe evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach’s alpha, assessed the questionnaire’s validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms.ResultsThe questionnaire was found to be reliable in assessing HCWs’ knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach’s alpha = 0.9), but not heat strain symptoms (Cronbach’s alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (β1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced.ConclusionsThe questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs’ attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.

Understanding Solid Waste Collectors' Awareness of Occupational Hazards and Personal Protective Equipment Practices in Northern Malawi.

The purpose of this study was to evaluate Solid Waste Collectors' (SWCs) knowledge of occupational hazards, their views on personal protective equipment (PPE), strategies for PPE use, and challenges in managing occupational risks. Previous studies have highlighted the importance of protective measures in addressing occupational hazards, but there is a need for further research to assess the knowledge levels of waste collectors regarding these hazards and PPE practices. This study used a qualitative research technique, particularly, a phenomenological research design to capture the living experiences from SWCs. Focused group discussions and in-depth interviews were employed to gather data. Subgroups of topics were created by coding the data using a predefined codebook as part of the content analysis process. SWCs demonstrated that they were aware of the risks they face in their work environments. The risks include which can range from long-term health issues brought by repetitive exposure to harmful substances and sharp objects. The lack of PPE accessibility and availability has become a significant issue, exposing waste collectors to various diseases and accidents, forcing them to work without necessary safeguards. Efforts to increase PPEs through public-private partnerships (PPPs) should be promoted. The city council should provide on-the-job training on health risks, occupational hazards related to waste collection, and PPE usage regularly; and establish efficient channels for SWCs to report problems and ensure that their grievances are properly addressed.

Compliance and associated factors of personal protective equipment among sanitary workers in selected public hospitals, Eastern Ethiopia: A cross-sectional study design.

Adherence to the proper use of protective personal equipment (PPE) in health care facilities including public hospitals is challenging among sanitation workers(SWs) across the world in general and in developing countries in particular. Despite the emphasis inline up on various policies and guidelines for PPE use implementation, inconsistent use of PPE, disobedience to PPE regulations, negligence, ignorance, discomfort, and lacking infection prevention and control (IPC) practice have been identified as main associated factors. All these and other factors contributing for the non-compliance of PPE practice among SWs within the hospitals in nations with limited resources such as Ethiopia, as well as study regions. Thus, such non-adherence or improper application of PPE is a major concern, and ultimately the consequences of unworthy PPE use has had an influence on the health and safety of sanitary workers. The aim of this study was to assess compliance and associated factors of personal protective equipment among sanitary workers in selected public hospitals, eastern Ethiopia. A cross-sectional research design used with mixed of quantitative and qualitative data. Surveys were conducted on 809 hospital sanitary workers from May-to-August, 2023. Face-to-face interview was conducted for the quantitative data. Sixteen Key Informant interviews were participated. Field observation also conducted. Epi Data version 3.1 was used for data import, while Stata version 17 MP was used for analysis. Multilevel binary and multivariable regression were for the crude odds ratio and adjusted odds ratio. Variables were analyzed at four levels: Model-0, Model-1, Model-2, and Model-3 for outcome, individual level, hospital level, and individual and hospital levels, respectively. Of these, only model 3 was reported for the interpretation. The cut-point of p-value for crude odds ratio and adjusted odds ratio at model 3 were 0.20 and 0.05, respectively, with a 95% confidence interval reported. Out of 809 sanitary workers, 729 (90.11%) of them were responded. The prevalence of compliance and noncompliance with protective personal equipment practice among sanitary workers were 46.78(95% CI: 43.11%-50.47%) and 53.22% (95% CI: 50.19%-57.11%), respectively. Multivariable multilevel analysis of model 3 shows that the overall variation for compliance of protective personal equipment practice between sanitary workers from hospitals to hospitals was 26.66%. The model also found that those had daily supervision (AOR = 13.71, 3.18-59.11), good infection prevention and control practice (AOR = 11.34, 1.97-65.24), and perceived less severity of protective personal equipment (AOR = 1.46, 0.85-2.59) were more likely to increase protective personal equipment practice. The study concluded that improper personal protective equipment practices among sanitary workers were caused by a shortage, discomfortable, wearing carelessly and negligence, felt less advantaged, and cues to action, and had worse self-efficacy. The study advised that maintaining a sufficient supply of protective personal equipment, increasing awareness of protective personal equipment utilization, and providing daily supervision are all necessary to improve the level of protective personal equipment compliance within the selected hospitals.

Assessment of Knowledge, Attitude, and Practices of Personal Protective Equipment among Health Care Providers in Tamil Nadu, South India

Introduction: Personal protective equipment provides considerable protection from hospital-acquired infections. Ample knowledge with a positive attitude and best practices of personal protective equipment by healthcare workers is indispensable to get protection themselves and to serve humanity. The study aimed to assess the knowledge, attitude, and practice (KAP) regarding personal protective equipment (PPE) among healthcare workers along with possible determinant factors. Methods: An observational cross-sectional study was conducted from August - September 2022 among 386 healthcare workers in Tamil Nadu, South India. The structured self-administered questionnaire was used for data collection. The study comprised questions evaluating a socio-demographic profile, knowledge, attitude, and practice of personal protective equipment. Descriptive statistics (percentage, frequency, mean) and inferential statistics (Chi-square test) were used for the data analysis. Results: The overall knowledge of the participants was satisfactory (73.3%). Physicians had a good knowledge level against non-physicians (p&lt;0.05). It was observed that the 30 and more years of experience group has less knowledge (p&lt;0.05). A positive attitude toward PPE was noted in 58.3% of the participants. Statistical significance in the attitude of participants with education, occupation, and experience was not observed (p&gt;0.05). Good practice of PPE was followed by 66.8% of participants. Nurses(91.7%) showed good practice of PPE than physicians and laboratory technicians and was found to be statistically significant (p&lt;0.05). Conclusion: The findings demonstrated that most healthcare workers had an overall good knowledge, positive attitude, and good practice regarding PPE however they need periodical training and auditing.

SG-APSIC1201: Knowledge and awareness of healthcare workers in a residential care home regarding the use of personal protective equipment (PPE) during the COVID-19 pandemic: A pilot study

Background: According to the World Health Organization (WHO), as of April 9, 2022, there had been 494,587,638 confirmed COVID-19 cases and 6,170,283 deaths reported worldwide. In Hong Kong, in recent outbreak, ~55% of confirmed cases were residential care home (RCH) residents and &gt;800 staff were infected. In 2016, ~15% of people aged ≥80 years were living in residential care homes. Objectives: To assess healthcare worker (HCW) knowledge level and attitudes about PPE use in residential care homes. Methods: This cross-sectional study, included participants who worked in the residential care homes, registered as healthcare workers (HCWs). HCWs who were part-time staff or worked &lt;3 months in the residential care home were excluded. Ethical review approval from the faculty research committee of the university was obtained in January 2022. The Knowledge, Attitude, Practical (KAP) questionnaire was adapted. The questionnaire has 33 items pertaining to knowledge, attitude, and practice regarding PPE. Results: In total, 50 questionnaires were received; 32 respondents (64%) were female and 18 (36%) were male. Nearly half of the participants had completed a high diploma course, and 32% had graduated from secondary school. Using ANOVA, there were no significant differences of education level of participants or participant knowledge level of PPE [F(2,47) = .181; P = .835], attitudes [F(2,47) = 1.995; P = .147] and practice [F(2,47) = .459; P = .635]. The Pearson correlation was used to measure the relationship between knowledge level and PPE practices. Our results indicated a significant difference and moderate correlation between knowledge level and PPE practice among HCWs. Conclusions: Knowledge level does not directly affect HCW practice regarding PPE. PPE practice skills have been influenced by various factors during the pandemic situation, such as availability of PPE, manpower, workload, and communication.

SG-APSIC1200: Infection prevention control along the fast track: Supporting the construction, operation, and closure of a COVID-19 community treatment facility in an F1 Pit

Objectives: The infection prevention team (IPT) was tasked with providing technical guidance for the construction and setup of a community treatment facility in 3 weeks at a Formula 1 (F1) racing pit to house elderly SARS-CoV-2–positive cases. Methods: The facility was setup with 737 beds including an isolation unit and a resuscitation bay. The multidisciplinary team decided on zone segregation (ie, green and hot zones) and discussed the clean–dirty workflow. IPC measures were revisited, especially regarding the layout of the donning and doffing station, as the facility expanded to accommodate patients with more comorbidities and those who needed dialysis. IPC training for nominated infection control liaison officers (ICLOs) was conducted using a “train the trainer” approach for mask fitting, hand hygiene, donning and doffing of personal protective equipment (PPE). Enhanced IPC measures, including weekly audit and staff surveillance, were mandatory, and monitoring was performed according to MOH guidelines. Linen and waste management and the cleaning and disinfection process were established at the beginning of the project. Results: Construction was completed within 3 weeks. The setup was completed in November 2021 for 737 beds. There were 758 admissions during the 4-month operation. In total, 12 trained ICLOs oversaw the training of 200 healthcare workers. They conducted 12 IPC audits and provided feedback to all staff. Compliance with PPE practices was inconsistent, and findings were shared during daily after-action reviews for improvement. The greatest challenges were converting the F1 facility to a healthcare facility, training staff with no IPC knowledge, and monitoring IPC on the ground. The trained ICLOs were successful in implementing, practicing, and monitoring IPC measures with minimal assistance from the infection prevention team. Conclusions: Operation began on November 5, 2021, and ceased on March 9, 2022. The community treatment facility construction, setup, and operations were completed within a short timeframe due to the efforts of various stakeholders. We faced many challenges, but we managed to implement and uphold IPC standards from beginning to end.

Changes in Personal Protective Equipment Practices of Craniofacial Surgeons during COVID-19: A Cross-sectional Study.

Two identical electronic survey studies, one in 2020 and one in 2022, were conducted on the use of PPE before, during, and after the pandemic among active craniomaxillofacial surgeons. Statistical changes in behaviors and preferences and differences across time points and demographic groups were evaluated. The initial study included responses from 48 surgeons, and the follow-up study consisted of 36 responses. Although only 4.3% of surgeons wore N95 masks or powered air purifying respirator for craniomaxillofacial operations before the pandemic, 91.5% wore these measures during the early pandemic (P < 0.001). However, this fell to 74.3% 2 years later. Similarly, more than 95% of surgeons wore a mask in clinic during the pandemic at both time points compared to only 40.3% before the pandemic (P < 0.001). In 2020, 31.9% of surgeons planned to continue using N95 masks or powered air purifying respirator for craniofacial cases after the pandemic was over, but that fell to 11.4% in the follow-up study. Craniofacial surgeon practices have shifted significantly toward more protective PPE over the course of the coronavirus disease 2019 pandemic. However, this effect was dampened over the course of a protracted pandemic. Despite this, our studies indicate a long-term shift in surgeon preference that is likely to persist after the pandemic is over.

Awareness and Practices on Occupational Safety among Building Construction Workers in Pokhara Metropolitan

Introduction: The risk of occupational injury and accident is more prominent in the construction industry than in other sectors. These accidents and injuries are the results of a low level of awareness and limited practice of safety measures. So, the main aim of this study was to assess the awareness and practices on occupational safety among the building construction workers.&#x0D; Methods: A cross-sectional study was carried out among 384 building construction workers of Pokhara Metropolitan. Multi-stage sampling technique was used. Face-to-face interview and interview schedule was the data collection technique and tool. The questionnaire was pre-tested among (10%) of the total sample. Ethical approval was taken from the Institutional Review Committee of Pokhara University.&#x0D; Results: This study showed that most of the workers (94.8%) were aware of the use of Personal Protective Equipment (PPE). The majority of the workers (63.8%) had poor levels of practice of PPE. The practice of PPE was significantly associated with the marital status, work experience, work hours, First aid kit facilities, Insurance services, awareness of the use of PPE, PPE availability, awareness about the occupational health problems, and workplace safety training.&#x0D; Conclusion: Most of the workers were aware of the use of safety measures but the practice of safety measures was poor. Marital status, awareness of safety measures, and so on were found to be significantly associated with the practice of PPE. Construction companies should implement the compulsory use of PPE to prevent accidents and injuries at construction sites.

Comparing Personal Protective Equipment Practice among Health Worker's Job Role and Hospital Unit

Health workers have the highest risk exposure that can increase the pathogen infection risk during the Covid-19 pandemic. The use of Personal Protective Equipment (PPE) is the most significant prevention, but mistakes while using PPE may occur in the donning (putting on) and doffing (taking off) process. This study compares the practice of using PPE among groups of health providers and hospital service units. The study design was a cross-sectional study conducted on non-infectious hospital employees in one specific hospital in Surabaya, totaling 102 employees. The Infection Prevention and Control Link Nurse (IPCLN) of the hospital conducted observations and analyses of health personnel in inpatient and triage units, treatment units, and support units. Based on the job roles, the employees were divided into health providers, healthcare support workers, and other health workers. Work units were categorized into inpatient units, outpatient and triage units, treatment units, and support units (cashier and registration areas). The results of the assessment were measured using One-Way ANOVA. Based on the job role, significant errors occurred when removing masks (p=0.048) made by health workers (38%). Meanwhile, in the hospital unit category, significant errors occurred in removing masks (p=0.000) and the use of gloves (p=0.002). Most mistakes were made in the outpatient and triage units, 92% and 42%, respectively. The complexity of wearing and removing PPE requires increased awareness and updated training on the correct use of PPE for all health workers who work in hospitals based on WHO recommendations during the Covid-19 pandemic.

Canadian Hospital Pharmacists' Perceptions of Workplace Preparedness and Personal Well-Being during the COVID-19 Pandemic.

Little is known about hospital pharmacists' experiences during the COVID-19 pandemic, as studies to date have focused on community pharmacy practices. To determine hospital pharmacists' perceptions of their workplace preparedness for the COVID-19 pandemic and to measure their mental well-being with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Pharmacists working in Canadian hospital inpatient settings during the COVID-19 pandemic were invited to participate in a 2-part online survey. Part A was a 46-item survey containing statements related to directions and support from leadership, personal protective equipment practices, work environment, and emotions. Part B assessed respondents' mental well-being using the validated 14-item WEMWBS. Responses to both parts of the survey were based on Likert scales. The survey was open from July to September 2020. Descriptive analyses were applied. A total of 432 hospital pharmacists consented to participate in the study. Most respondents were women (337/432, 78%), and most were 25 to 44 years old (293/432, 68%). Most respondents were confident that their workplace and pharmacy department were effectively managing patient demand (314/389, 81%) and the pandemic more generally (263/394, 67%). They also felt that their workplace teams were working well together (314/386, 81%). Interestingly, 22% (86/391) of the respondents did not agree that they had received training for COVID-19 infection prevention and control practices. The mean WEMWBS score was 48.9 (standard deviation 8.6), which indicated average mental well-being. After the initial wave of the COVID-19 pandemic, respondents perceived their hospitals and departments as being able to manage the pandemic and reported average mental well-being. Ensuring that all hospital pharmacists receive training for effective COVID-19 infection prevention and control practices is crucial. How their perceptions and well-being have changed since the time of the survey is unknown.

Knowledge, attitude and practices related to the use of personal protective equipment among welders in small-scale metal workshops in Nansana Municipality, Wakiso District, Uganda

ABSTRACT Background Despite the risks involved in welding, there is limited evidence of the knowledge, attitude and practices related to the use of personal protective equipment (PPE) among welders in small-scale metal workshops. We assessed the level of knowledge, attitude and practices (KAP) related to PPE use among welders in small-scale workshops in Nansana Municipality, Wakiso district, Uganda. Methods A cross-sectional study was conducted among 329 welders. A structured questionnaire was used to collect data on welder knowledge and attitude while an observation checklist was used to establish utilization of PPE. Ten key informant interviews were conducted to further understand welders’ knowledge, attitude and PPE-related practices. A ‘modified Poisson’ regression analysis was done to establish the independent factors associated with PPE KAP. NVivo 12 was used for the management of qualitative data. A thematic content approach guided qualitative data analysis. Results About 61.4% (202/329) of the respondents had a high level of knowledge, 68.7% (226/329) had a negative attitude, and only 37.1% (122/329) exhibited good PPE-related practices. Knowledge of PPE use was associated with the type of training (aPR = 1.52, CI = 1.29–1.80). Attitude toward PPE use was associated with the level of education (aPR = 2.31, CI = 1.28–4.14), duration of work experience (aPR = 2.37, CI = 1.01–5.55), (aPR = 2.79, CI = 1.13–6.89), and level of knowledge (aPR = 1.73, CI = 1.13–2.65). PPE-related practices were associated with the type of training (aPR = 2.91, CI = 2.14–3.96) and attitude (aPR = 1.45, CI = 1.08–1.93). Conclusion While the welders’ level of knowledge of PPE was found to be high, the majority exhibited a negative attitude and poor PPE-related practices. A high level of knowledge was associated with a positive attitude. In turn, a positive attitude was associated with good PPE practices. Welders need to be sensitized on the health risks that may arise from the non-use of PPE.

A Recipe for Success: Conducting a Gap Analysis to Decrease Central Line-associated Bloodstream Infection (CLABSI) Rates in a Post-COVID-19 World

BackgroundDuring the 2020 COVID-19 pandemic hospitals nationwide saw significant increases in central line-associated bloodstream infections (CLABSIs). Factors that likely influenced this include staffing challenges, personal protective equipment practices and drift in compliance with infection prevention bundles. To prevent further infections in 2021, a 788-bed teaching hospital established a multidisciplinary team to conduct a gap analysis to identify practice drifts that may have resulted due to the COVID-19 pandemic and develop targeted interventions.MethodsA team composed of infection prevention, nursing, physicians, and environmental services conducted a gap analysis that included re-evaluation of policies, procedures, and infection prevention bundles in conjunction with a frontline staff survey of current practices to assess for practice drift. Inconsistent use of a central line insertion checklist and nursing maintenance handoff tool and lack of frontline staff participation in a CLABSI committee were identified and targeted for modification & re-implementation in January 2021. To assess intervention effectiveness 2020 pre-implementation CLABSI rate and standardized infection ratio (SIR) (January – December) were compared to 2021 post-implementation CLABSI rate (January -September) and SIR using the exact binomial test and mid-p 95% confidence.ResultsDuring the pre-implementation period, there were 34 CLABSIs with a rate 0.745 CLABSIs per 1,000 central-line days and an SIR of 0.691. After implementation, 18 CLABSIs occurred with rate of 0.494 per 1,000 central-line days and SIR of 0.463. While not statistically significant this represented a 47.0% decrease in CLABSI events, a 33.7% decrease in rate (IDR p-value: 0.1583) and 33.0% decrease in SIR (two-tailed p-value: 0.1679, 95% Conf. Interval: 0.371 – 1.178) between the two periods.ConclusionsMultidisciplinary gap analysis identified practice drifts in use of evidence-based tools during the COVID-19 pandemic. Re-implementation of these modified tools and improved participation in the CLABSI committee lead to an approximate 33% reduction in CLABSI rate and SIR.

Adverse Effects of Personal Protective Equipment Used on Healthcare Workers' Skin during COVID-19 Outbreak

Objective: To investigate the adverse events on skin with continuous practice of personal protective equipment (PPE) in COVID-19 management among healthcare workers (HCWs).Methods: This cross-sectional multicenter study was conducted at hospitals operating in Karachi, Pakistan from November 2020 to January 2021. The target population was HCWs including doctors, paramedical staff, postgraduate, and undergraduate students involved in the care of patients during COVID-19; and continuously wearing level 3 barrier protection personal protective equipment (L3PPE), such as masks, gloves, and protective clothing. Adverse effect was defined as presence of new onset obvious skin damages with continuous PPE used during used COVID-19 management. Results: Of 383 HCWs, adverse effect was observed in 168 (43.9%) HCWs. The most common adverse effects because of facial mask were indentation and ear pin 200 (52.2%), by gloves was dry skin 186 (48.8%), by gown was wheals 19 (7.0%), and by goggles was pressure injury 40 (43.0%). A significantly higher association of adverse effect of using L3PPE was found with age &gt;27 years (p-value &lt;0.031), eczema and asthma as preexisting diseases (p-value &lt;0.001), ≤10 times daily standard hand hygiene procedure (p-value 0.002), &gt;6 hours of PPE worn per day (p-value &lt;0.001), N-95 mask use (p-value 0.029), both OPD and isolation ward work setting (p-value &lt;0.001), and systematic features like, headache (p-value 0.019), sneezing (p-value &lt;0.001), feeling of intense heat (p-value &lt;0.001), claustrophobia (p-value &lt;0.001), and facial suffusion (p-value &lt;0.001). Conclusion: A higher number of HCWs reported adverse effects of L3PPE continuously usage during COVID-19 management.

Mixed-Methods Survey of Healthcare Workers' Experiences of Personal Protective Equipment during the COVID-19 Pandemic in Aotearoa/New Zealand.

There have been widespread issues with the supply and distribution of personal protective equipment (PPE) globally throughout the COVID-19 pandemic, raising considerable public concern. We aimed to understand the experiences of healthcare workers using PPE during the first COVID-19 surge (February–June 2020) in Aotearoa/New Zealand (NZ). This study consisted of an online, voluntary, and anonymous survey, distributed nationwide via multimodal recruitment. Reported domains included PPE supply, sourcing and procurement, fit-testing and fit-checking, perceived protection, trust and confidence in the workplace, mental health, and the likelihood of remaining in the profession. Differences according to demographic variables (e.g., profession and workplace) were examined. We undertook a descriptive analysis of responses to open-text questions to provide explanation and context to the quantitative data. The survey was completed in October–November 2020 by 1411 healthcare workers. Reported PPE shortages were common (26.8%) among healthcare workers during surge one in NZ. This led to respondents personally saving both new (31.2%) and used (25.2%) PPE, purchasing their own PPE (28.2%), and engaging in extended wear practices. More respondents in the public system reported being told not to wear PPE by their organisation compared with respondents in the private sector. Relatively low numbers of respondents who were required to undertake aerosol-generating procedures reported being fit-tested annually (3.8%), a legal requirement in NZ. Healthcare workers in NZ reported a concerning level of unsafe PPE practices during surge one, as well as a high prevalence of reported mental health concerns. As NZ and other countries transition from COVID-19 elimination to suppression strategies, healthcare worker safety should be paramount, with clear communication regarding PPE use and supply being a key priority.

Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self‐Contamination During Donning and Doffing

BackgroundAt least 115,000 health and care workers (HCWs) are estimated to have lost their lives to COVID-19, according to the the chief of the World Health Organization (WHO). Personal protective equipment (PPE) is the first line of defense for HCWs against infectious diseases. At the height of the pandemic, PPE supplies became scarce, necessitating reuse, which increased the occupational COVID-19 risks to HCWs. Currently, there are few robust studies addressing PPE reuse and practice variability, leaving HCWs vulnerable to accidental contamination and harm. ObjectiveThe objective of this study was to assess potential HCW contamination during PPE donning, doffing, and reuse. MethodsThe study included 28 active acute care physicians, nurses, and nurse practitioners that evaluated 5 simulated patients with COVID-like symptoms while donning and doffing PPE between each patient encounter. An N95 mask was contaminated with a transparent fluorescent gel applied to the outside of the N95 mask to simulate contamination that might occur during reuse. Participants were evaluated after PPE doffing for each encounter using a black light to assess for face and body contamination. ResultsAll participants had multiple sites of contamination, predominantly on their head and neck. None of the participants were able to don and doff PPE without contaminating themselves during five consecutive simulation cycles. ConclusionsThe current Centers for Disease Control and Prevention PPE guidelines for donning and doffing fall short in protecting HCWs. They do not adequately protect HCWs from contamination. There is an urgent need for PPE and workflow redesign.