Characteristics of personal protective equipment training programs in Australia and New Zealand hospitals: A survey

Ruth Barratt, Ramon Z Shaban, Gwendolyn L Gilbert, Ruth Barratt, Ramon Z Shaban, Gwendolyn L Gilbert

Abstract

Background: Using personal protective equipment (PPE) is one of several fundamental measures to prevent the transmission of infection and infectious diseases and is particularly pertinent in the current COVID-19 pandemic. Appropriate use of PPE by healthcare workers is, however, often suboptimal. Training and monitoring of PPE competency are essential components of an infection prevention and control program but there is a paucity of research and data on the content of such training programs across Australasia. This paper reports the results of a survey that characterised the nature of PPE training in Australian and New Zealand hospitals.

Methods: A population-based online survey was distributed to members of three major Australasian colleges representing infection prevention and control.

Results: Results indicate that, although training is frequently provided at orientation, many healthcare workers do not receive regular updates. Training programmes combine online and classroom sessions, but over a third do not include a practical component. The frequency of monitoring PPE competency is variable with one third of respondents indicating that no auditing occurs. PPE items used for high-level training are variable, with use of powered air purifying respirators (PAPRs) uncommon.

Conclusion: The results of this study suggest that HCWs' confidence, competence and familiarity with PPE are a concern, which in the context of the current global COVID-19 pandemic is problematic. More research is needed into how PPE training programs could be better designed, to prepare HCWs for practice using PPE safely and confidently.

Keywords: COVID-19; Education; Infection prevention and control; Personal protective equipment; Training.

Copyright © 2020 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
Geographical distribution of 137 survey respondents in Australia and New Zealand.
Fig. 2
Fig. 2
Reported frequencies of healthcare facility types represented by respondents.
Fig. 3
Fig. 3
Reported frequency of compliance audits for PPE use.
Fig. 4
Fig. 4
Reported distribution among 162 specific departments that received training in high-level PPE, in 125 facilities.
Fig. 5
Fig. 5
Reported frequencies of departments responsible for delivering training in high-level PPE.
Fig. 6
Fig. 6
Reported frequency of Personal Protective Equipment (PPE) items used in training for high-level PPE in Australasia.

References

    1. World Health Organisation . 2011. Report on the burden of endemic health care-associated infection worldwide. [Internet] Available from:
    1. Weiner L.M., Webb A.K., Limbago B., Dudeck M.A., Patel J., Kallen A.J. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the national healthcare safety network at the centers for disease control and prevention, 2011–2014. Infect Control Hosp Epidemiol. 2016 Nov;37(11):1288–1301.
    1. Australian guidelines for the prevention and control of infection in healthcare. National Health and Medical Research Council; Canberra: 2019. [Internet] Available from:
    1. Giard M., Laprugne-Garcia E., Caillat-Vallet E., Russell I., Verjat-Trannoy D., Ertzscheid M.-A. Compliance with standard precautions: results of a French national audit. Am J Infect Control. 2016 Jan;44(1):8–13.
    1. Gammon J., Morgan-Samuel H., Gould D. A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs. 2008 Jan;17(2):157–167.
    1. Williams V.R., Leis J.A., Trbovich P., Agnihotri T., Lee W., Joseph B. Improving healthcare worker adherence to the use of transmission-based precautions through application of human factors design: a prospective multi-centre study. J Hosp Infect. 2019 Sep;103(1):101–105.
    1. World Health Organisation . World Health Organization; Democratic Republic of the Congo: 2019. Ebola situation reports. [Internet] Available from:
    1. Gilbert G.L. Australia’s response to Ebola virus disease in West Africa, 2014–15. Public Heal Res Pract. 2016 Dec;26(5)
    1. Al-Tawfiq J.A., Abdrabalnabi R., Taher A., Mathew S., Rahman K.A. Infection control influence of Middle East respiratory syndrome coronavirus: a hospital-based analysis. Am J Infect Control. 2019 Apr;47(4):431–434.
    1. Australian Commission on Safety and Quality in Health Care . 2nd ed. ACSQHC; Sydney: 2017. National safety and quality health service standards. Available from:
    1. Safe Work Australia Personal protective equipment [Internet] Available from:
    1. WorkSafe New Zealand Government . 2018. Personal protective equipment – a guide for businesses. [Internet] Available from:
    1. Standards New Zealand. NZS 8134.3 . Standards New Zealand; Wellington: 2008. Health and disability services standards – health and disability services (infection prevention and control) standards.
    1. Grayson M.L., Stewardson A.J., Russo P.L., Ryan K.E., Olsen K.L., Havers S.M. Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. Lancet Infect Dis. 2018 Nov;18(11):1269–1277.
    1. Peng P.W.H., Ho P.-L., Hota S.S. Outbreak of a new coronavirus: what anaesthetists should know. Br J Anaesth. 2020 May;124(5):497.
    1. Jamieson D.J., Steinberg J.P., Martinello R.A., Perl T.M., Rasmussen S.A. Obstetricians on the coronavirus disease 2019 (COVID-19) front lines and the confusing world of personal protective equipment. Obstet Gynecol. 2020 June;135(6):1257–1263.
    1. Mahase E. Covid-19: retired doctors could be asked to return to work, says Hancock. BMJ. 2020 Mar 2;368:m831.
    1. Harris P.A., Taylor R., Minor B.L., Elliott V., Fernandez M., O’Neal L. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208.
    1. Zellmer C., Van Hoof S., Safdar N. Variation in health care worker removal of personal protective equipment. Am J Infect Control. 2015 Jul;43(7):750–751.
    1. Barratt R., Gilbert G.L., Shaban R.Z., Wyer M., Hor S. Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians. Australas Emerg Care. 2019 June;23(2):105–113.
    1. Ault A. Medscape Medical News; 2020 Apr 06. COVID-19 Exposes Potential Gaps in PPE Training, Effectiveness. [accessed 2020 Apr 08]; Available from:
    1. Semple S., Cherrie J.W. COVID-19: Protecting worker health. Ann Work Expo Heal. 2020 Mar 23:1–4. doi: 10.1093/annweh/wxaa033.
    1. Doll M., Feldman M., Hartigan S., Sanogo K., Stevens M., McReynolds M. Acceptability and necessity of training for optimal personal protective equipment use. Infect Control Hosp Epidemiol. 2017 Feb;38(2):226–229.
    1. Barratt R. Infection prevention and control lessons learned from the management of the first suspected Ebola virus disease case admitted to a New Zealand hospital. Healthc Infect. 2015 Jun;20(2):78–80.
    1. World Health Organization . World Health Organization; Geneva: 2019. Minimum requirements for infection prevention and control programmes. Licence: CC BY-NC-SA 3.0 IGO.
    1. Poller B., Hall S., Bailey C., Gregory S., Clark R., Roberts P. ‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment. J Hosp Infect. 2018 Jun;99(2):229–235.
    1. Iedema R., Carroll K., Collier A., Hor S.Y., Mesman J., Wyer M. CRC Press; 2018 Dec 21. Video-reflexive ethnography in health research and healthcare improvement: theory and application.
    1. Tartari E., Fankhauser C., Masson-Roy S., Márquez-Villarreal H., Fernández Moreno I., Rodriguez Navas M.L. Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control. Antimicrob Resist Infect Control. 2019 Dec;8(1):206.
    1. World Health Organization Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19) Interim guidance. [Internet]
    1. Eubanks J.C., Somareddy V., McMahan R.P., Lopez A.A. Springer; Cham: 2016 Jul 17. Full-body portable virtual reality for personal protective equipment training. International conference on virtual, augmented and mixed reality; pp. 490–501.
    1. Havers S.M., Russo P.L., Page K., Wilson A., Hall L. Clinician perspectives of policy implementation: A qualitative study of the implementation of a national infection prevention policy in Australian hospitals. Am J Infect Control. 2019 Apr;47(4):366–370.
    1. Gould D.J., Creedon S., Jeanes A., Drey N.S., Chudleigh J., Moralejo D. Impact of observing hand hygiene in practice and research: a methodological reconsideration. J Hosp Infect. 2017 Feb;95(2):169–174.
    1. Zhang H., Yan X., Li H., Jin R., Fu H. Real-time alarming, monitoring, and locating for non-hard-hat use in construction. J Constr Eng Manag. 2019 Mar;145(3)
    1. Verbeek J.H., Ijaz S., Tikka C., Ruotsalainen J.H., Mäkelä E., Neuvonen K. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Occup Environ Med. 2018;75:A177.
    1. Mulvey D., Mayer J., Visnovsky L., Samore M., Drews F. Frequent and unexpected deviations from personal protective equipment guidelines increase contamination risks. Am J Infect Control. 2019 Sep;47(9):1146–1147.
    1. Sykes A. 2018. An international review of high level isolation units. [Internet] Available from.
    1. Corley A., Hammond N.E., Fraser J.F. The experiences of health care workers employed in an Australian intensive care unit during the H1N1 Influenza pandemic of 2009: A phenomenological study. Int J Nurs Stud. 2010 May;47(5):577–585.
    1. Den Boon S., Vallenas C., Ferri M., Norris S.L. Incorporating health workers’ perspectives into a WHO guideline on personal protective equipment developed during an Ebola virus disease outbreak. F1000Research. 2018;7 doi: 10.12688/f1000research.12922.2.
    1. Chughtai A.A., Seale H., Rawlinson W.D., Kunasekaran M., Macintyre C.R. Selection and use of respiratory protection by healthcare workers to protect from infectious diseases in hospital settings. Ann Work Expo Heal. 2020 Apr 30;64(4):368–377.
    1. Wizner K., Stradtman L., Novak D., Shaffer R. Prevalence of respiratory protective devices in U.S. Health Care Facilities. Workplace Health Saf. 2016 Aug;64(8):359–368.
    1. Herlihey T.A., Gelmi S., Flewwelling C.J., Hall T.N.T., Bañez C., Morita P.P. Personal protective equipment for infectious disease preparedness: a human factors evaluation. Infect Control Hosp Epidemiol. 2016 Sep;37(9):1022–1028.
    1. Chughtai A.A., Chen X., Macintyre C.R. Risk of self-contamination during doffing of personal protective equipment. Am J Infect Control. 2018 Dec 1;46(12):1329–1334.
    1. Bleasdale S.C., Sikka M.K., Moritz D.C., Fritzen-Pedicini C., Stiehl E., Brosseau L.M. Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015. J Occup Environ Hyg. 2019 Aug 3;16(8):582–591.
    1. Wax R.S., Christian M.D. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020 Feb;12:1–9.
    1. Australian Government Department of Health Guidance on the use of personal protective equipment (PPE) in hospitals during the COVID-19 outbreak. Available from.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren