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4 Using PPE: Individual and Institutional Issues
Pages 113-146

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From page 113...
... The recent heightened awareness of patient safety issues has opened up opportunities to improve worker safety with the potential to benefit workers, patients, family members, and others who interact in the healthcare setting. Because PPE works by acting as a barrier to hazardous agents, healthcare workers face challenges in wearing PPE that include difficulties in verbal communications and interactions with patients and family members, maintaining tactile sensitivity through gloves, and physiological burdens such as difficulties in breathing due to respirators.
From page 114...
... The chapter begins with an overview of studies regarding PPE use by healthcare workers and the context of PPE use in the healthcare setting. Four strategies for improving worker safety are then discussed in detail with a focus on collaborative efforts and commitments by employers and healthcare workers to: provide leadership and commitment to worker safety, emphasize education and training, improve feedback and enforcement, and clarify relevant work practices.
From page 115...
... found 57 percent overall adherence to hand hygiene protocols among 163 physicians. Given the poor use of PPE, particularly respiratory PPE, and the high risk of exposure of healthcare workers to bloodborne and airborne pathogens and other hazardous materials, it is crucial to use the data described below and in Table 4-1 to develop and implement strategies to improve the rates of adherence to PPE protocols and to mitigate risk.
From page 116...
... Of those ity stating they practiced 38.4% Precautions per universal precautions, ceived as unnecessary 44.3% reported wear- 19.9% Barriers difficult ing a surgical mask to obtain for deliveries, 53.4% 19.6% Cost of barriers reported wearing eye prohibitive protection for deliv- 10.3% Unaware of uni eries, and 74.7% versal precautions reported wearing gloves when handling soiled linens
From page 117...
... , face mask (55.5%) DiGiacomo Staff involved Videotape review of Compliance improved et al., 1997 in trauma 66 resuscitations with pre-notification of resuscitation found full compli- patient arrival ance with barrier precautions by 89.1% of healthcare workers Helfgott et Obstetrics and Total compliance 64% Time constraints al., 1998 gynecology stu- with universal pre- 52% Too much trouble dents and resi- cautions by 89% of 34% Judged patient as dents in Houston the 61 participants not infected observed during during 459 proce- 23% Do not consider deliveries and dures recommending themselves at risk surgeries after PPE use.
From page 118...
... , no gloves (3.0%) Madan et al., Hospital health- Overall compliance Noncompliance data not 2001 care workers with barrier precau- collected in New Orleans tions during 12 re observed during suscitations (with 104 trauma healthcare workers)
From page 119...
... , except in describing research in which the authors specifically use the term universal precautions.
From page 120...
... FRAMEWORK FOR A CULTURE OF SAFETY Improving worker safety necessitates an organization-wide dedication to the creation, implementation, evaluation, and maintenance of effective and current safety practices -- a culture of safety. An organization that has a functional and healthy safety culture is one in which all employees show a concern for safety issues within the infrastructure and act to maintain or update safety standards.
From page 121...
... . In the healthcare setting, a strong culture of safety has been shown to result in a higher rate of adherence to standard infection control precautions among employees, a decreased incidence of exposure mishaps in hospitals, and fewer workplace injuries among employees (Gershon et al., 1995, 2000)
From page 122...
... and administrative or work practice controls (e.g., protocols to ensure early disease recognition, vaccination policies, disease surveillance, infection control guidelines for patients and visitors, decontamination of healthcare equipment and patient care rooms, risk assessment education programs for healthcare workers) (Thorne et al., 2004)
From page 123...
... Factors Underlying Safety Culture in Healthcare Facilities Much of the analysis of the safety cultures in healthcare organizations has focused on controlling the risk of bloodborne pathogens. A factor analysis of the results of a survey of 789 healthcare workers identified six organizational factors underlying the hospital safety climate: senior management support for safety programs; absence of workplace barriers to safe work practices; cleanliness and orderliness of the worksite; minimal conflict and good communications among staff; frequent safetyrelated feedback and training by supervisors; and availability of PPE and engineering controls (Gershon et al., 2000)
From page 124...
... Safety training was emphasized, as was the need for consistent safety instructions and the importance of a wide range of communication strategies. Evidence-based and practical infection control policies were seen as important -- including the need for adequate resources and the participation of "frontline" healthcare workers in the development of infection control guidelines.
From page 125...
... emphasize healthcare worker education and training; (3) improve feedback and enforcement of PPE policies and use; and (4)
From page 126...
... . Close collaboration between staff in occupational health and infection control and their joint leadership in worker safety issues will be particularly important.
From page 127...
... Institutional commitment to worker safety is also demonstrated by the presence and ready availability of adequate supplies of proper safety equipment that promotes timely and proper use of PPE. In a crosssectional survey of healthcare workers at state correctional facilities, Green-McKenzie and colleagues (2001)
From page 128...
... Efforts should be made to identify best practices for communications regarding worker safety across a variety of healthcare settings and to further explore and disseminate best practices in planning for these communications during an influ
From page 129...
... found that healthcare workers who had repeated occupational exposures to blood and body fluids, but who did not acquire infection, had poorer PPE compliance and may have perceived a decreased risk of acquiring infection compared to those who had not been exposed. This experience may lead to a false sense of invulnerability, resultant noncompliance with standards, and increased risk taking, which ill prepare the worker for the next unknown infectious disease.
From page 130...
... Healthcare workers during the SARS outbreaks in Canada have said that the existing programs for training in infection control had been inadequate prior to the SARS epidemic because they were often given only to newly hired employees and no systems existed for ongoing training in infection control (Yassi et al., 2004; Moore et al., 2005b; SARS Commission, 2006)
From page 131...
... More information is needed on the characteristics of formative and continuing education training that will be most effective in maintaining good infection control practices. Rothman and colleagues (2006)
From page 132...
... Further, the organizations that credential and license healthcare workers, such as state licensure boards, should add or strengthen the testing requirements for knowledge regarding appropriate PPE use and infection control procedures. This would then require that curricula in schools of medicine, nursing, and allied health fields be adjusted to accommodate this knowledge base.
From page 133...
... provides examples of educational goals and objectives for pandemic infection control strategies that emphasize the following: • education about recommended control precautions; • prompt reporting of cases by clinicians; • communications about confirmed cases admitted to or present in a facility; • correct use of PPE, hand hygiene, and respiratory hygiene and etiquette; • training of infection control monitors to observe and correct deficiencies in PPE use and proper hygiene; • use of simulations to allow for practice; • development of risk communication materials; and • information about vaccination and antiviral medications. Training should focus on helping workers to reduce barriers in working with patients and performing their job duties while wearing PPE and complying with infection control standards.
From page 134...
... Healthcare facilities need to foster and promote a strong culture of safety that includes a commitment to worker safety, adequate access to safety equipment, and extensive training efforts that utilize protocols requiring specific safety actions and detailing consequences for noncompliance. By incorporating safety expectations into the job requirements, individual employees know that this is a part of their job responsibilities and that worker safety is a high priority in the organization with accountability at multiple levels.
From page 135...
... Communicating the results of the survey to all staff will focus healthcare workers on what needs to be improved, while helping to boost the overall safety culture. Annual or quarterly audits are also useful in reviewing procedures and assessing the performance of all departments in using PPE and following other safety protocols and could be accompanied by incentives in the form of rewards for superior compliance and adherence.
From page 136...
... Challenges to be examined include developing and disseminating effective supervisory and reporting procedures that encourage feedback and fairly enforce adherence to infection prevention practices. Clarifying Relevant Work Practices Much remains to be learned about specific issues related to wearing PPE in the healthcare setting particularly during an influenza pandemic.
From page 137...
... should be identified and their infection control practices, including PPE protocols and training methods, should be shared as should model practices in other healthcare settings. Identifying best practices in infection control and worker safety will provide the standards to be expected for units with similar patient mix during a pandemic.
From page 138...
... • Efforts by the Joint Commission and state health departments to emphasize PPE compliance in accreditation and other assessments could focus attention on PPE issues and enhance adherence to PPE protocols. Key Research Needs Opportunities abound for improving worker safety and promoting the culture of safety in healthcare facilities.
From page 139...
... A concerted effort is needed to identify best practices in infection control and disseminate this information to all sites where health care is provided. These best practices could increase worker and patient safety and have positive ramifications well beyond preparedness for an influenza pandemic.
From page 140...
... • Healthcare workers should take responsibility for their safety by working to enhance the culture of safety in the workplace and by adhering to PPE pro tocols. • Healthcare accrediting organizations (including the Joint Commission and state health departments)
From page 141...
... • Develop, implement, and evaluate worker safety communication programs focusing on infection con trol, PPE, and reduction of risk and barriers during an influenza pandemic. • Monitor, enforce, and provide feedback to supervi sors and employees regarding appropriate use of PPE.
From page 142...
... Ameri can Journal of Infection Control 30(7)
From page 143...
... 2001. Infection control practices among correctional healthcare workers: Effect of management atti tudes and availability of protective equipment and engineering controls.
From page 144...
... 2005a. Protecting health care workers from SARS and other respiratory pathogens: Organiza tional and individual factors that affect adherence to infection control guide lines.
From page 145...
... 2005b. Occupa tional health and infection control practices related to severe acute respiratory syndrome: Health care worker perceptions.
From page 146...
... 2001. Use and efficacy of tuberculosis infection control practices at hospitals with previous outbreaks of multidrug-resistant tuberculosis.


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