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

Crit Care Med. 2009 Feb 24. [Epub ahead of print] LinkOut

Daugherty EL, Perl TM, Needham DM, Rubinson L, Bilderback A, Rand CS.

From the Division of Pulmonary/Critical Care Medicine (ELD, DMN, AB, CSR), and Division of Infectious Diseases (TMP), Johns Hopkins University School of Medicine, Baltimore, MD; and Division of Pulmonary/Critical Care Medicine (LR), Department of Medicine, University of Washington, Seattle, WA.

BACKGROUND:: Intensive care units (ICUs) are potential high-risk areas for transmission of viruses causing febrile respiratory illness, such as influenza. Health care-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 health care-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 health care-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, 84% (n = 244) completed the survey. Only 55% of respondents were able to correctly identify adequate influenza PPE, and 61% 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 0.43, 95% confidence interval 0.22-0.82), and those reporting likelihood of being reprimanded for nonadherence were more likely to adhere (odds ratio 2.16, 95% confidence interval 1.13-4.11).

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.PMID: 19242326 [PubMed - as supplied by publisher]