Personal Protective Equipment implementation in the healthcare: a scoping protocol
Creators: name: CORDEIRO, LUCIANA
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medicine and Health Sciences

description: Despite personal protective equipment (PPE) being an important component in infection control strategies to protect healthcare workers (HCW), very little is known about how it is actually used in the healthcare daily practice (Kang et al, 2017; Reddy, Valderrama, Kuhar, 2019). PPE adequate use in clinical settings rely on multiple variables such as availability in the market and in the healthcare unit, adequacy for each individual considering PPE type, sise and quality, HCW burden, equipment training, adhesion, monitoring and assessment, level of potencial exposure, etc. Since Ebola outbreak in 2014-2016 researchers have been developing new alternatives for PPEs. Specialists have been warning about the lack of a standardized protocol for PPE and also the lack of sufficient quantities of PPE. These problems had not been examined in depth, so the protocols were kept imperfect (Kang et al, 2017). The Coronavirus Disease (COVID-19) pandemic evidenced the importance of HCW’s adherence to the PPE, as far as PPE’s value and problems. Several guidelines for HCW protection against infection were released in 2020 (WHO, 2020; United Kingdom, 2020; United States, 2020; CDC, 2020; Public Health Agency, 2020), though some discrepancies still exist among them. Besides that, there is a global concern regarding the shortage in supply chain of PPE. HCW are adapting PPEs and they report frequent reuse of single-use items, along with disinfection for PPE reprocessing. Due to extreme work conditions and PPE scarcity, HCW are not utilizing PPE exactly as it is recommended by guidelines, and just a few have access to fit test or Powered Air-Purifying Respirators (Tabah, 2020; Rowan, Laffey, 2020). For optimal PPE use, HCW competency in donning and doffing PPE alone is insufficient (Kang et al, 2017) Systematic reviews examining the use of PPE, its’ adherence (Moralejo et al, 2018; Houghton et al, 2020), PPE protocol compliance (Verbeek et al, 2020), and behavioural intervention to promote respirator use in the healthcare (Luong et al, 2016) were recently published. The authors conclude that even that using worker’s protection guidelines recommendations for doffing may lead to less contamination compared to no guidance, education and training may not contribute to protocol proper adherence. Just a slight improvement on the frequency or correctness of PPE use by HCW was observed after training and education regardless the type of it (Luong et al, 2016; Moralejo et al, 2018). Studies show, otherwise, that face-to-face training and the use of additional computer simulation may reduce noncompliance with doffing guidance more than video or folder-based training, and additional spoken instruction may lead to fewer contamination spots (Verbeek et al, 2020). Qualitative systematic reviews aim to synthesise the healthcare workers’ experience and cultural and social phenomena, and is able to explain why an intervention is or is not effective from a person-centred perspective (Lockwood et al, 2020). Houghton et al (2020) examined the non-adherence to PPE use guidelines by healthcare workers. Twenty primary studies were included in the qualitative systematic review that revealed some of this phenomena reasons: lengthy and ambiguous guidelines that are hard to follow; protocols may lead to increased workloads and fatigue; poor quality and uncomfortable equipment and scarcity of PPE in the unit; insufficient PPE use training and support from the management team to comply with recommendation; facilities and physical space inadequacies; inclusion of administrative and logistics tasks in the daily care routine; equipment may make patients feel isolated, frightened or stigmatised. Besides that, donning and doffing is time consuming, PPEs tend to be cumbersome, and HCW are not always well informed about PPE effectiveness (Kang et al, 2017). By the other hand, HCW feel motivated to follow the guidance to avoid infection of patients, themselves and their families (Houghton et al, 2020). For all those aspects, the effective PPE use in the clinical setting is considered a complex event. To accomplish effectiveness, PPE competency needs to be complemented with system-level support, such as leadership, policies, teamwork, training efforts, and safety culture (Kang et al, 2017). Focusing at the patient, provider, organization, and policy levels of healthcare, implementation science proposes that the knowledge translation process gain multiple interacting levels that requires the engagement of a wide range of stakeholders. Implementation process intends to improve the quality and effectiveness of health services, assuming that implementing and sustaining innovation is a manifold undertaking (Mark et al; Peters, Tran, Adam, 2013). Implementation research may focus on the identification of common implementation problems, understanding how to facilitate health interventions and develop solutions to tackle eventual barriers, and to promote use and sustainability of a technology or intervention (Peters, Tran, Adam, 2013). So, considering the complexity entailed in the effective use of PPE in healthcare settings, and the urgent call for optimise HCW infection protection in the present context as new pathogens are emerging, it is critical to scrutinise the PPE implementation process. The whole implementation cycle that initiates with the item selection and ends with the process of all levels’ assessment should be verified. This will help to evidence gaps and barriers and to identify potentialities in the PPE implementation process and to prepare HCW and policy makers to advance in the challenge of saving lives during the present and upcoming pandemics, and in the healthcare assistance in general. So, the objective of this scoping review is to map the process of implementation of personal protective equipment in the healthcare. Specifically, we intend to clarify the PPE election, acquisition, training, maintenance, strategies used, acceptance, adherence, and how the implementation has been assessed.