2019 Research Forum

Harpreet Bal RN, Gabriela Hendrix RN, Stephanie Montes RN, Nicole Spiropoulos RN Medical-Surgical Unit (3C and 3D) Personal Protective Equipment Compliance of Visitors on Medical-Surgical Unit

Introduction

Methods

Conclusions Our research project revealed an increase in education and an increase in compliance rates regarding proper PPE among patient visitors in isolation precautions on 3C and 3D of Kern Medical’s Med-Surg/Tele unit from 40% to 70% compliance. Prior to the implementation of the educational brochure, our studies revealed a 60% non-compliance rate with proper donning and doffing personal protective equipment, while only 40% were compliant. Through developing the five question survey, we were able to assess and establish the visitors baseline education on the isolation precautions. The pre- implementation education showed that up to half of the visitors received no education regarding PPE and the other half received some education, nurse education, and care notes. There were barriers to visitors’ compliance with PPE during the research project. Barriers include initial education, not being well informed, unable to grasp the concept, improper donning and/or doffing of PPE, timing, and a total disregard of education. We established an educational brochure specifically for visitors of patients on contact isolation precautions. This brochure depicted a step by step visual aid in the proper donning and doffing of PPE. After implementation of the brochure, we reassessed knowledge and compliance and found compliance and education rates increased among visitors. Therefore, based on our results of this study, implementation of the educational brochure on PPE requirements will lead to an overall increase in compliance rates among patient’s visitors. Our research project did have some limitations. Unfortunately, the project’s timeframe, a three-month study starting in October 2018 through December 2018, limits the ability to determine whether compliance rates would remain high over an extended period of time. Also, the number of participants in the research project may not represent the entirety of the visitor population. The research project contained a relatively small sample size of 20 participants during pre-implementation and 20 participants during post-implementation. Thus, this sample size may not show a proper view of the actual population size. We recommend: • Increase the length of this research study to 6-9 months to exemplify a comprehensive and more accurate population. • Utilize nurses to hand out the educational brochure on admission or with the admission education packet to ensure immediate education regarding isolation precautions. Lastly, providing the brochure in other languages may help provide to Kern County’s broad cultural population. References Alsmeyer, M. R. (2014). Increasing Compliance of Personal Protective Equipment Selection and Use for Isolation Precautions Among RNs & NAs on a Med-Surg- Unit. Master's Projects and Capstones. 77 . Retrieved from htp://repository.usfca.edu/capstone/77 CDC (n.d.). Retrieved from https://www.cdc.gov.html Krein, S. L., Mayer, J., Harrod, M., Weston, L. E., Gregory, L., Petersen, L., Drews, F. A. (2018). Identification and Characterization of Failures in Infectious Agent Transmission Precaution Practices in Hospitals. JAMA Internal Medicine,178 (8), 1051. doi:10.1001/jamainternmed.2018.1898 U.S. Department of Health and Human Services, U.S. Department of Defense, and U.S. Department of Veterans Affairs. (2013). National action plan to prevent health care associated infections: Road map to elimination. Retrieved from http://www.hhs.gov/ash/initiatives/hai/index.html Ontario Agency for Public Health Protection and Promotion, (2013) Public Health Ontario . Retrieved from https://www.publichealthontario.ca/fr/eRepository/ECT_PPE_Sequence_2013. pdf Acknowledgements We would like to thank Pamela Gavin (NRP Director) for all her hard work and dedication toward our NRP program, Roger Miller (3C Supervisor) and Patricia Baldivia (3D Supervisor) for allowing us to present our project on both units, Beth Ann Tilley (Senior Office Services Specialist) for printing our educational material for our project, Kristi Brownfield (Infection Preventionist) and Nicole Pumphrey (Infection Control Coordinator) for guiding us towards our project idea, Thad (from engineering) for providing us with laminated material for our project, Valerie Cantorna & Leah Noriega (NRP Educational Coordinators) for assisting our group with valuable feedback and ideas for areas of research, the nurses on 3C & 3D (Kern Medical’s Medical- Surgical and Telemetry units) for taking the time to participate in our study, and finally we would like to thank the visitors that were surveyed for our study.

Survey Compliance (Based on observation) Was the PPE placed and removed properly? Education 1. How were you aware that the patient is on isolation - did someone tell you or did you see the sign? 2. What do you know about your isolation, what education did you receive? 3. Do you know where the isolation equipment is located?

According to the the Center for Disease Control (CDC), approximately 1.7 million healthcare associated infections occur in U.S. hospitals every year. This has led to an excess $40 billion annually, in health care costs (U.S. Department of HHS, 2013). Healthcare workers are at risk for occupational infections when performing clinical activities. They are exposed to many infectious pathogens such as; MRSA, C-diff, ESBL, and VRE. “Using personal protective equipment and isolation precautions are primary strategies for reducing the transmission of infectious agent” (Krein, 2018). Personal protective equipment (PPE) includes hand hygiene, specialized gowns, and gloves; it may also include masks, goggles, and face shields depending on the of isolation precaution. Failure to use proper PPE can potentially lead to self-contamination and further spread infectious agents. Preventing the spread of infectious organisms is a priority for hospitals and health care workers. A main concern is the spread of organisms and the possibility of cross contamination. This can lead to patients becoming colonized with bacteria and acquire many different infections such as hospital acquired C-diff and MRSA. Isolation precautions are a key to infection prevention, as it helps protect health care personnel, patients, and visitors. “The strict use of PPE provides a safe barrier between the patient and healthcare workers by actively preventing physical contact or filtering out infectious particles” (Alsmeyer, 2014). Studies suggest that there is a poor compliance with PPE use. “One study found less than 50% personnel removed their PPE in the correct order and only 17% both properly removed and disposed of their PPE in the patient room” (Krein, 2018). Violations and noncompliance that were observed range from entering the isolation rooms without proper PPE placement (donning), incomplete donning and doffing (removing), and disposing of PPE improperly. This was often observed with health care professionals and patient visitors. Although health care personnel are educated regarding PPE requirements, visitors on the other hand, have minimal knowledge regarding PPE. Due to the lack of education on PPE, visitors have a higher risk of being noncompliant and increase the spread of infection to their family members and health care personnel. The key is to train and educate visitors to demonstrate their knowledge, compliance, and proficiency when donning and doffing PPE properly. The purpose of this project is to determine visitor’s level of education and knowledge on PPE standards and educating the gap in their knowledge. 1. Observe compliance and noncompliance rates among visitors. 2. Determine visitor’s level of education by assessing their knowledge through a survey questionnaire. 3. Identifying components of noncompliance? -Initial Education (not being informed) A qualitative study will be preformed identifying the objectives listed above. The study will be limited to a population of 40 visitors, for those patients on isolation precautions. A five question survey will be provided to visitors to evaluate education of PPE on the Medical Surgical units, 3C and 3D of Kern Medical Hospital. In addition, we will be observing compliance rates of PPE among visitors.

4. Do you understand the contact precautions the patient is on? 5. Do you know which equipment is required for you to wear?

DonningandDoffingposter

Brochurepg1

Brochurepg2

Isolationposter

The sample size for this study is 40 visitors (20 before and 20 after implementation). Data from the observation and survey were collected and results are shown in the charts below. Visitor compliance to PPE improved from 40% compliant to 70% compliant after education. Results

Objectives

Pre-Implementation Education

Pre Implementation Compliance

Some Education 6%

Nurse Education 31%

Compliant8/20 40%

Compliant 8/20

NonCompliant12/20 60%

No Education 50%

NonCompliant 12/20

Care Notes 13%

A brochure will be distributed to visitors to properly educate on PPE. After teaching, knowledge and compliance will be re-assessed.

The goal of this study is to increase compliance rates by educating the patients and visitors.

Post-Implementation Education

Post Implementation Compliance

Some Education 7%

NonCompliance6/20 30%

Compliance 14/20 NonCompliance 6/20

No Education 28%

Nurse Education 47%

Compliance14/20 70%

Care Notes 18%

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