Quality of personal protective equipment (PPE) is a key issue for healthcare staff treating infectious respiratory illnesses worldwide, according to a new international study undertaken by NUI Galway (NUIG) researchers.
A rapid review of global experiences and perceptions of staff identified a number of key barriers to infection prevention and control which the researchers believe hospital and health managements must tackle.
These include serious concerns over lack of quality PPE, discomfort of ill-fitting equipment, lack of clear communication and proper training, and fatigue associated with fully complying with infection prevention and control guidelines.
The NUIG research team, led by Dr Catherine Houghton of NUIG’s school of nursing and midwifery, analysed 20 of the most relevant published studies and found a number of common challenges.
'Overwhelmed because local guidelines constantly change'
Challenges included healthcare workers feeling “unsure when local guidelines were long, unclear, or did not match national or international guidelines”.
Health staff could also feel “overwhelmed because local guidelines were constantly changing”, and described how their responses to infection prevention and control guidelines are “affected by the level of support they felt they received from their management team” and by the culture of a workplace.
Clear communication about the guidelines is seen as vital, and lack of training about the infection and about how to use PPE is also identified. Staff also think it is a problem when such training is not compulsory They also pointed to the importance of including all staff, including cleaning staff, porters, kitchen staff and other support staff when implementing infection prevention and control guidelines.
The findings, which are published by global medical research network Cochrane, will be submitted to the World Health Organisation (WHO). The study includes a checklist for health and hospital managements.
Dr Houghton explained that the 20 studies represent a geographical and economic spread, with healthcare staff attached mainly to hospitals but also primary and community care settings.
Ten studies are from Asia, four from Africa, four from North America and two from Australia, with Singapore, Taiwan, Korea and Canada having experience of SARS and MERS.
The views of staff treating other infectious respiratory illnesses including H1N1, tuberculosis and seasonal influenza were also analysed.
It found that healthcare workers are motivated to follow guidelines for fear of self-infection, or because of a responsibility towards patients and family they were in contact with.
Key environmental factors include having enough space to isolate infectious patients, and having hygiene routines and access to cleaning facilities, such as showers.
There were also concerns raised about patient isolation, or wearing face masks, which could stigmatise patients or frighten them.
Dr Houghton explained that the study’s brief did not extend to sourcing PPE and identifying shortages.
This research was part of an initiative called the Emergency Evidence Response Service, and is one of a series of rapid reviews prepared to inform the 2020 COVID-19 pandemic.