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Effectiveness of a multisite personal protective equipment (PPE)–free zone intervention in acute care

Published online by Cambridge University Press:  07 June 2019

Lindsay D. Visnovsky Open the ORCID record for Lindsay D. Visnovsky [Opens in a new window] ,
Yue Zhang ,
Molly K. Leecaster ,
Nasia Safdar ,
Lauren Barko ,
Candace Haroldsen ,
Diane L. Mulvey ,
McKenna Nevers ,
Catherine Shaughnessy  and
Kristina M. Stratford
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Lindsay D. Visnovsky*
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Yue Zhang
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Molly K. Leecaster
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Nasia Safdar
Affiliation:
William S. Middleton VA Hospital, Madison, Wisconsin Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
Lauren Barko
Affiliation:
Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
Candace Haroldsen
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Diane L. Mulvey
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
McKenna Nevers
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Catherine Shaughnessy
Affiliation:
Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
Kristina M. Stratford
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Frank A. Drews
Affiliation:
Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah Department of Psychology, University of Utah, Salt Lake City, Utah
Matthew H. Samore
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Jeanmarie Mayer
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
*
Author for correspondence: Lindsay D. Visnovsky, Email: lindsay.visnovsky@hsc.utah.edu
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Abstract

Objective:

Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.

Design:

Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.

Setting:

All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.

Intervention:

A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.

Results:

We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.

Conclusions:

HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 7 , July 2019 , pp. 761 - 766
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

PREVIOUS PRESENTATION: Some of the data reported in this article were presented at IDWeek 2018, on October 3-7, 2018, in San Francisco, California.

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