Improving Infection Prevention with PPE

The number of healthcare-associated infections (HCAIs) continues to increase, despite increased efforts to control them.

FREMONT, CA: Adherence to infection prevention and control (IPC) measures, including the proper use of personal protective equipment (PPE), in health care is complex and is influenced by many factors. Isolated interventions do not have the potential to achieve optimal PPE adherence and appropriate provision, leading to incomplete PPE implementation.

It is essential to understand the specific context of each healthcare setting to identify staff, organizational, and system factors that facilitate and hinder PPE use. Interventions need to consider the multi-faceted nature of PPE use, targeting both individual and organizational components to ensure successful implementation.

PPE shortage and unavailability: A shortage or unavailability of personal protective equipment (PPE) was reported for EVD and COVID-19 cases, including filtering facepiece respirators and gowns, which were needed as additional transmission-based precautions for human safety. Public and private HFs reported these shortages. Specific sizes needed for adequate protection were unavailable, so poorly fitting PPE was used. There were many factors contributing to inadequate adaptations,

Implementation interventions: In order to minimize the shortage of personal protective equipment, masks can be donated to hospitals that are actively evaluating patients for respiratory infection diseases, Non-disposable respirators can be allocated to clinical staff with direct airway manipulation, and procedures can be implemented to prevent equipment degradation. PPE waste and unnecessary use were reported to be reduced through education. PPE reprocessing systems can operate during extreme conditions with improved implementation of PPE stock control and supply procedures. 

It was recommended to identify and track reprocessed PPE, return it to stock, and enter it into the HF inventory to ensure HWs' safety. Sterile and processing personnel should be trained to ensure HWs' safety. The PPE type and filter facepiece respirators should be sterilized and disinfected differently. Logistical, planning, and communication challenges thwarted efforts to stockpile PPE.

Implementation interventions: HWs can choose and purchase PPE based on their body sizes and preferences, such as long sleeves that some prefer but may not always be available or surgical caps that protect the head in the hood of a coverall suit. Establishing and monitoring institutional IPC processes is important, as well as maintaining a baseline inventory of every critical item and managing the supply of PPE. Routine and regular facility-level assessments of PPE may be beneficial. PPE can be allocated and arranged to maximize space and improve accessibility.

HF inadequate infrastructure, lack of preparedness and policies: Among the inconsistencies reported by the IPC were inadequacies of facility infrastructure, including inadequate equipment storage space, which could adversely affect HWs and patient safety. Furthermore, disposable PPE was not discharged in a biocontainment unit, spaces between the clean and contaminated areas were inadequate, and donning and doffing zones and procedures were inadequate. It was not considered whether the physical environment and ICP measures were compatible in some clinical setting plans concerning the doffing area, the boundary of zones, and the lack of standard locations for items. A lack of or conflicting PPE protocols was cited as a barrier to respirator availability or low frequency of fit tests. According to one study, HF managers and frontline HW were inefficiently communicating and lacked support from the community and government.