Given the hazardous nature of the nursing work, nurses are required to use specialized clothing and equipment in order to protect themselves and patients as well from infection-causing germs. Personal protective equipment creates a barrier between the nurse and the bacteria, virus, or fungi. Personal protective equipment comprises of gloves, face masks and shields, gowns, and goggles (U.S. Department of Labor, 2017). Goggles and face shields are preferred for certain specific procedures and are worn to protect mucous membranes of the eyes from contact with body fluids. Gloves, gowns, and footwear are equally used to protect the body against contact with germs. A respirator is a form of a surgical mask that protects against the entry of small droplets into the body by fitting tightly in a way that seals the area around one’s mouth and nose. These equipment are of different sizes, thus for effective protection, one must wear the appropriate size. For instance, the Occupational Safety & Health Administration (OSHA) requires employees to fit test in order to determine the appropriate size that fits the wearer. While this set of equipment will not be worn on all occasions, it is important to make the right choice of equipment relative to the type of infection or germ. In addition, there are standard precautions that must be observed when serving all patients irrespective of their condition.
Specific Clinical Examples/ Stories
In my workplace, cases have been reported of nurses’ noncompliance with PPE. There was an outbreak of cholera in the hospital whereby 13 health care workers contracted the disease due to negligence to use PPE in handling a patient who was suffering from the disease. This is a classic example of the lack of use of PPE despite the availability of the apparel.
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Literature Review
Research on personal protective equipment (PPE) use has found that many healthcare workers either do not use protective apparel or use it inappropriately and at the appropriate time. According to the Occupational Safety & Health Administration (OSHA), the use of PPE minimizes worker exposure to hazards in cases where engineering and administrative controls are neither feasible nor effective (Pyrek, 2011). Pyrek’s research relays data from the Bureau of Labor Statistics indicating that a vast majority of workers who sustained workplace injuries were not in PPE. These stats illustrate the high rate of PPE noncompliance. This noncompliance is based on the workers' perception that PPE is not a requirement. Other reasons for noncompliance that research has revealed include worker attitude that PPE is uncomfortable, unattractive-looking, a poor fit, too hot, and unavailability in the task neighborhood.
Many recommendations have been documented as guidelines to ensure the safety of healthcare workers. Also, the prevalence of high-risk conditions has been highlighted by a variety of studies. Yet, still stats on compliance show low rates of PPE use. Attempts to explain this awful trend suggest that the evaluation of the reasons behind noncompliance should be focused beyond the individual level and be centered on the institutional structures that favor, hinder or allow noncompliance (National Academies, 2008). Some of the barriers to PPE compliance as established by most studies include lack of time, unavailability of PPE when needed, physical discomfort, and perception that the use of PPE tampers with the ability to perform a particular job (Pyrek, 2011).
Viewpoints of ANA, NLN. NYSNA, NCF, NCQA, Joint Commission, QSEN
All these associations advocate for the appropriate use of PPE in healthcare workplace practice. They call for enhanced measures at the organizational level for purposes of enhancing employee safety. They support OSHA’s efforts to advance enhanced use of PPE across organizations and the making of organizational safety the first priority. In connection with personal protective equipment, the Joint Commission provides national quality and safety goals that guide the prevention of infection. The commission, under NPSG.07.01.01 to NPSG.07.06.01, stipulates the use hand cleaning guidelines as provided for by the Centers for Disease Control and Prevention and WHO to prevent infection, use of proven guidelines to prevent infections that are difficult to treat, infections of the blood from central lines, infection after surgery, and infections of the urinary tract that are caused by catheters (The Joint Commission, 2019).
My Employer’s Position
My employer is committed to ensuring a safe and productive workplace for all employees, patients, families, and everyone else that forms part of the organization. My organization and employer support effective PPE use and serves as a role model for employee safety. It is the position of my employer that everyone has the responsibility of ensuring their safety and promotes the adherence to the organization’s workplace policy on safety as it’s the culture to uphold high standards of safety for all.
Problem Management Plan
The management of resolving PPE noncompliance issues in an organization rests at the organization’s administration despite the fact that employees have individual responsibility of using PPE as appropriate. From the start, an organization should be determined to create a culture of safety that ensures the running of effective and up-to-date safety practices. According to OSHA, it is the responsibility of the employer to design and implement workplace employee safety measures such as initiating a respiratory protection program, monitoring and assessing program efficacy, and maintenance of the correct records of the program. A healthy and functioning organizational culture is characterized by the employees’ commitment to and concern for safety within its framework (Pyrek, 2011).
In addition, it is through policies, procedures, resources dedicated to safety, and management support that an organization’s commitment to safety is evaluated. A company that prioritizes safety will also provide effective state-of-the-art equipment for its workers. The results of such an organizational culture include a higher level of compliance to standard infection control precautions, fewer on-the-job injuries, and a reduced incidence of exposure to calamity in hospitals. The development of an effective safety culture is a joint manager-employee responsibility because of the respective roles each of the parties play.
PPE compliance takes place within a continuum of safety interventions. These interventions are comprised of environmental controls, engineering controls, and work practice controls. This hierarchy of controls implies that hazards are first handled and controlled right at the source of infection and then, the control follows through the path between the source and the worker (National Academies, 2008). It is with this understanding that effective infection prevention and control interventions underscore hand hygiene as vital in the reduction of disease transmission. With these measures in place, evidence-based improvements can be deployed at any point to strengthen the safety culture.
In addition to creating a culture of safety, managers can also promote a greater PPE compliance through strategies such as provision of leadership and role modeling for worker safety, enhanced monitoring of employees, developing incentive programs, clarity of worksite practices and policies, improving the existing educational and training programs, purchasing of more stylish and more comfortable PPE, improved feedback and enforcement of PPE policies, and assessing compliance on individual performance evaluations.
Impact on Nursing Practice
The increased use of PPE in the workplace will definitely impact nursing practice in many ways. Enhanced safety as a result of PPE use will create a good working environment for nurses leading to increased motivation to work. Also, the reduced risk of disease and injury to nurses will lead to improved quality of nurses’ lives as well as increase nurse satisfaction in their service delivery (Hersi et al., 2015). Workplace safety will foster employee confidence with the systems and processes thus lead to increased productivity. This motivation, job satisfaction, confidence with systems and processes, and assurance of safety will translate to reduced medical errors, lowered accident and injury incidences, thus fostering improved quality patient care delivery. Ultimately, there will be improvements in general organizational productivity and outcomes.
References
Hersi, M., Stevens, A., Quach, P., Hamel, C., Thavorn, K., Garritty, C., Moher, D. (2015). Effectiveness of personal protective equipment for healthcare workers caring for patients with filovirus disease: A rapid review. PLOS ONE , 10 (10), e0140290. doi:10.1371/journal.pone.0140290
The Joint Commission. (2019, January). 2019 Hospital national patient safety goals. Retrieved from https://jntcm.ae-admin.com/assets/1/6/NPSG_2019_Presentation_-_FINAL.pdf
National Academies. (2008). Preparing for an influenza pandemic: Personal protective equipment for healthcare workers. Retrieved from https://www.cdc.gov/niosh/docket/archive/pdfs/NIOSH-129/129-010108-Report_doc.pdf
Pyrek, K. M. (2011, October 14). Addressing the challenges of PPE non-compliance. Retrieved from https://www.infectioncontroltoday.com/personal-protective-equipment/addressing-challenges-ppe-non-compliance
U.S. Department of Labor. (2017, June 28). Personal protective equipment. Retrieved from https://www.osha.gov/SLTC/personalprotectiveequipment/
