The document discusses various methods for measuring personal protective equipment (PPE) compliance in healthcare settings. It describes observing PPE use, conducting surveys of healthcare workers and patients, and tracking PPE supply usage to measure compliance. Multiple measurement methods are recommended, including direct observation by staff trained in monitoring techniques, patient surveys, and monitoring product usage across facilities. Aspects that can be observed include the type of PPE used, cleaning thoroughness, glove use, and which worker groups are adhering to PPE guidelines.
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How do we measure PPE compliance?
1. How in the real world are we
measuring PPE compliance?
2. WHO guidelines for Hand
hygiene
http://www.who.int/gpsc/5may/background/5moments/en/inde
x.html
3. Perceived barriers to adherence with
hand hygiene....
skin irritation caused by hand hygiene agents
inaccessible hand hygiene supplies
interference with HCW–patient relationships
patient needs perceived as a priority over hand
hygiene
wearing of gloves
forgetfulness
lack of knowledge of guidelines
insufficient time for hand hygiene
high workload and understaffing
lack of scientific information showing a definitive
6. Environment
Use of signage
Counting the amount of PPE equipment being
used
Determining perceived comfort
Changing hospital policy
Making sure the equipment is available and in
good supply
Ease of access
7. Patients
Education – in the form of
posters, signage, advertisements
Use of an assessment scale
And the use of surveys
8. How successful is PPE
compliance in the real world?
This is what I found....
9. The Joint Commission....
The Association for Professionals in Infection
Control and Epidemiology, Inc.
The Centres for Disease Control and Prevention
The Institute for Healthcare Improvement
The National Foundation for Infectious Diseases
The Society for Healthcare Epidemiology of
America
The World Health Organization World Alliance for
Patient Safety
10. According to the Joint
Commission...
Observation
Product measurement
Surveys
11. Using multiple methods to measure
hand hygiene...
Triangulation, or the use of more than one
approach to study the same phenomenon.
multiple perspectives can provide more and
different information
12. Another example from the Joint
Commission....
Direct observation by frontline health care
workers and training others to do the same
Gathering of information about patients’
perceptions of health care worker hand hygiene
practices, using a patient satisfaction survey.
Monitoring of hand hygiene product usage
system wide
13. Deciding on which aspects to
observe
Type of product or agent used
Thoroughness of cleaning
Glove use
14. Determining who to observe
Nurses, nursing assistants, orderlies, physicians,
medical residents, pharmacists, and therapists
Technicians/technologists
Nonclinical staff
Environmental staff
Pastoral care, social workers, discharge planners
Food service staff
Transporters
Vendors
Students, visitors, patient
sitters, parents/guardians
15. Determining who will conduct
observations:
Infection preventionists
Other trained personnel
Use of patients
So we’ll start with the WHO guidelines for hand hygiene which can be roughly incorporated under the banner of PPE compliance...No visible dirt, blood, or body fluids on hands of HCW in the following clinical situations:1. Before direct patient contact2. After removing gloves3. Before handling invasive device for insertion4. After contact with blood body fluids, mucous membranes, non-intact skin, and wound dressings5. Moving from contaminated patient body site to clean site during patient care6. After contact with inanimate objects or medical equipment close to patient
World Health Organisation. (2009). WHO Guidelines on Hand Hygiene in Health Care.According to WHO: Perceived barriers to adherence with these hand hygiene guidelines can include....skin irritation caused by hand hygiene agentsinaccessible hand hygiene suppliesinterference with Health Care Worker– patient relationshipspatient needs perceived as a priority over hand hygiene wearing of gloves forgetfulnesslack of knowledge of guidelinesinsufficient time for hand hygienehigh workload and understaffinglack of scientific information showing a definitive impact of improvement on hygiene on Health Care Acquired Infection rates
So from our fishbone data – these are the barriers we found to PPE compliance
From the Personnel point of view of measuring PPE compliance:This would include the measuring of...Incident reportsPersonnelSurveysEducation and trainingAnd the use of communication and meetings
From the environment point of view of measuring PPE compliance:This would include the measuring of and efficiency of...The use of signageCounting the amount of PPE equipment being usedDetermining perceived comfortChanging hospital policyMaking sure the equipment is available in good supplyAnd ensuring the ease of access on every floor for everyone not just Health Care Workers
From the Patient’s point of view of measuring PPE compliance:This would include the measuring of...Education in the form of posters, signage and advertisements as well as encouraging the education of the patients on the ward as well as out in the public sphere. Use of an assessment scale and use of patient satisfaction surveys on departure.
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.htmlThe Joint Commission joined various disease control organisations together to help create a measurement of hand hygiene adherence guidelines. The commission consisted of.... The Association for Professionals in Infection Control and EpidemiologyThe Centres for Disease Control and PreventionThe Institute for Healthcare ImprovementThe National Foundation for Infectious DiseasesThe Society for Healthcare Epidemiology of AmericaThe World Health Organization World Alliance for Patient Safety
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.htmlAccording to the Joint Commission...“The three most commonly used methods for measuring hand hygiene are observation, product measurement, and surveys. Observation of health care workers involves directly watching hand hygiene behaviour and recording the number of hand hygiene indications, opportunities, and actions. Product measurement, includes indirectly assessing hand hygiene practice by calculating how much liquid soap, alcohol-based hand rub, and paper towels are used in a given area of the organization per patient day; through the electronic monitoring of sinks and alcohol based hand rub dispensers; or by automated counting devices. Surveys can be used to gather information on health care worker perceptions, attitudes, and practices related to hand hygiene, as well as patients’ and families attitudes and perceptions related to the hand hygiene practices of health care workers” (The Joint Commission, 2009, p. 20).
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.html“It is often useful to implement more than one measurement method at the same time. Using multiple measurement approaches makes it possible to validate your results. Because all measurement methodologies have weaknesses, the level of confidence in your findings increases if you obtain similar results when using different approaches. Researchers call this triangulation, or the use of more than one approach to study the same phenomenon” (The Joint Commission, 2009, p. 21).Multiple perspectives can also provide more and different information. An example taken from the Joint Commission’s guidelines recommends, assessing both the structural capacity (ie;the availability of products and the proper functioning of sinks and dispensers) and staff knowledge of hand hygiene guidelines and reasons for noncompliance, which could be revealed through focus groups. This, they believe, allows you to better understand your facility and staff and target your interventions more effectively and efficiently.
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.htmlAnother example taken from the guidelines recommends: Using multiple measures to track staff hand hygiene activity: With direct observation by frontline health care workers and others trained by the infection preventionist.The gathering of information about patients’ perceptions of health care worker hand hygiene practices, using a patient satisfaction survey. The preventionist would send this survey to a random sample of inpatients and emergency department patients.Monitoring of hand hygiene product usage system wide, with ounces of products used per 100 adjusted patient days routinely reported. This measurement showed a statistically significant increase in the use of both hand soap and alcohol-based hand rub between 2006 and 2007 in the Greenville Hospital System in Greenville, South Carolina.
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.htmlDeciding on which aspects to observe: Type of product or agent used – whether alcohol rub, soap and waterThoroughness of cleaningAnd glove use
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.htmlDetermining who to observe:Nurses, nursing assistants, orderlies, physicians,medical residents, pharmacists, and therapistsTechnicians/technologistsNonclinical staff Environmental staff Pastoral care, social workers, discharge plannersFood service staffTransportersVendorsStudents, visitors, patient sitters, parents/guardians
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.htmlDetermining who will conduct observations is important to ensure the minimal amount of bias is contributed to the study...Infection Preventionists....So the advantages of choosing the infection preventionists:• Infection preventionists have knowledge of hand hygiene guidelines.• They can intervene and teach on the spot to correct unacceptable hand hygiene performance and may require less training on guidelines• They can provide immediate feedback to staff for good hand hygiene performance.Disadvantages:Staff recognize infection preventionists, which can cause them to change their behaviour and makes it difficult to observe “true” hand hygiene performance.Having infection preventionists conduct observation can also work to limit bias to the different units.Other Personnel: Use of other specifically trained personnel can help to promote widespread acceptance of, ownership of, and participation in activities to improve hand hygiene. The extra training can also increase staff knowledge of hand hygiene guidelines and heighten their awareness that hand hygiene is an organizational concern, not just something for which the infection preventionists or quality improvement department is responsible. However it is not such a good idea to use staff in their own departments as they may affect the data from their co-workers Patients:Need to be relatively healthy and aware of their situation, staff would also need to know that they should perform hand hygiene in front of a patient as the patient will not see hands being cleansed if it is done outside.
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.htmlThis is a sample observation schedule for observing hand hygiene behaviour. And this is another example taken from The Joint Commission....So Janet, an infection preventionist, wants to observe staff hand hygiene behaviour four times a year in each of the nursing units. For each unit, she wants to conduct one-half of the observations between 7 A.M. and 7 P.M., one-fourth between 7 P.M. and 7 A.M., and one-fourth on weekends. She has trained three staff members in how to conduct the observations correctly. The observer records each hand hygieneopportunity for each staff member observed and then records whether hand hygiene was performed.
