If items of personal protective equipment (PPE) are not readily accessible, will healthcare workers use them? And is the dispensing system being utilized properly? That's the dilemma many healthcare institutions face when trying to juggle the barrier protection needs of employees while finding a solution that is cost-effective and convenient.
One healthcare system faced with such a challenge was WakeMed Health & Hospitals, an 870-bed private healthcare system based in Raleigh, N.C. The WakeMed system faced unnecessary problems providing its patient care staff proper access to PPE. WakeMed had been using metal carts to house gowns, gloves, masks, hand sanitizer and disposable stethoscopes; however, on a day-to-day basis, director of infection prevention, Robin Carver, found that the staff was using the carts to store gauze, lunch containers, purses and other unapproved items. Additionally, the carts were not easily mobile and protruded into hallways, posing hazards to employees, patients and visitors. Lastly, compliance with the use of PPE and staff productivity was compromised. Identifying the carts to locate the required gear posed a daily challenge and, since carts were not designed to hold PPE, supplies frequently needed to be refilled.
As a result of continued medical staff and unit staff complaints, the infection prevention team began a five-year mission to provide the Wa-keMed facilities with a standardized system to house PPE that was simple to navigate and easily identifiable. Throughout the search, the team explored many options, including custom cabinetry and various roving metal cartseach posing their own unique limitations.
In April 2008, after conducting extensive research and utilizing both in-house and outsourced design teams, Carver discovered the Kimberly-Clark Health Care PPE Dispensing System. Carver's request that nursing staff use the PPE Dispensing System, met with resistance, as staff members said they were "too bulky." After one med/surg nursing unit agreed to a trial implementation, WakeMed purchased its first six dispensers, realizing that they were the right fit and size. Within two weeks, Carver began fielding additional requests for the new dispensers from the other units in the WakeMed system. WakeMed purchased additional dispensers in an effort to equip their entire community hospital with the PPE Dispensing System, this was followed by efforts from their acute care, long-term care, rehabilitation, and extended rehabilitation facilities. WakeMed currently houses 96 PPE Dispensing Systems across its entire network.
"Compliance with PPE usage was somewhat compromised prior to the implementation of the PPE Dispensing System," Carver says.Â "Previously, there was no standardization of how and where we housed our PPE, and our storage spaces (chairs and bedside tables) had to be shared between rooms because there were not enough to accommodate all patient rooms. Implementing the new system allowed our staff to have consistent, immediate and convenient access to PPE in easy-to-find storage units."
Carver continues, "The incidence level of PPE waste before the implementation of the PPE Dispensing System was low; however, it was fairly high when it came to the misuse of PPE. Our previous system was flawed as it did not provide any consistency in how it housed our PPE, therefore, staff would often misuse the PPE carriers by using them to store personal belongings. In addition, because the PPE was so publicly available, we found that people took more than what they needed."
Carver says WakeMed staff have come to depend on the PPE Dispensing System and "commented that they appreciate the consistent availability of the PPE, which is there to protect themselves, and the look of the organizer now everything neat and readily available. Theres no longer a question as to where the PPE is and how staff can access it. This approach greatly increases the availability of PPE, thereby increasing compliance with its use."
Most importantly, Carver says there was a discernable correlation between improved use of PPE and the prevention of infections. "Any time you increase compliance with PPE, you can reduce the incidence of HAIs," she says. "We saw a marked decrease in methicillin-resis9tant Staphylococcus aureus (MRSA) infections over the last several years, however there are always many interventions ongoing such as hand hygiene education, prevention of bloodstream infection education, etc. in addition to the implementation of the new PPE dispensing system."