1. Done by: Sandra Goodall Liza McGill Elecia Trowers Vivarian Malcolm

2.  After observing the use of personal protective equipment (PPE) at several hospitals in the central Florida, it became apparent that more could be done to increase adherence.  Although personal protective equipment (PPE) is one of the best lines of protection against hazardous exposures, many healthcare workers either shun this protective apparel or do not wear it in an appropriate manner at the appropriate time.  It is proposed that periodic education, training, and accountability be implemented. This would be beneficial in increasing compliance of PPE and potentially decreasing the transmission of communicable diseases in the hospital setting.

3.  According to Occupational Safety & Health Administration (OSHA) the use of personal protective equipment is required to reduce employee exposure to hazards and communicable diseases. The graph depicts infection rate when healthcare workers are compliant with PPE (International Federation of Infection Control 2014).

4. Recognizing patients with communicable diseases before exposure to workers (CDC, 2014) Identification of hazards and appropriate PPE (Infection Control Today, 2011) Train healthcare providers on proper use of selected PPE Simulation Bi-Annual In-services  In a survey conducted by the Canadian Journal of Emergency Medicine (2011), 22% of participants reported that they had never received PPE training and 32% had not been trained in the past two years and 53% reported that they were somewhat comfortable in their knowledge for PPE.

5.  National Academies (2008), Mandatory training is needed across all levels of the organization to communicate the institution’s safety rules.  Provide leadership, commitment, and role modeling for worker safety: Employees who perceive a strong organization-wide commitment to safety have been found to be more than 2.5 times more likely to adhere to safety protocols than those who lack such perceptions (Gershon, 2011).  According to the National Institute of Health (2010), Emphasize healthcare worker education and training: The presence of safety education within a hospital or other healthcare facility demonstrates the organization’s commitment to safety and increases individual knowledge of safety practices.

6.  Sincere engagement by those in leadership positions who enforce appropriate PPE use and safety.  positive reinforcement of individual compliance behavior, and  negative reinforcement (e.g., verbal warnings).  According to a study performed by Visentin and colleagues (2009), healthcare personnel often rely on their own personal assessments of risk in deciding whether or not to use PPE  Identify staff members who actively and openly oppose changes in practice.  According to National Institute of Health (2010), Promotion and encouragement of worker participation in health and safety discussions, significantly increased compliance with PPE use.

7. Requirements for proposed change: Evaluation: Determine the occurrence of communicable infections at the prospective hospital for the proposed change Utilize self assessments for healthcare providers to determine their compliance to PPE Utilize a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to assess healthcare workers compliance with PPE from the patients perspective Create an evaluation tool to assess knowledge, competency, and compliance of PPE among staff

8. EDUCATION: Infection control will teach nursing staff proper donning, removal, and protocol for communicable diseases. Evidenced based articles will be mandated for staff to read outlining the advantages of PPE and staff role ENGAGEMENT: Staff buy in will be orchestrated through the educators, unit managers, charge nurses, clinicians, and special committees promotion of the importance of the proposed change, put the change into action, reinforcing it, and hold those accountable for non-compliance. PILOT PROGRAM: Infection control program on the Medical Surgical Units

9. The CDC highlights the importance of proper usage of personal protective equipment which can help to decrease the incidences of communicable diseases in patients from healthcare providers cross contamination Recommendations: According to the National Institute of health (2010),  Identify and disseminate effective leadership and training strategies and other interventions to improve PPE use. Such as, to develop, implement, and evaluate comprehensive leadership, training strategies and interventions that go beyond simple knowledge-based training  examine long-term practice change and safety culture implementation related to educational interventions  Identifying and evaluating strategies to mitigate organizational barriers that limit the use of PPE by healthcare personnel

10. During a three month span the evaluation of implemented plans will be made by: Observing staff members when donning PPE Conduct an anonymous survey to get staff feedback on the new initiative. Compare data for infection rate during the three months after implementation. Compare data for PPE usage within the current three months and three months before implementation. Based on the result from observation, statistics and staff feedback, alterations will be made to enhance the implemented plans or make complete changes if necessary.

11. Implementation of an evaluation, education & training, and increasing accountability in an infection control plan to promote PPE will be initiated through the hospital Recommended materials, and trainings will be provided to all units with the assistance of the infection control specialists, unit educations, managers, and charge nurses. In services will be provided bi annually to all hospital staff by members of the infection control committee as a refresher on PPE

12. Centers for Disease Control and Prevention [CDC]. (2010). Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved from http://www.cdc.gov/HAI/prevent/ppe_train.html Gershon, R. R. M., 2011. Compliance with universal precautions among healthcare workers at three regional hospitals. American Journal of Infection Control. Infection Control Today. (2011). Addressing the Challenges of PPE Non- Compliance. Retrieved from http://www.infectioncontroltoday.com/articles/2011/10/addressing http://www.infectioncontroltoday.com/articles/2011/10/addressing -the-challenges-of-ppe-non-compliance.aspx?pg=2#content Occupational Safety & Health Administration [OSHA]. (2012). PPE Assessments. Retrieved from https://www.osha.gov/dte/library/ppe_assessment/ppe_assessm ent.html https://www.osha.gov/dte/library/ppe_assessment/ppe_assessm

13. Occupational Safety & Health Administration [OSHA]. (2012). Personal Protective Equipment. Retrieved from https://www.osha.gov/SLTC/personalprotectiveequipment/ National Institute of Health [NIH]. (2010). Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases. Using PPE: Individual and Organizational Issues. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK209587/ Visentin, L. M., S. J. Bondy, B. Schwartz, and L. J. Morrison. 2009. Use of personal protective equipment during infectious disease outbreak and non-outbreak conditions: A survey of emergency medical technicians. Canadian Journal of Emergency Medicine 11(1):44-56