Personal Protective Equipment (PPE) for Infection Control in Healthcare Settings

EDUCATIONAL RESOURCEEDUCATIONAL RESOURCE
Name of the Student
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BACKGROUND
RESEARCH OBJECTIVES
RESULTS
REFERENCES
A narrative literature review was conducted on the research question. A start strategy was adopted with
the identification of important key phrases and concepts present within the research question. The
singular and plural forms of the key terms were also taken into consideration. Some of the major search
phrases used in this case were ‘infection’, ‘nosocomial’, ‘rates’, ‘personal protective equipment’, ‘PPE’,
‘nurse’, ‘nursing staff’, ‘prevention’, and ‘reduction’. These terms were combined with the use of Boolean
operators and fed into two electronic database namely, PubMed and CINAHL. Use of filters helped in
restricting the retrieved articles to those published in English on or after 2013. These articles were
appraised with the use of CASP critical appraisal tool that helped in determining the trustworthiness and
rigour of the scholarly articles. A total of four articles were selected for the purpose.
• To determine the effectiveness of PPE in clinical setting
• To explore the different PPE that can be used by nursing staff in clinical setting
Apart from one study, the others could establish an association between use of PPE and rates of
infection due to transmission of germs in healthcare settings. The findings provide evidence for the fact
that use of PPE acts as a barrier between germs and the healthcare workers, thereby lowering the rates
of being exposed to germs and eliminating chances of infection.
A hospital acquired infection or nosocomial infection is encountered in healthcare settings due to the
onset of a toxin or infection that exists at a particular location, such as a nursing home or hospital.
Although the two terms are used interchangeably, an HAI infection must not be existing before a patient
has been admitted under clinical care. The intensive care units or ICUs have been recognised as the
major sites where most of the HAIs occur, due to the fact that the healthcare staff treat chronic and
serious health complications in the unit (Cornejo-Juárez et al. 2015). Increase in the rates of HAI have
been significantly correlated with momentous mortality, morbidity, increased length of stay in hospitals,
and high costs of treatment. With an increase in complexity in healthcare services and antibiotic
resistance, the incidence of HAIs is expected to increase (Leyland et al. 2016). Personal protective
equipment (PPE) in healthcare refers to the use of protective helmets, clothing, face shields, gloves,
facemasks, goggles, and respirators for protesting the staff from the spread of infectious agents. These
PPE act in the form of barrier and have the potential of blocking the transmission of a range of
contaminants from body fluids, blood, or respiratory secretions. PPE also has the potential of providing
protection to the admitted patients who have been found to lie at an increased risk for acquiring
infections via implementation of any surgical procedure or immunodeficiency. Furthermore, the chances
of infection get increased due to exposure to potentially infectious items that are brought in the
healthcare setting by the healthcare workers and the visitors (Centers for Disease Control and
Prevention 2014). All personal protective equipment (PPE) that are intended for usage in the form of
medical devices must follow the regulations propose by the department of health of the state. Wearing
gloves have the benefit of protecting the hands from the spread of germs. Masks are used for covering
the nose and the mouth. Clothing also acts as an essential PPE and encompasses head covering,
aprons, gowns and shoe covers. Hence, the primary objective is to formulate a PICO question for
determining the efficacy of PPE.
Centers for Disease Control and Prevention, 2014. Guidance on personal protective equipment to be used by healthcare
workers during management of patients with Ebola virus disease in US hospitals, including procedures for putting on
(donning) and removing (doffing). Atlanta, GA: CDC.
Cornejo-Juárez, P., Vilar-Compte, D., Pérez-Jiménez, C., Namendys-Silva, S.A., Sandoval-Hernández, S. and Volkow-
Fernández, P., 2015. The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology
intensive care unit. International Journal of Infectious Diseases, 31, pp.31-34.
Fischer II, W.A., Weber, D.J. and Wohl, D.A., 2015. Personal protective equipment: Protecting health care providers in an
Ebola outbreak. Clinical therapeutics, 37(11), pp.2402-2410.
Hersi, M., Stevens, A., Quach, P., Hamel, C., Thavorn, K., Garritty, C., Skidmore, B., Vallenas, C., Norris, S.L., Egger, M.
and Eremin, S., 2015. Effectiveness of personal protective equipment for healthcare workers caring for patients with
filovirus disease: a rapid review. PloS one, 10(10), p.e0140290.
John, A., Tomas, M.E., Cadnum, J.L., Mana, T.S., Jencson, A., Shaikh, A., Zabarsky, T.F., Wilson, B.M. and Donskey, C.J.,
2016. Are health care personnel trained in correct use of personal protective equipment?. American journal of infection
control, 44(7), pp.840-842.
Leyland, N.S., Podporska-Carroll, J., Browne, J., Hinder, S.J., Quilty, B. and Pillai, S.C., 2016. Highly Efficient F, Cu doped
TiO 2 anti-bacterial visible light active photocatalytic coatings to combat hospital-acquired infections. Scientific
reports, 6, p.24770.
McGowan, J., Sampson, M., Salzwedel, D.M., Cogo, E., Foerster, V. and Lefebvre, C., 2016. PRESS peer review of
electronic search strategies: 2015 guideline statement. Journal of clinical epidemiology, 75, pp.40-46.
Mitchell, R., Roth, V., Gravel, D., Astrakianakis, G., Bryce, E., Forgie, S., Johnston, L., Taylor, G., Vearncombe, M. and
Canadian Nosocomial Infection Surveillance Program, 2013. Are health care workers protected? An observational
study of selection and removal of personal protective equipment in Canadian acute care hospitals. American journal of
infection control, 41(3), pp.240-244.
METHODOLOGY
The PICO question framework was used with the aim of framing a healthcare related clinical question,
and associated literature search techniques (McGowan et al. 2016). The research question was as
follows:
Does the use of PPE reduce the rates of infection in a clinical care setting?
The four core components of the PICO framework are given below:
P Nursing staff
I Wearing personal protective equipment
C No protection measures
O Reduced rates of nosocomial and hospital
acquired infections
Questions Article 1 (John et al. 2016) Article 2 (Mitchell et al.
2013)
Article 3 (Fischer II, Weber
and Wohl 2015)
Article 4 (Hersi et al. 2015)
Was there a clear statement
of the aims of the research?
Yes. The aim was to
determine the presence of
training in relation to use of
PPE among healthcare
workers
Yes. The objective was to
assess the protection levels
of the healthcare workers
regarding PPE.
Yes. The article investigated
the association between use
of PPE and spread of Ebola
virus
Yes. The authors
investigated the
effectiveness of Personal
Protective Equipment used
by healthcare workers for
the prevention of Filovirus
disease
Is a methodology
appropriate?
Yes. Electronic surveys
were sent to the hospital for
collection of data
Yes. Conduction of an
observational study helped
to draw inference from the
sample population
Yes. The researchers
conducted a secondary data
analysis
Yes. A secondary research
was conducted by the
authors ford determining
PPE efficacy in filovirus
outbreak
Was the research design
appropriate to address the
aims of the research?
Yes, the observational
study was accurate to
determine the presence of
PPE trained personnel
Yes. The research was
conducted in a way that
helped in surveying
healthcare workers who
used PPE and performed
hand hygiene techniques
Yes. The article tried to
establish the link between
presence of Ebola virus on
PPE and the transmission of
the disease
Yes. Conduction of
secondary research helped
in collation, summarising,
and synthesis of already
existing evidences on PPE
usage and benefits.
Was the recruitment
strategy appropriate to the
aims of the research?
No. Convenience sampling
suffers from biases in
selection and is not chosen
at random
Yes. The study recruited all
physicians, nurses,
laboratory technicians,
respiratory therapists, and
housekeeping
No clear information
regarding selection of
sample was provided
Yes. Use of a rapid review
strategy helped in retrieval
of evidences in a timely
manner that facilitated
decision making
Was the data collected in a
way that addressed the
research issue?
Yes. Use of electronic
surveys helped in
addressing the issue
Yes. Data collection was
related to the assortment
and removal of PPE.
Yes. The researchers were
able to identify the function
of PPE and the risks that
are associated with
infections
Yes. Appropriate inclusion
and exclusion criteria helped
in analysing articles that
addressed the role of PPE in
preventing infection in
clinical settings
Has the relationship
between researcher and
participants been
adequately considered?
No clear information
provided on the same
Yes. Trained observers
were instructed on the data
collection procedure
No information was provided
on the same
No information was provided
on the same
Have ethical issues been
taken into consideration?
The study received approval
from the Cleveland Veterans
Administration Medical
Center Institutional Review
Board
No informed consent was
required.
No information was provided
on the same
No information was provided
on the same
Is there a clear statement of
findings?
Yes. 14% workers did not
report any previous PPE
training
Most workers used gloves
(885), masks (88%), and
gowns (83%). Eye
protection were used by only
37% workers.
Yes. The common sites of
transmission of Ebola virus
must be covered with
appropriate PPE for
preventing the spread of
infection.
No. The comparative
effectiveness of the PPE
types were not established.
How valuable is the
research?
PPE training was identified
suboptimal in health care
facilities
Adherence to use of
appropriate PPE in
healthcare settings was
recommended as the best
precaution against HAIs.
The article established the
importance of PPE in
infection prevention.
Poor reporting of PPE use
and infection prevention
failed to add value to the
research
CONCLUSION
Personal protective equipment (PPE) must be put on by healthcare workers as an effective infection
control strategy.