Hand hygiene before donning nonsterile gloves: Healthcare workers' beliefs and practices

Baloh, Jure; Thom, Kerri A.; Perencevich, Eli N.; Rock, Clare; Robinson, Gwen; Ward, Melissa; Herwaldt, Loreen A.; Reisinger, Heather Schacht

doi:10.1016/j.ajic.2018.11.015

Cited by 36 publications

(44 citation statements)

References 26 publications

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“…Hence, of particular importance are the knowledge, skills and actions of medical personnel with respect to HAI prevention and one of its elements is the use of SPs, especially medical staff’s HH [4,5]. Unfortunately, observing the rules of its proper execution poses a global problem due to low rates of compliance [12]. Data from Poland are also disturbing since as many as 75% of the physicians and medical students examined could not properly perform the Ayliffe handwashing technique that is recommended by the WHO [15].…”

Section: Discussionmentioning

confidence: 99%

“…Although HH, or broadly SPs, is the simplest and cheapest method of preventing infections, the praxis reveals that these principles are often overlooked or applied selectively, in various situations, by different groups of medical workers, both in Poland and in other countries [9,10,11,12]. Polish observational studies on HH compliance among healthcare workers revealed that in the situation prior to contact with the patient only 16.8% of doctors and 4.7% of nurses performed hand hygiene according to the recommendations, and after contact these proportions were 53.1% and 25.3%, respectively [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Factors Shaping Attitudes of Medical Staff towards Acceptance of the Standard Precautions

Rosiński

Różańska

Jarynowski

et al. 2019

IJERPH

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Standard precautions (SPs) guidelines are the minimum infection prevention practices that apply to all types of patient care, regardless of suspected or confirmed infection status of the patient. They are based on risk assessment, make use of common sense practices and personal protective equipment that protect healthcare providers from infection and prevent the spread of infection from patient to patient. The aim of this study was to determine medical staff’s attitudes towards SPs and analyse the factors shaping these attitudes. The study was conducted using a questionnaire that comprised 25 statements describing the attitudes of medical personnel towards SPs. They were designed to pinpoint the factors that determine these attitudes. There were five factors identified that shape employees’ attitudes towards SPs: assessment of the situation, favourable patterns of behaviour, negative norms, unfavourable patterns of behaviour and rationalising. The study analysed 505 questionnaires filled in by hospital workers from five Polish cities. The majority of the respondents were women (92.1%), nurses (87.5%); the average age was 41.8 and the average seniority was 19.2 years. Over one-third of the respondents worked in non-surgical (36.4%) and surgical (31.6%) wards, 12.3% were employed in intensive care units (ICUs) and 8.9% in emergency departments (EDs). The variable significantly affecting the level of acceptance of SPs was seniority: initially the support was high, then it later decreased, with the greatest decrease occurring between the third and eighth year of work. The staff of medical wards and ICUs demonstrated significantly lower support for SPs and strong environmental impact on SPs perception; low degree of acceptance among medical ward staff correlated negatively with factors from the category “favourable patterns of behaviour”. The substantially strongest support for SPs was found in ED workers. The results indicate the need for continuous education of individual groups of workers concerning the application of SPs, but also the necessity to change the organisational culture in Polish hospitals.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors Shaping Attitudes of Medical Staff towards Acceptance of the Standard Precautions

Rosiński

Różańska

Jarynowski

et al. 2019

IJERPH

View full text Add to dashboard Cite

show abstract

“…In one paediatric ED setting, only 1-12% of clinicians reported that they always or usually wore a mask or eye protection, while assessing febrile respiratory patients during winter [28]. Although gloves are worn frequently, patient safety may be compromised by misuse, such as not changing them between dirty and clean tasks on the same patient or between different patients and/or failing to comply with hand hygiene before and after use, which often contaminates the clinician's hands [29][30][31]. Commonly cited factors contributing to sub-optimal compliance with PPE in healthcare include inadequate knowledge and training, perception of risk, organisational culture and environmental barriers [32,33].…”

Section: Introductionmentioning

confidence: 99%

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Barratt

Gilbert

Shaban

et al. 2020

Australasian Emergency Care

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a b s t r a c tBackground: The risk of healthcare-acquired infection increases during outbreaks of novel infectious diseases. Emergency department (ED) clinicians are at high risk of exposure to both these and common communicable diseases. Personal protective equipment (PPE) is recommended to protect clinicians from acquiring, or becoming vectors of, infection, yet compliance is typically sub-optimal. Little is known about factors that influence use of PPE-specifically gloves and masks-during routine care in the ED. Methods: This was an ethnographic study, incorporating documentation review, field observations and interviews. The theoretical domains framework (TDF) was used to aid thematic analysis and identify relevant enablers of and barriers to optimal PPE use. Results: Thirty-one behavioural themes were identified that influenced participants' use of masks and gloves. There were significant differences, namely: more reported enablers of glove use vs more barriers to mask use. Reasons included more positive unit culture towards glove use, and lower perception of risk via facial contamination. Conclusion: Emerging infectious diseases, spread (among other routes) by respiratory droplets, have caused global outbreaks. Emergency clinicians should ensure that, as with gloves, the use of masks is incorporated into routine cares where appropriate. Further research which examines items of PPE independently is warranted. (R. Barratt).severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and pandemic influenza A [2]. Healthcareassociated transmission of these viral infections, into previously unaffected communities, was a key feature of the early stages of, for example, SARS in Toronto and MERS in Seoul [3,4]. A notable feature of both outbreaks was the high proportion of those affected who were healthcare workers, with reports of up to 27% and 57% for MERS and SARS, respectively [5]. First responders and emergency department (ED) clinicians are at high risk of exposure to both common and emerging communicable diseases of high consequence, as they are in close contact with symptomatic patients before a diagnosis is made [5][6][7]. For example, ED staff are among

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“…HCWs in clinical practice are busy and use PPE frequently, which likely influences them to doff more expediently than they would otherwise. They may be more likely to doff expediently in routine care, which they perceive to be low risk, particularly if they see PPE as self-protection rather than a measure to prevent cross-contamination [24, 25]. These findings suggest that efforts to improve PPE use and doffing should address both safety and expediency through new and improved PPE designs, doffing methods, training approaches, and organizational policies and procedures.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Workers’ Strategies for Doffing Personal Protective Equipment

Baloh

Reisinger

Dukes

et al. 2019

Clinical Infectious Diseases

Self Cite

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Background Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from pathogens and prevents cross-contamination. PPE effectiveness is often undermined by inappropriate doffing methods. Our knowledge of how HCWs approach doffing PPE in practice is limited. In this qualitative study, we examine HCWs’ perspectives about doffing PPE. Methods Thirty participants at a Midwestern academic hospital were recruited and assigned to 1 of 3 doffing simulation scenarios: 3 mask designs (n = 10), 2 gown designs (n = 10), or 2 glove designs (n = 10). Participants were instructed to doff PPE as they would in routine practice. Their performances were video-recorded and reviewed with participants. Semistructured interviews about their doffing approaches were conducted and audio-recorded, then transcribed and thematically analyzed. Results Three overarching themes were identified in interviews: doffing strategies, cognitive processes, and barriers and facilitators. Doffing strategies included doffing safely (minimizing self-contamination) and doffing expediently (eg, ripping PPE off). Cognitive processes during doffing largely pertained to tracking contaminated PPE surfaces, examining PPE design cues (eg, straps), or improvising based on prior experience from training or similar PPE designs. Doffing barriers and facilitators typically related to PPE design, such as PPE fit (or lack of it) and fastener type. Some participants also described personal barriers (eg, glasses, long hair); however, some PPE designs helped mitigate these barriers. Conclusions Efforts to improve HCWs’ doffing performance need to address HCWs’ preferences for both safety and expediency when using PPE, which has implications for PPE design, training approaches, and hospital policies and procedures.

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Hand hygiene before donning nonsterile gloves: Healthcare workers' beliefs and practices

Cited by 36 publications

References 26 publications

Factors Shaping Attitudes of Medical Staff towards Acceptance of the Standard Precautions

Factors Shaping Attitudes of Medical Staff towards Acceptance of the Standard Precautions

Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Healthcare Workers’ Strategies for Doffing Personal Protective Equipment

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