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Personal protective equipment is a group of protective devices that directly protect a worker against hazards in the work environment (Koradecka, 2010). In the case of health care workers, PPE acts as a barrier between infectious materials (such as blood and respiratory secretions) and the skin, mouth, nose and eyes (Infection Control Today, 2007). It should meet selection criteria that consider the hazards and work environment conditions and at the same time conform to the basic requirements of safety and ergonomics (Koradecka, 2010).It is the duty of the employer to provide suitable PPE free of charge, ensure appropriate storage, cleaning, disinfection, maintenance and necessary servicing of PPE and provide training on its appropriate use (Koradecka, 2010).
PPE for health care workers includes items such as gloves, gowns, masks, respirators, and eyewear used to create barriers that protect skin, clothing, mucous membranes, and the respiratory tract from infectious agents. The items selected for use depend on the type of interaction a public health worker will have with a client and the likely modes of disease transmission.Wear gloves when touching blood, body fluids, non-intact skin, mucous membranes, and contaminated items. Gloves must always be worn during activities involving vascular access, such as performing phlebotomies.Wear a surgical mask and goggles or face shield if there is a reasonable chance that a splash or spray of blood or body fluids may occur to the eyes, mouth, or nose (Wisconsin Department of Health Services, 2011).Wear a gown if skin or clothing is likely to be exposed to blood or body fluids.Remove PPE immediately after use and wash hands. It is important to remove PPE in the proper order to prevent contamination of skin or clothing.
This sign illustrates the correct method for donning and removing PPE as recommended by the World Health Organisation.To don, the PPE should be applied as follows: first gown tied at neck and waste, second face shield or mask, third eye goggles if required. Last of all, gloves should be applied over the cuff of the gown.To remove, the user should be mindful that the PPE is now contaminated. Gloves should be removed first, followed by the gown. The contaminated surfaces should be inverted and disposed off immediately. Wash hands. Goggles should be removed via the ear pieces and masks/face shields from behind. Dispose. Wash hands (WHO, 2007).
In the hospital setting, patients are placed under airborne, droplet, or contact isolation precautions, depending on the mode of transmission of the presumed agent. The image shown on screen is an example of signage placed at the entry to isolation rooms. The signs outline the reason for isolation and the PPE required to attend to the patient. PPE supplies are stored outside the patient room or in the ante room (Department of Health, 2009).Image taken from http://www.google.se/imgres?q=isolation+precaution+signage&um=1&hl=sv&sa=N&biw=1366&bih=667&tbm=isch&tbnid=q5z8-xzPyq-ABM:&imgrefurl=http://www.lhsigns.com/PatientCare.php&docid=5pW3Ne0jePjFeM&imgurl=http://www.lhsigns.com/p7lsm_img_10/fullsize/pic-l.jpg&w=453&h=400&ei=9RcET6KJDc2P4gTJ86SSCA&zoom=1&iact=hc&vpx=1094&vpy=152&dur=367&hovh=163&hovw=185&tx=120&ty=126&sig=106690102852487833910&page=3&tbnh=133&tbnw=151&start=41&ndsp=19&ved=1t:429,r:5,s:41
Various studies have shown that PPE non-compliance is a common occurrence amongst health care workers. One particular study found numerous examples of non-compliance, with the most common being that the gown was not tied at both neck and waist, there was no seal check performed on goggles or mask, the PPE was not donned in the recommended sequence and improper mask removal technique (Beam, Gibbs, Boulter, Beckerdite, & Smith, 2011). A fire fighter would not attend to a fire without appropriate PPE, so why is this such a common problem in the health care sector?
Ability to access and acquire the proper PPE, discomfort and burden of PPE, ability to perform work tasks while wearing PPE, multi-tasking and the need for changing or removing PPE between activities and/or patients are barriers to using PPE effectively (National Institute for Occupational Safety and Health, n.d.).A Polish study carried out on the same issue found the most commonly stated reasons for non-compliance were non-availability of PPE, the conviction that the source patient was not infected and staff concern that following locally recommended practices actually interfered with providing good patient care (Ganczak & Szych, 2007).
Quality improvement must be carried out for non-compliance with PPE in hospitals and healthcare settings as it is a contributing factor to the contraction of hospital-acquired infection. The correct use of PPE is especially important given the rise of immunocompromised patients, the increasing resistance of bacteria to current antibiotic strains and the threat of pandemics such as H1N1 and SARS.Image taken from http://www.google.se/imgres?q=quality+improvement&hl=sv&biw=1366&bih=631&gbv=2&tbm=isch&tbnid=KjmW-lMb-TcX7M:&imgrefurl=http://www.medicaltourismmag.com/article/Quality-Improvement-Health-Care.html&docid=0VgCF7JuHod-pM&imgurl=http://www.medicaltourismmag.com/upload/articles/Quality-Improvement-Health-Care-main.jpg&w=488&h=336&ei=3EAET_ipN4Xf4QTXocmNCA&zoom=1&iact=hc&vpx=1062&vpy=378&dur=433&hovh=148&hovw=216&tx=88&ty=153&sig=106690102852487833910&page=1&tbnh=128&tbnw=186&start=0&ndsp=19&ved=1t:429,r:18,s:0
Image taken from http://www.google.se/imgres?q=lean+toyota+model&um=1&hl=sv&sa=N&biw=1366&bih=667&tbm=isch&tbnid=rLwHPzc1IxS-oM:&imgrefurl=http://thereliabilityroadmap.com/html/articles.html&docid=MAsWRjIY-ZrszM&imgurl=http://thereliabilityroadmap.com/assets/images/toyota1__Medium_.jpg&w=800&h=483&ei=rUwET_rNO4yB4ASLtcWNCA&zoom=1&iact=hc&vpx=1044&vpy=210&dur=750&hovh=128&hovw=212&tx=165&ty=87&sig=106690102852487833910&page=1&tbnh=113&tbnw=187&start=0&ndsp=20&ved=1t:429,r:5,s:0
Problem-solving: Education and training, peer review, random audit.People and partners: Staff in contact with infectious patients.Process: Practice adequate and effective PPE.Philosophy: to improve health care by reducing the incidence of hospital-acquired infection.
Personal protective equipment
Groupof protective devices that directly protect a worker against hazards in the work environment. Shouldmeet selection criteria that consider the hazards and work environment conditions and at the same time conform to the basic requirements of safety and ergonomics.
Protective clothing Hand and foot protection Head protection Hearing protection Eye and face protection Respiratory protection Protection against falling from height
Did not tie the gown at both the neck and waist. Did not place mask straps properly. Did not properly seal the mask to the face. Did not conduct a seal check. Did not don equipment in the CDC-recommended sequence. Removed potentially contaminated eye protection from the room. Used poor technique for gown removal. Did not use proper mask removal technique. Did not use wall mounted hand sanitizer before exiting the room. Removed other potentially contaminated items from the room. Did not doff equipment in the CDC recommended sequence. Did not remove gloves first.
Non-availability of PPE. Conviction that the patient was not infected. Utilising PPE interfered with providing good patient care.
Tojudge whether or not specific quality improvement theories can be applied to the problem of PPE non-compliance in hospitals...
Beam, E., Gibbs, S., Boulter, K., Beckerdite, M., & Smith, P. (2011). A method of evaluating health care workers’ personal protective equipment technique. American journal of infection control, 39(5), 415-420. Department of Health. (2009). Hospital infection prevention and control guidelines: Influenza-like illness. Retrieved from http://www.health.wa.gov.au/circularsnew/attachments/412.pdf Ganczak, M., & Szych, Z. (2007). Surgical nurses and compliance with personal protective equipment. Journal of hospital infection, 66(4), 346-351. Infection Control Today. (2007). Personal protective equipment. Retrieved from http://www.infectioncontroltoday.com/articles/2007/05/personal-protective- equipment.aspx Koradecka, D. (Ed.). (2010). Handbook of occupational safety and health. Boca Raton, FL: CRC Press. National Institute for Occupational Safety and Health (n.d.). National personal protective technology laboratory request your assistance. Retrieved from http://www.cdc.gov/niosh/npptl/pdfs/PotentialBarriersPPE.pdf Wisconsin Department of Health Services. (2011). Infection control and prevention. Retreived from http://www.dhs.wisconsin.gov/communicable/InfectionControl/StdPrecautions.htm World Health Organisation. (2007). How to put on and take off personal protective equipment. Retrieved from http://www.who.int/csr/resources/publications/PPE_EN_A1sl.pdf