Research Paper on Use of Personal Protective Equipment
Personal protective equipment is worn by healthcare professionals prior to contact with hazardous materials or contagious patients. PPE is used to prevent the spread of infection and examples of this include gowns, gloves, masks, and goggles. The type of PPE that is used will be determined by the isolation precaution the patient is put on. The correct order for donning PPE is gown, mask, gloves, then goggles (Mahmood et al., 2020). When donning the gown, it should be secured around the neck and waist. Then, in order to correctly wear gloves, they have to overlap the gown so no skin is left uncovered. The second pair of gloves can be worn in case the first pair becomes soiled so you can doff the dirty pair without contaminating yourself. When it is time to leave the room, PPE will be doffed in the following order: gloves first, then the gown, preceded by the goggles, and lastly the mask (Mahmood et al., 2020).
Even with these infection prevention protocols in place, there is a growing concern with multidrug resistant organisms. Some of the most common MDROs are C. diff, MRSA, and vancomycin resistant enterococcus (VRE) (Multidrug resistant organisms (mdros) and clostridioides difficile (C. diff), 2020). The reason that MDROs are difficult to get rid of is that they spread “by direct contact with an infected person’s bodily fluids such as stool, wound drainage, sputum, urine, and blood” (Memorial Sloan Kettering Cancer Center, 2021). While this type of infection can be prevented, it is costing hospitals a significant amount of money each year. the use of personal protective equipment is mandatory to reduce the spread of MDROs. The purpose of this project was to determine if proper donning techniques impacted the spread of microorganisms. For this project, the following EBP question has been formulated; In nurses who care for patients in isolation (P), how does properly donning PPE (I) affect the spread of multidrug resistant organisms?
In a randomized controlled trial study, researchers investigated the effect that universal gown and glove precautions had on the spread of MRSA in ICU patients spread throughout 20 different hospital sites. Research showed a “40.2% relative reduction in MRSA acquisition rates” (Harris et. al, 2017). However, these findings were not able to distinguish just how much of the reduction was due to the use of isolation precautions. Therefore, a separate study was conducted to build off these results and gain more specific data. Through the use of a carefully calibrated agent-based model and simulation replications, this study determined that glove and gown utilization resulted in a 44 % decrease in MRSA transmissions providing evidence that protective equipment can prevent the spread of MDROs in certain settings (Harris et. al, 2017).
An interesting bundle intervention study consisting of a control and experimental group. This study evaluated the efficacy of isolation precautions, hand hygiene, and screening in the prevention of healthcare-associated MRSA. Over 11,000 patients were used for the study which found that compliance with isolation precautions for MRSA rose from 55.88% to 92.86%” (Huang et al., 2019). This is a significant increase and further data showed that Hospital Acquired infections and MRSA detection rates declined as well. The conclusion of this study found that multifaceted measures like isolation precautions can be taken to prevent MRSA transmission (Huang et al., 2019).
Human factors and education may also play a role in infection control. A cross-sectional study was conducted within two university hospitals in Seoul, South Korea to determine which factors contribute to nursing compliance with infection control. The survey consisted of 20 items that were categorized over four areas: handwashing, contaminated material control, protective equipment, and MDRO control (Kim et al., 2020). Nurses were given the task of grading themselves on how often they performed each of the four areas on a scale of 1 (never) to 5 (always). Each nurse that participated was given information about the study, which included not only the purpose and method of the survey but information regarding their confidentiality and autonomy as well (Kim et al., 2020). If a nurse agreed to be involved in this study, they signed a consent form, filled out the survey, and dropped it into the ICU survey box, which would be collected a week after the surveys were handed out. From the two hospitals, a total of 197 nurses participated in the survey and the average percentage of self-reported infection prevention and control practices was 87%; meaning nurses admitted to not following safe infection prevention and control practices 13% of the time (Kim et al., 2020). This study concluded that hospitals, especially ones with novice nurses, need further teaching to improve knowledge about MDRO control (Kim et al., 2020).
Furthermore, the last source of information contributing to our project was a systematic literature review consisting of 19 different published works. Each source identified facilitators and barriers to MRSA exposure in the NICU. The information useful to our project was that “the prevalence of human carriers of the disease creates the perfect environment in which a lack of strict adherence can propagate MRSA infection” (Mileski et al., 2018). Therefore, individuals must recognize their role in the spread of MDROS.
After conducting the research necessary for this assignment, we recommend that each time you encounter a patient who is on isolation precautions, you wear the proper PPE. Even if a nurse is simply going into a patient's room to set down a food tray, proper PPE protocols need to be followed. This includes hand hygiene and the appropriate donning and doffing of the personal protective equipment. As mentioned earlier, the proper donning sequence is a gown, mask, gloves, and then goggles while the doffing sequence is gloves, gown, goggles, and lastly the mask. Not only is it important for nurses to wear proper PPE to protect themselves, but to protect the patients that are elderly, have a weakened immune system, are diagnosed with a chronic illness, or have had recent surgery (Memorial Sloan Kettering Cancer Center, 2021).
