Enhancing PPE Practices and Infection Prevention Knowledge Through Engaging In-Person Training

Jenny Hayes, MSN, RN, CIC, CAIP, CASSPT

Although COVID-19 has taught us critical lessons, the need for proper infection prevention (IP) practices and the use of personal protective equipment (PPE) in health care settings remains crucial. Despite the availability of virtual training programs, inconsistencies in putting on and taking off PPE and gaps in knowledge about infection prevention persist. Addressing these issues is essential for ensuring the safety of health care workers and patients alike.

A recent study presented in a poster, “Don't Gamble With Your Safety,” at the Association for Professionals in Infection Control and Epidemiology (APIC) 2024 Annual Conference & Exposition June 3 to 5 in San Antonio, Texas, by Jenny Hayes, MSN, RN, CIC, CAIP, CASSPT, aimed to evaluate the effectiveness of in-person, engaging training sessions on improving PPE practices and IP knowledge.

Hayes, the director of infection prevention for Jefferson Health—New Jersey, in Stratford, New Jersey, spoke with Infection Control Today^® (ICT^®) about the study.

The inception of virtual training during the pandemic was intended to provide essential infection prevention knowledge and guidelines on PPE usage. However, health care professionals reported variability in the effectiveness of these virtual programs, particularly in practical application.

Jenny Hayes, MSN, RN, CIC, CAIP, CASSPT, and Tori Whitacre Martonicz, senior editor for Infection Control Today, at the APIC Annual Conference & Exposition held in San Antonio, Texas.

This study hypothesized that in-person, interactive training could enhance adherence to PPE protocols and deepen understanding of IP principles more effectively than virtual methods alone. “The premise for this pilot research study that was funded by the American Nurses Association Project Frontline was to really assess in-person training versus computer-based learning for personal protective equipment,” Hayes said. “The reason we chose to do that is because computer-based learning became a tool during COVID-19. So, [instructors] seem to have lost that personal level of interaction which sometimes is helpful in assessing learning needs, maybe body language. You can see when somebody doesn't understand."

The study, conducted from July to August 2023, was approved by the institutional review board and employed a preexperimental design to assess the impact of in-person training. Infection preventionists (IPs) conducted the training sessions, which reached 106 participants across a variety of healthcare settings.

Participants completed pretests designed to gauge their baseline knowledge on key topics, including types of PPE, proper disposal methods, types of isolation precautions, and hand hygiene practices. The IPs then provided comprehensive education sessions covering these topics.

A unique feature of the training was the use of a “wheel of organisms,” where participants spun a wheel to select different pathogens, discussed the appropriate PPE for handling each, and practiced donning and doffing PPE with a focus on minimizing cross-contamination. Posttests were administered to measure any changes in knowledge and confidence in applying IP principles.

"So, we made it fun," Hayes said. "We had a spin wheel, which was the Wheel of Misfortune. Each section on the Spin wheel had a pathogen. Then, the participants got a handful of cards. And from that hand, they had to pick which PPE they would wear for the pathogen that they landed on.”

Hayes, also a member of ICT’s editorial advisory board, said, “Participants could enter drawings for Apple AirPods and UV foam sanitizer devices. Then, there were other immediate giveaways and snacks. We had them demonstrate the donning and doffing of PPE we use.”

Results

The pretest results revealed significant areas for improvement in PPE practices and IP knowledge among participants:

• Only 57% of participants strongly agreed that they always dispose of PPE inside the patient room.
• Just 5% of participants strongly agreed that standard precautions do not necessarily require the use of PPE.
• About 59% strongly agreed that they consistently performed hand hygiene before donning gloves or PPE.
• Only 42% strongly agreed that they could locate information on transmission-based precautions effectively.

Following the training sessions, there was a notable improvement in the participants' knowledge and confidence:

• 72% of participants strongly agreed that they knew how to better protect themselves from contamination when doffing PPE.
• 75% strongly agreed that the session had enhanced their understanding of when and why to use PPE.
• 69% strongly agreed that their overall comprehension of infection prevention topics had improved.

The pretest results indicated that 84% of participants knew where to find information on Transmission-Based Precautions. Post-test results showed an improvement, with 94% of participants reporting that they knew where to locate the Isolation Grid with details on Transmission-Based Precautions. This pilot study suggests that in-person training for the proper use of PPE may be more effective than online training. In-person sessions can be conducted with departmental cohorts or across multiple disciplines in a common space.

Updated The Joint Commission Standards for 2024 emphasize the importance of training and competency in PPE use. Implementing a train-the-trainer model could be an effective approach to complying with these standards and enhancing the effectiveness of in-person training sessions.

These results highlight the efficacy of in-person, interactive training in reinforcing proper PPE practices and increasing IP knowledge. The engaging training sessions, which included hands-on activities and immediate feedback, likely contributed to these positive outcomes.

This study demonstrated that in-person training sessions can significantly improve health care professionals' knowledge and practices regarding PPE and infection prevention. The interactive and entertaining format of the training was particularly effective in engaging participants and facilitating learning. Despite the lack of a control group to compare the effectiveness of in-person training versus virtual methods, the findings underscore the value of hands-on education in promoting better adherence to infection prevention protocols.

Health care facilities should consider incorporating such interactive training sessions to bolster their infection control efforts, particularly considering the ongoing challenges presented by emerging infectious diseases. By doing so, they can enhance the safety and well-being of both healthcare workers and patients, contributing to a more robust and resilient health care system.

Other authors were Cindy Hou, Do, FACOI, FIDSA, FACP; Mary E. Miller, BSN, RN, CIC; Laura Maguire, MLT, BS, CIC; Ashlee Hiester, BSN, RN, CIC; Daniel Jefferson, MS, MT(ASCP), all employees of Jefferson Health.