Effectiveness of a multisite personal protective equipment (PPE)–free zone intervention in acute care

Abstract

Objective:Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.Design:Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.Setting:All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.Intervention:A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.Results:We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.Conclusions:HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.

Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review

“…Twelve of the 17 studies that employed a single intervention provided percentage data on HH compliance both before and after the intervention. However, the results of two of these studies [44,69] did not reach significance. Of those studies recording percentage data, there were mixed results.…”

“…Two studies (11%) that used a single intervention involved the removal of elements of hygiene procedures to measure the effect of their absence on compliance [60,69]. These included introducing a personal- [67] Medical/surgical ward (1) Direct (52,065) Derde et al [35] Adult ICUs ( 13) Direct (41,558) Chhapola and Brar [79] Neonatal ICU ( 1) Direct (28,726) Mu et al [82] Whole organization (1) Direct (27,852) Aghdassi et al [43] Medical/surgical wards ( 20) Direct (21,424) Reisinger et al [44] Medical/surgical wards þ ICU (11) Direct (13,195) Stewardson et al [61] Whole organization (1) Direct (12,579) Rodriguez et al [87] Adult ICU (1) Direct (10,429) Saharman et al [84] Adult ICUs (2) Direct (7187) Kuruno et al [72] Adult ICU ( 1) Direct (6050) Lee et al [62] Medical/surgical wards (2) Direct (4895) Medeiros et al [89] Adult ICU ( 1) Direct (4837) Labi et al [40] Whole organization (2) Direct (4296) Primary healthcare centre (13) Chakravarthy et al [41] Adult ICUs (3) Direct (3612) Tschudin-Sutter et al [80] Medical/surgical wards ( 12) Direct (2923) Santoaningsih et al [77] Medical/surgical wards ( 5) Direct (2766) Stevenson et al [83] Whole organization ( 1) Direct (2654) Su et al [86] Medical/surgical wards ( 5) Direct (2079) Schmitz et al [37] Medical/surgical wards ( 4) Direct (2000) Diefenbacher et al [65] Medical/surgical wards ( 4) Direct (1894) Apisarnthanarak et al [55] Adult ICUs ( 6) Direct (1872) Fouad and Eltaher [71] Medical/surgical ward (1) Direct (1374) Teesing et al [90] Nursing homes (…”

“…Of the 50 studies that recorded compliance, 34 (68%) directly identified both baseline and postintervention HH compliance in the intervention group. A further 12 studies (24%) [36,44,52,55,57,60,62,67,69,77,78,87] showed the results in tables, and the authors of this review calculated the appropriate percentage results using the tables provided. These include studies that provided results for individual groups involved in the study but did not give an overall figure.…”

Environmental Contamination with Candida Species in Multiple Hospitals Including a Tertiary Care Hospital with a Candida auris Outbreak

“…We found that Candida species contamination was more common on high-touch surfaces in close proximity to patients (3.1% contamination on surfaces <3 feet from the patient and 0.7% on surfaces >3 feet from the patient). Surfaces in close proximity to patients may be more frequently contaminated than more distant surfaces in patient rooms [25, 26]. In addition, it has been demonstrated that during procedures shedding of methicillin-resistant Staphylococcus aureus (MRSA) by colonized patients occurs significantly more often on surfaces less than 3 feet versus greater than 3 feet from the patient [27].…”

“…In addition, it has been demonstrated that during procedures shedding of methicillin-resistant Staphylococcus aureus (MRSA) by colonized patients occurs significantly more often on surfaces less than 3 feet versus greater than 3 feet from the patient [27]. Therefore, it has been proposed that personnel remaining in more distant lower-risk areas of contact precautions rooms might not be required to wear personal protective equipment if they do not contact surfaces [25, 26].…”