Self-Reported Use of Personal Protective Equipment among Chinese Critical Care Clinicians during 2009 H1N1 Influenza Pandemic

Abstract

BackgroundCritically ill patients with 2009 H1N1 influenza are often treated in intensive care units (ICUs), representing significant risk of nosocomial transmission to critical care clinicians and other patients. Despite a large body of literature and guidelines recommending infection control practices, numerous barriers have been identified in ICUs, leading to poor compliance to the use of personal protective equipment (PPE). The use of PPE among critical care clinicians has not been extensively evaluated, especially during the pandemic influenza. This study examined the knowledge, attitudes, and self-reported behaviors, and barriers to compliance with the use of PPE among ICU healthcare workers (HCWs) during the pandemic influenza.Methodology/Principal FindingsA survey instrument consisting of 36 questions was developed and mailed to all HCWs in 21 ICUs in 17 provinces in China. A total of 733 physicians, nurses, and other professionals were surveyed, and 650 (88.7%) were included in the analysis. Fifty-six percent of respondents reported having received training program of pandemic influenza before they cared for H1N1 patients, while 77% reported to have adequate knowledge of self and patient protection. Only 18% of respondents were able to correctly identify all components of PPE, and 55% reported high compliance (>80%) with PPE use during patient care. In multivariate analysis, vaccination for 2009 H1N1 influenza, positive attitudes towards PPE use, organizational factors such as availability of PPE in ICU, and patient information of influenza precautions, as well as reprimand for noncompliance by the supervisors were associated with high compliance, whereas negative attitudes towards PPE use and violation of PPE use were independent predictors of low compliance.Conclusion/SignificanceKnowledge and self-reported compliance to recommended PPE use among Chinese critical care clinicians is suboptimal. The perceived barriers should be addressed in order to close the significant gap between perception and knowledge or behavior.

The association between self-perceived proficiency of personal protective equipment and objective performance: An observational study during a bioterrorism simulation drill

“…Nevertheless, the 2009 H1N1 influenza pandemic taught us that knowledge and self-reported compliance to recommended PPE use are suboptimal among HCWs. 8 More than 850 confirmed HCW infections were reported from Guinea, Liberia, and Sierra-Leone in the recent EVD outbreak with more than 500 reported deaths (see http://www.cdc.gov/vhf/ebola/ outbreaks/2014-west-africa/index.html). Three cases of nosocomial transmission among apparently protected HCWs in Spain and the United States heightened concerns among health care professionals and decision makers.…”

“…13,14 Nevertheless, most studies were conducted in a hospital setting and were based on self-reported questionnaires without matched objective observations. 8 Moreover, studies were not conducted in settings of a severe contagious outbreak in which participants need to combine contact, droplet, and airborne precautions.…”

Hospital unit safety climate: Relationship with nurses' adherence to recommended use of facial protective equipment

“…3 More recently, a study of 21 intensive care units in China found that 55% of health care workers complied with the proper use of FPE. 4 Two studies from Canada found 44% of nurses in 6 hospitals 5 and 11% of doctors in 14 hospitals reported they properly adhered to FPE. 6 Such suboptimal adherence rates are of great concern because it is estimated that 1 in 4 health care workers contract a communicable respiratory illness through work.…”

Fatores associados ao uso de equipamentos de proteção individual por profissionais de saúde acidentados com material biológico no Estado do Maranhão

“…Esse resultado também foi encontrado em uma pesquisa realizada em 50 municí-pios de Minas Gerais 29 . Assim como na literatura pesquisada 17,[20][21][22][23][24] houve maior frequência de acidentes por exposição percutânea, provavelmente pelo fato de a dimensão da superfície corporal cutânea ser maior que a mucosa e estar diretamente envolvida no manuseio de instrumentos durante a realização dos procedimentos 23 . O sangue foi o material biológico de maior predominância nos acidentes em estudo, causados principalmente pelo uso de agulhas, instrumento que mais contribuiu para os acidentes com exposição percutânea.…”