Adherence to Personal Protective Equipment for Pandemic Influenza

Background: Proper use of personal protective equipment (PPE) is essential for reducing transmission of the novel H1N1 influenza A virus. However, compliance with PPE is suboptimal.

Objective: To assess the knowledge, attitudes and self-reported practices of healthcare workers regarding PPE for the novel H1N1 influenza A pandemic at an academic medical center.

Methods: We undertook an electronic survey which was sent to nursing healthcare workers and faculty/housestaff. Questions pertaining to the frequency of PPE use, attitudes and perceptions regarding PPE were asked. A 10 point Likert scale was used for most questions. The survey was refined following pilot testing. Results were analyzed using StatsDirect software. Proportions were calculated and responses among the various categories of healthcare workers were compared using logistic regression.

Results: We obtained 619 responses, 79 respondents were faculty or housestaff and 459 were nurses.45% of respondents worked in general inpatient care, 20% in the ICU and 31% in the outpatient setting. 69% worked with adults and 16% with children. 21% had worked for 5-10 years, 21% for 11-20 years and 28% for more than 20 years. 20% of respondents felt that PPE was too cumbersome. 84% said a fit tested N-95 respirator was required, 88% correctly identified that a surgical mask was suitable to place on patients with a febrile respiratory illness. When asked how often they donned PPE for H1N1, 83% of healthcare workers said they wore PPE for each contact with suspected/confirmed H1N1 patients. When we compared factors hindering PPE use in faculty/housestaff compared with nurses, faculty or housestaff were more likely to state that PPE was cumbersome (OR 3.33, 95% CI 1.787-5.88), more likely to be unsure of decontamination procedures following removal of PPE (OR 3.33, 95% CI 1.21-5.88)and more likely to state that they had difficulty identifying the respirator they had been fit tested for (OR 3.3, 95% CI 1.8-11.8).

Conclusions: HCWs report suboptimal levels of adherence to PPE for H1N1 infection.  Faculty and housestaff were more likely to have gaps in knowledge and practices regarding PPE use. Given the differences in PPE recommendations for H1N1 influenza and seasonal influenza, intensive education is required to ensure adequate knowledge of  and adherence to PPE for influenza, including the novel H1N1 virus.