Emma Hitt, PhD

March 23, 2010

March 23, 2010 (Atlanta, Georgia) — Personal protective equipment (PPE) is frequently used when it is not clinically indicated, with gloves being used more than 40% of the time when they are not indicated, according to a new study.

Timothy F. Landers, CNP, PhD, from Ohio State University in Columbus, and colleagues presented the findings here at the Fifth Decennial International Conference on Healthcare-Associated Infections 2010.

"Appropriate use of personal protective equipment is important and reduces the risk of healthcare-associated infections and protects healthcare workers," Dr. Landers told Medscape Infectious Diseases. "However, these precautions can also have drawbacks and should only be used when they provide a clear benefit."

Dr. Landers and colleagues sought to determine the extent of unnecessary use of PPE and isolation precautions among practicing nurses at a single academic medical center. A total of 317 nurses responded to a Web-based questionnaire asking which PPE they would use in 10 clinical scenarios. Scenarios included a brief clinical history and a specific care task that was to be performed.

Gloves were the most overused PPE. In scenarios with no clinical indications for isolation, 42.1% of respondents said they would use gloves, 19.2% said they would use fluid shields, and 13.1% said they would use N-95 respirators, whereas less than 10% said that they would use unnecessary eye protection (8.3%), surgical masks (6.2%) and sterile gloves (6.2%).

In 3 scenarios requiring the use of only standard isolation precautions, excess use was indicated in 38.7%, 11.6%, and 9.3%.

The researchers reported that greater infection control knowledge decreased the likelihood of selecting unnecessary glove use (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.79 - 0.94; P < .01) and fluid shield use (OR, 0.94, 95% CI, 0.90 - 0.98; P < .01). Sex, practice location, and years of experience did not appear to influence the extent of PPE use.

"Written policy (84.9%) and infection preventionists/hospital epidemiologists (76.3%) were most frequently cited as important sources of information for infection control practices," the authors stated in their poster. "Other sources included colleagues (41.1%), nurse managers (33.8%), and self-learning (33.3%)."

"It is increasingly recognized that there may be adverse effects associated with the use of PPE in isolation precautions, including higher rates of depression and anxiety, higher risk for falls, limited contact with physicians and nurses, and possibly lower patient satisfaction," Dr. Landers pointed out.

According to Dr. Landers, efforts to encourage the use of PPE should look at ways to improve PPE adherence in appropriate situations and recognize that the overuse of these precautions could be a drawback of these programs.

"These are very interesting and novel findings," said Allison Aiello, PhD, MS, assistant professor of epidemiology at the University of Michigan in Ann Arbor. "Existing studies describe the incorrect use of PPE but none has characterized the potential for overuse under specific scenarios," she told Medscape Infectious Diseases.

According to Dr. Aiello, the findings might have economic and patient-treatment implications. "For example, 13% of participants said they would use an N-95 respirator in a scenario with no clinical indication for use," she said. "This type of PPE is costly and, in some settings, may be in limited supply, as was the case during the start of the H1N1 pandemic."

Dr. Aiello added that it would be of interest to examine whether the reported use in this study matches the actual practices of the participants when faced with these scenarios in the clinical setting, and also whether reported PPE use under these scenarios changes after outbreaks in the hospital setting .

This study was supported by a Centers for Disease Control and Prevention Cooperative Agreement. Dr. Landers was supported by a training grant from the National Institute of Nursing Research. Dr. Aiello has disclosed no relevant financial relationships.

Fifth Decennial International Conference on Healthcare-Associated Infections (ICHAI) 2010: Abstract 626. Presented March 20, 2010.

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