The use of personal protective equipment for control of influenza among critical care clinicians: A survey study

Elizabeth L. Daugherty, Trish M. Perl, Dale M. Needham, Lewis Rubinson, Andrew Bilderback, Cynthia S. Rand

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

BACKGROUND: Intensive care units (ICUs) are potential high-risk areas for transmission of viruses causing febrile respiratory illness, such as influenza. Healthcare-associated influenza is prevented through healthcare worker (HCW) vaccination and effective use of U.S. Centers for Disease Control and Prevention recommended infection control practices, including use of personal protective equipment (PPE). Although effective PPE use may significantly reduce healthcare-associated influenza transmission, PPE adherence among ICU HCWs for preventing nosocomial influenza infection has not been evaluated. OBJECTIVE: To characterize ICU HCW behavior, knowledge, and attitudes about recommended precautions for the prevention of healthcare-associated influenza infections. DESIGN, SETTING, AND PARTICIPANTS: A survey of 292 internal medicine housestaff, pulmonary/critical care fellows and faculty, nurses, and respiratory care professionals working in four ICUs in two hospitals in Baltimore, MD. MEASUREMENTS AND MAIN RESULTS: Of those surveyed, 88% (n = 256) completed the survey. Only 63% of respondents were able to correctly identify adequate influenza PPE, and 62% reported high adherence (>80%) with PPE use for prevention of nosocomial influenza. In multivariable modeling, odds of high adherence varied by clinician type. Respondents who believed adherence was inconvenient had lower odds of high adherence (odds ratio 0.42, 95% confidence interval 0.22-0.82), and those reporting likelihood of being reprimanded for nonadherence were more likely to adhere (odds ratio 2.40, 95% confidence interval 1.25-4.62). CONCLUSIONS: ICU HCWs report suboptimal levels of influenza PPE adherence. This finding in a high-risk setting is particularly concerning, given that it likely overestimates actual behavior. Both suboptimal adherence levels and significant PPE knowledge gaps indicate that ICU HCWs may be at a substantial risk of developing and/or transmitting nosocomial respiratory viral infection. Improving respiratory virus infection control will likely require closing knowledge gaps and changing organizational factors that influence behavior.

Original languageEnglish (US)
Pages (from-to)1210-1216
Number of pages7
JournalCritical Care Medicine
Volume37
Issue number4
DOIs
StatePublished - Apr 1 2009

Fingerprint

Critical Care
Human Influenza
Intensive Care Units
Cross Infection
Delivery of Health Care
Virus Diseases
Infection Control
Respiratory Tract Infections
Odds Ratio
Confidence Intervals
Baltimore
Surveys and Questionnaires
Personal Protective Equipment
Centers for Disease Control and Prevention (U.S.)
Internal Medicine
Vaccination
Fever
Nurses
Viruses
Lung

Keywords

  • Critical care
  • Infection control and prevention
  • Personal protective equipment
  • Survey

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

The use of personal protective equipment for control of influenza among critical care clinicians : A survey study. / Daugherty, Elizabeth L.; Perl, Trish M.; Needham, Dale M.; Rubinson, Lewis; Bilderback, Andrew; Rand, Cynthia S.

In: Critical Care Medicine, Vol. 37, No. 4, 01.04.2009, p. 1210-1216.

Research output: Contribution to journalReview article

Daugherty, Elizabeth L. ; Perl, Trish M. ; Needham, Dale M. ; Rubinson, Lewis ; Bilderback, Andrew ; Rand, Cynthia S. / The use of personal protective equipment for control of influenza among critical care clinicians : A survey study. In: Critical Care Medicine. 2009 ; Vol. 37, No. 4. pp. 1210-1216.
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abstract = "BACKGROUND: Intensive care units (ICUs) are potential high-risk areas for transmission of viruses causing febrile respiratory illness, such as influenza. Healthcare-associated influenza is prevented through healthcare worker (HCW) vaccination and effective use of U.S. Centers for Disease Control and Prevention recommended infection control practices, including use of personal protective equipment (PPE). Although effective PPE use may significantly reduce healthcare-associated influenza transmission, PPE adherence among ICU HCWs for preventing nosocomial influenza infection has not been evaluated. OBJECTIVE: To characterize ICU HCW behavior, knowledge, and attitudes about recommended precautions for the prevention of healthcare-associated influenza infections. DESIGN, SETTING, AND PARTICIPANTS: A survey of 292 internal medicine housestaff, pulmonary/critical care fellows and faculty, nurses, and respiratory care professionals working in four ICUs in two hospitals in Baltimore, MD. MEASUREMENTS AND MAIN RESULTS: Of those surveyed, 88{\%} (n = 256) completed the survey. Only 63{\%} of respondents were able to correctly identify adequate influenza PPE, and 62{\%} reported high adherence (>80{\%}) with PPE use for prevention of nosocomial influenza. In multivariable modeling, odds of high adherence varied by clinician type. Respondents who believed adherence was inconvenient had lower odds of high adherence (odds ratio 0.42, 95{\%} confidence interval 0.22-0.82), and those reporting likelihood of being reprimanded for nonadherence were more likely to adhere (odds ratio 2.40, 95{\%} confidence interval 1.25-4.62). CONCLUSIONS: ICU HCWs report suboptimal levels of influenza PPE adherence. This finding in a high-risk setting is particularly concerning, given that it likely overestimates actual behavior. Both suboptimal adherence levels and significant PPE knowledge gaps indicate that ICU HCWs may be at a substantial risk of developing and/or transmitting nosocomial respiratory viral infection. Improving respiratory virus infection control will likely require closing knowledge gaps and changing organizational factors that influence behavior.",
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AB - BACKGROUND: Intensive care units (ICUs) are potential high-risk areas for transmission of viruses causing febrile respiratory illness, such as influenza. Healthcare-associated influenza is prevented through healthcare worker (HCW) vaccination and effective use of U.S. Centers for Disease Control and Prevention recommended infection control practices, including use of personal protective equipment (PPE). Although effective PPE use may significantly reduce healthcare-associated influenza transmission, PPE adherence among ICU HCWs for preventing nosocomial influenza infection has not been evaluated. OBJECTIVE: To characterize ICU HCW behavior, knowledge, and attitudes about recommended precautions for the prevention of healthcare-associated influenza infections. DESIGN, SETTING, AND PARTICIPANTS: A survey of 292 internal medicine housestaff, pulmonary/critical care fellows and faculty, nurses, and respiratory care professionals working in four ICUs in two hospitals in Baltimore, MD. MEASUREMENTS AND MAIN RESULTS: Of those surveyed, 88% (n = 256) completed the survey. Only 63% of respondents were able to correctly identify adequate influenza PPE, and 62% reported high adherence (>80%) with PPE use for prevention of nosocomial influenza. In multivariable modeling, odds of high adherence varied by clinician type. Respondents who believed adherence was inconvenient had lower odds of high adherence (odds ratio 0.42, 95% confidence interval 0.22-0.82), and those reporting likelihood of being reprimanded for nonadherence were more likely to adhere (odds ratio 2.40, 95% confidence interval 1.25-4.62). CONCLUSIONS: ICU HCWs report suboptimal levels of influenza PPE adherence. This finding in a high-risk setting is particularly concerning, given that it likely overestimates actual behavior. Both suboptimal adherence levels and significant PPE knowledge gaps indicate that ICU HCWs may be at a substantial risk of developing and/or transmitting nosocomial respiratory viral infection. Improving respiratory virus infection control will likely require closing knowledge gaps and changing organizational factors that influence behavior.

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