Boosting PPE compliance: This simple switch can improve patient, staff safety

Hospitals are placing more emphasis on reducing healthcare-associated infections amid the emerging threat of antibiotic-resistant pathogens and growing financial penalties from government payers for high infection rates.

Personal protective equipment represents a simple, yet crucial tool clinicians can use to protect themselves — and patients — from dangerous infections. However, clinicians may not always use PPE properly, often due to a lack of standardized training and testing around protective equipment protocols. When this happens, staff and patient safety is jeopardized. Even something as simple as an untied gown neck closure can expose clinicians to harmful pathogens and promote the spread of HAIs, according to Scott Wall, BSN, MSN, senior clinical consultant for Dublin, Ohio-based Cardinal Health.

Mr. Wall has more than 30 years of experience in clinical and supply chain roles. Prior to joining Cardinal Health, he served in various nursing capacities at both university and community hospitals, focusing on general medical-surgical and neuroscience patient care, along with other surgical specialties.

Mr. Wall spoke with Becker's Hospital Review about the importance of proper PPE use and shared how hospitals can boost compliance.

Note: Responses have been lightly edited for length and clarity.

Question: When considering PPE, can you explain the difference between low-risk and high-risk healthcare environments?   

Scott Wall: In today's clinical settings, there really isn't a difference between low and high risk. The infection control practitioners I've worked with have to balance so much — from overseeing staff and patient safety to leading educational efforts to implementing processes and changes to help reduce HAIs. They must also deal with the increasing threats of antibiotic-resistant "superbugs," concerns over high-risk pathogens and the ever-changing regulatory environment. In my opinion, it's never been a more challenging time to balance all of these potential threats with day-to-day priorities.

When taking all of this into consideration, it's easy to lose track of the nuts and bolts of ensuring compliance in environments that clinical staff members view as low-risk. So, while clinicians know the importance of PPE, sometimes trade-offs are made in situations they view as low-risk. For example, if a clinician just needs to pop in a room quickly, they might not take the time to fasten the neck of their gown properly. This can quickly become a habit that carries over into higher-risk environments. When PPE is required, there truly is no such thing as a low- or high-risk environment. Clinicians should treat every situation with the same level of attention and application.

Q: What are you seeing in the industry when it comes to PPE and proper donning and doffing?

SW: PPE is a hot topic and a continual focus for healthcare providers. I recently reviewed a survey conducted by Infection Control Today in which readers identified standard precautions that needed the most improvement at their institutions. PPE was the No. 1 answer, even over hand hygiene.

A simulation study conducted at the University of Pittsburgh (Pa.) Medical Center found contamination occurred in more than 90 percent of "simple set" PPE donning or doffing instances1. Researchers cited human error during donning as a major issue, especially for isolation gowns. Sixty-nine percent of surveyed nurses estimated traditional neck closures using ties or tape-tabs on gowns were left unfastened at least a quarter of the time. Thus, it is clear there is significant room for improvement in education and practice when it comes to proper use of PPE in the clinical setting.

Q: Why is it an issue to leave isolations gowns unfastened?

SW: Not fastening the neck of an isolation gown can cause the gown to droop in the front, which leaves the clinician's chest and shoulders unprotected and increases the likelihood of workplace exposure and cross-contamination. Consider this scenario: There's a nurse checking on her isolation patients. She quickly puts on her isolation gown and gloves and enters the room for a simple check-in. As the nurse introduces herself, her patient starts to feel nauseous so she grabs an emesis basin and goes over to the bedside. If she didn't tie her gown correctly at the neck, the front could slip off her shoulders as she leans forward to pass the basin to her patient. This puts the nurse at risk. What if her patient gets sick and fluid splashes on her? Since clinicians never know when a seemingly low-risk situation could turn high-risk, they should always ensure they're properly protected with PPE.

Q: How can hospitals ensure clinicians are using PPE properly?

SW: To standardize practice and help drive compliance, many leading hospitals have transitioned away from isolation gowns with traditional neck-tie or tape-tab closures to over-the-head, full-back, AAMI level 2 isolation gowns. Over-the-head gowns are easier and quicker to don correctly, which removes the potential for human error. The over-the-head gown design promotes better PPE compliance in every situation, regardless of the perceived infection risk. The gowns also simplify the practice of PPE protocol, reduce auditing and retraining time, and make facilities inspection-ready. Using over-the-head gowns supports healthcare facilities' efforts to reduce exposure risk and ensure clinicians and patients are always protected.

1 “Use of personal protective equipment among health care personnel: Results of clinical observations and simulations” from American Journal of Infection Control 45 (2017) 17-23

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