PERSONAL PROTECTIVE EQUIPMENT

II. PERSONAL PROTECTIVE EQUIPMENT:

GLOVES
1. Wear gloves when touching blood, body fluids, secretions,
excretions, mucous membranes, non-intact skin.
2.87 Highly Adhered
2. Change gloves between tasks and procedures on the
same patient after contact with potentially infectious
material.
2.71 Highly Adhered
3. Remove gloves after use, before touching non-
contaminated items and surfaces, and before going to
another patient.
2.86 Highly Adhered
GLOVES 2.81 HIGHLY ADHERED
FACIAL PROTECTION (eyes, nose, mouth)
4. Wear mask when performing operations/procedures that
might induce spraying of blood, body fluid, secretions
and excretions.
2.80 Highly Adhered
5. Wear protective eye patch or goggle when performing
operations/procedures that might induce spraying of
blood, body fluid, secretions and excretions.
2.10 Moderately Adhered
FACIAL PROTECTION 2.45 HIGHLY ADHERED
GOWN AND CAP
6. Wear protective suit or gown when performing
operations/procedures that might induce spraying of
blood, body fluid, secretions and excretions.
2.30 Moderately Adhered
7. Wearing protective cap or shoe shade to protect hair or
shoes in instances that might induce the spraying,
flowing or leaking of blood, body fluid, secretion or
excretion.
2.07 Moderately Adhered
GOWN AND CAP

2.18 MODERATELY
ADHERED
TOTAL PPE 2.53 HIGHLY ADHERED


RESULTS
Analyses of respondents extent of adherence being classified to as highly
adhered, moderately adhered and highly adhered were evaluated using
weighted mean.
Table 2 indicates adherence among Staff Nurses of ITRMC to the use of
Personal Protective Equipment categorized as glove-use during procedures,
using of facial protection (eyes, nose, and mouth) and wearing gowns and caps
which was adapted to WHO guidelines for Standard Precaution.
With reference to the above result under the GLOVE category, first item
which is wearing of gloves when touching blood, body fluids, secretions,
excretions, mucous membranes, non-intact skin has a weighted mean of 2.87,
next item which is changing of gloves between tasks and procedures on the
same patient after contact with potentially infectious material has a weighted
mean of 2.71 and last item which is removing of gloves after use, before
touching non-contaminated items and surfaces, and before going to another
patients which has a weighted mean of 2.86. The general average mean which
result to a range of 2.81 was interpreted as highly adhered.
The next category under PPE pertains to FACIAL PROTECTION. It was
clearly stated that respondents do highly adhered into wearing mask when
performing operations/procedures that might induce spraying of blood, body
fluid, secretions and excretions as an evidenced of 2.80 weighted mean. The
following item which is wearing protective eye patch or goggle when performing
operations/procedures that might induce spraying of blood, body fluid,
secretions and excretions has a weighted mean of 2.10 which was interpreted
as moderately adhered. Regardless of this, the general average mean resulted
to 2.45 and therefore was interpreted as highly adhered.
On GOWN and CAP category, wearing of protective suit or gown when
performing operations/procedures that might induce spraying of blood, body
fluid, secretions and excretions has a weighted mean of 2.30 and wearing
protective cap or shoe shade to protect hair or shoes in instances that might
induce the spraying, flowing or leaking of blood, body fluid, secretion or
excretion which has a result of 2.07, both represent an interpretation of
moderately adhered. The general average mean which result to a range of 2.18
clearly denotes moderate adherence.

DISCUSSION
GLOVE USE ADHERENCE
In this study, full adherence among staff nurses of ITRMC was observed
when it comes to glove use every time they have clinical interaction to patients.
The overall compliance of glove utilization which ranges to 2.81 significantly
demonstrates that staff nurses of ITRMC have a great risk assessment skill in
terms to contacting blood and body fluids, performing tasks and procedures as
well as touching non-contaminated items and surfaces and before going to
another patient. Nurses highest compliance rate to glove use is similar to that
found in other studies. According to Flores, Wilkinson (1992) observed glove
use compliance rates averaged 80% to 90%, with the nurses glove compliance
rate ranging to 91.4% being higher than the doctors rate which was 73.2 %.
[Flores, A., Pevalin, D. (2007) Glove use and compliance with hand hygiene.
Nursing Times; 103: 38, 4648.]
FACIAL PROTECTION ADHERENCE
Due to contemporary health threats from respiratory infections (severe acute
respiratory syndrome (SARS), avian influenza, bioterrorism events, H1N1),
there is a heightened concern about respiratory communicable diseases in
health care. It was recently indicated that adherence to Facial Protective
Equipment (respirators, surgical masks, eye/face protection) for the prevention
of acquiring communicable respiratory illness has become the focus of
research. Literatures have shown that adherence to FPE was the most
problematic among other types of PPE in health care. [Behind the mask:
Determinants of nurses adherence to facial protective equipmentKathryn
Nichol PhD*, Allison McGeer MD, Philip Bigelow PhD, Linda OBrien-Pallas
PhD, James Scott PhD, D. Linn Holness MDOccupational Health Services
Program, St Michaels Hospital, Toronto, ON, Canada
doi:10.1016/j.ajic.2011.12.018] There are studies that substantiated that eye
protection was the most challenging PPE category. Eye injury is one of the s
that nearly three out of very alarming events happened among health care
personnel. Statistics shows that nearly three out of five workers who
experienced eye injuries were found not to be wearing eye protection at the
time of the accident or were wearing the wrong kind of eye protection for the
job. Add to this the fact that that thousands of workers are blinded each year
from work-related eye injuries that could have been prevented when proper
compliance and usage is observed.
(http://www.infectioncontroltoday.com/articles/2011/10/addressing-the-
challenges-of-ppe-non-compliance.aspx)
In this study, we can ascertain that our respondents have a high
adherence in terms of wearing mask when performing operations/procedures
that might induce spraying of blood, body fluid, secretions and excretions.
Contrary to this, wearing of protective eye patch or goggles resulted to a
weighted mean of 2.10 which suggest moderate adherence among the
respondents. Barriers which may affect nurses compliance in wearing eye
protections may include non-availability of resources at the time of need or
inadequacy of supplies. Say for example at OR-ITRMC, nurses may have a good
access to Control Supply Room where they can just easily gathered equipment
(eye patch or specialized goggles) in emergency situation which causes
splashing of blood, body fluids, secretion and excretion from patients. In spite
of this, other departments, particularly on wards located distantly from CSR
may have difficulty gathering equipment during emergency call. In the study of
Nichol et al (2008), they identified five factors as key predictor to nurses
compliance to the recognized use of facial protection. These factors include full-
time work status, more than 5 years tenure as a nurse, at least monthly use of
facial protection, a belief that media coverage of infectious illnesses impacts
risk perception and work practices, and lastly, the organizational support for
health and safety. [Individual, environmental, and organizational factors that
influence nurses' use of facial protection to prevent occupational transmission
of communicable respiratory illness in acute care hospitals Journal
Article2008Nichol K, Bigelow P, O'Brien-Pallas L, McGeer A, Manno M, Holness
DL American Journal of Infection Control DOI: 10.1016/j.ajic.2007.12.004]
GOWN AND CAP ADHERENCE
Gowns should be worn during delivery, surgical procedure and cleaning
if splashing is anticipated. An isolation gowns as specified by standard and
Transmission-based Precautions, are used to protect HCW exposed body areas
from contamination of clothing with blood, body fluids and other potentially
infectious materials. Gowns are always been worn in combination with gloves
and other PPE as well.[http://www.cdc.gov/hicpac/2007IP/2007ip_part2.html]
On the other hand, goggles or protective eyewear should be worn when
there is risk of splash or spilling of blood or body fluids.
The aforementioned result shows moderate adherence of staff nurses to
wearing of gowns and protective eye wears. Utilization of gowns and eye
protections should be emphasized to staff nurses especially when performing
surgical procedures which could lead to splashing of large amounts of blood,
body fluids and other infectious materials. Based on the study of Sharma et al
(2003), there is a very high risk of facial and blood contamination in major
gynecologic surgeries placing doctors and HCW at risk of obtaining viral
infectious diseases. Use of masks and protective goggles is strongly
recommended to avoid body fluid contamination and acquiring disease in
obstetrics. [Facial and body blood contamination in major gynecologic
surgeries. Sharma JB, Gupta A, Malhotra M, Arora R .Department of
Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak
Hospital, New Delhi, India. DOI: 10.1111/j.1341-8076.2003.00137.x]
PPE ADHERENCE IN GENERAL
Use of Personal Protective Equipment is essential to health and safety.
They reduce the risk of exposure of the Health Care Workers skin or mucous
membranes to blood, body fluids and other potentially infectious materials.
Selection of PPE must be based on an assessment of the risk of transmission of
microorganisms to the patient or the HCW, and the risk of contamination to
the HWC clothing and skin, mucous membranes by patients blood, body
fluids, secretions and excretions (except tears and sweat). The advantage of
using appropriate PPE is twofold, giving protection to both patients and those
caring for them. (http://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04.pdf)




A numbers of literatures have documented barriers to PPE compliance
that is, lack of time, the perception that using PPE interferes with the ability to
perform the job,, physical discomfort (dexterity) / difficulty communicating
when wearing masks, and the non-availability of PPE resources in times of
need.