Healthcare Hygiene magazine January 2024 January 2024 | Page 20

In the study by Haas , et al . ( 2023 ), researchers found that :

• Healthcare personnel self-reported and were observed to make PPE errors during the COVID-19 pandemic .

• Adherence to PPE guidelines varied by job type : more registered nurses ( 33.3 %) and physicians ( 26.5 %) reported at least one error in the previous two weeks than those in the “ other ” category ( 9.6 %).

• Respondents reported reliable access to PPE , with most saying they always had access to gowns ( 93 %), gloves ( 99 %), eye shields ( 98 %), and face masks ( 98 %).

33.3 %

NURSES

26.5 %

PHYSICIANS

9.6 %

OTHER

93 %

GOWNS

99 %

GLOVES

98 %

98 %

EYE SHIELDS

FACE MASKS

• Hand hygiene was the infection precaution most frequently performed incorrectly , with study observers noting that hand and glove hygiene protocols were only adhered to 40 % of the time between visits to rooms with patients who had COVID-19 .

• Less common HCP roles need training and education during a public health emergency .

• The combination of repetitive job tasks and demands may contribute to PPE errors .

• A systems-level approach to support HCP knowledge may improve adherence behavior . demands , exacerbating already-present barriers to adherence . For example , when workload increases , so does frequency and pace of PPE donning and doffing , which heightens the risk for self-contamination and infection .”

For this study , researchers analyzed responses to surveys from 191 healthcare personnel at the University of North Carolina Medical Center between July 2020 and January 2021 . They were questioned about their experiences in SARS-CoV-2 exposure and adherence or non-adherence to infection precaution protocols . Respondents were grouped into three categories : physicians , advanced practice providers , physician assistants , and nurse practitioners ; registered nurses ; and “ other ,” which included therapists , dieticians , and members of food and environmental services . In addition to the self-reported survey data , study researchers also routinely observed healthcare personnel and monitored their compliance with infection precautions to collect validation data . The authors report that in general , the trends reported in survey responses and by the observers were concordant .

In the study , researchers examined associations between healthcare personnel ’ s infection precautions adherence and potential explanatory factors including job role , potential risk of exposure to SARS-CoV-2 ( via self-reported tasks ), and perceived stress toward COVID-19 . During the time of this study , the medical center ’ s protocol indicated that PPE use was required regardless of patients ’ COVID-19 status and job tasks being performed throughout the medical facility including the use of gowns , gloves , eye protection , and N95 filtering facepiece respirators .

The findings showed statistically significant differences between job role , risk of potential exposure to SARS-CoV-2 , and the likelihood of making errors in infection precaution adherence . For example , 57.4 percent of registered nurses completed job tasks that placed them at a higher risk of SARS-CoV-2 exposure , compared to nearly 29 percent of physicians and 38 percent of the “ other ” category . Healthcare personnel who were more likely to be exposed to the virus were also 5.74 times more likely to report at least one error in infection precautions in the previous two weeks , such as failure to don PPE .

Of the 191 participants who completed the survey , 167 ( 87 percent ) reported encountering patients not known or suspected to be positive for SARS-CoV-2 and 129 ( 68 percent ) reported encountering patients known or suspected to have COVID-19 within the two weeks prior to the survey completion . Regarding PPE availability , 93 percent of workers reported always having access to gowns , 99 percent to gloves , 98 percent to eye shields , and 98 percent to face masks in the prior two weeks . The other job group reported significantly fewer errors ( 9.6 percent ) compared to the physician ( 26.5 percent ) and registered nurse groups ( 33.3 percent ).

The researchers report that 41.2 percent of the respondent sample self-reported tasks that placed them at a higher risk of potential exposure to SARS-CoV-2 . For all these respondents , they reported exposures with these patients for at least one hour . The average risk of potential exposure to SARS- CoV-2 among registered nurses was higher than that of the physician and other groups .

“ While error rates varied by job type , what this study really shows is that all three groups of healthcare personnel were at risk of SARS-CoV-2 exposure and were making errors in adherence to infection prevention protocols during the height of the pandemic ,” says Haas . “ This is a clear demonstration that we need to improve engagement in our training for emergency preparedness and to create a more strategic response that will help our healthcare workers stay safe even in times of extreme stress .”

But the study findings produced some surprises , the researchers say .

“ From my perspective going into the analysis and when we were defining the variables that we were going to examine , I anticipated that perceived stress related to COVID-19 to have been much more prevalent than it was and to play a greater role in the results ,” Haas says . “ Even though stress was there , it wasn ’ t as high as I thought it would be . However , those healthcare workers did have access to PPE , and in this sample , there didn ’ t appear to be prevalent or widespread shortages , so that could have been a factor . That was surprising , but it also makes me think about the bigger picture in the sense of how these results would have been different at a facility in a rural area , or at an institution with limited access to PPE or had more shortages of resources .”

Ciccone says she was intrigued by one of the main findings that healthcare personnel who were performing more high-risk procedures related to exposure , such as aerosol-generating procedures , were more likely to report errors in infection prevention practices . “ I thought that was an interesting finding , but it makes a good deal of sense because those are the people who are probably using PPE much more frequently , even if they ’ re not reporting elevated levels of overall stress . Maybe when they are in a more stressful kind of environment , knowing that the procedures are aerosol-generating and perhaps associated with a higher risk of exposure , which may influence the likelihood of a PPE error . I ’ m hypothesizing here , as we did not ask these questions or address

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