Study Highlights Need to Strengthen Infection Prevention Measures Among Health Care Professionals

Woman from the environmental hygiene department of a hospital is cleaning the walls of the pre-operating room with a special brush.

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During the COVID-19 pandemic, how well did healthcare workers, other than nurses and doctors, perform with the enhanced infection prevention protocols? A new study, featured in the American Journal of Infection Control, titled “Infection precaution adherence varies by potential exposure risks to SARS-CoV-2 and job role: Findings from a US medical center,” conducted a comprehensive survey of health care professionals during the peak of the COVID-19 pandemic, shedding light on the need for enhanced infection prevention protocols. Unlike previous studies primarily focusing on physicians and nurses, this research included various health care roles exposed to infection risks, such as therapists, dieticians, and environmental services staff. Findings revealed that professionals at the highest risk of SARS-CoV-2 exposure were more likely to report errors in adhering to infection prevention measures.

The study analyzed responses from 191 health care personnel at the University of North Carolina Medical Center, from July 2020 to January 2021. It categorized respondents into 3 groups: physicians and advanced practice providers, registered nurses, and other health care roles. While respondents generally reported reliable access to personal protective equipment (PPE), hand hygiene was a frequent point of incorrect practice.

To learn more, Infection Control Today^® (ICT^®) interviewed Emily Haas, PhD, research health scientist, National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, CDC, and Janet Glowicz, PhD, RN, infection preventionist, Division of Health care Quality Promotion, CDC, about the study.

ICT: What were the key findings of your study regarding infection prevention measures among health care professionals during the COVID-19 pandemic?

Emily Haas, PhD: The focus of this specific paper did not study infection prevention measures among health care personnel (HCP) during the pandemic. What our study did find was that:

• Adherence to infection precaution measures varied by job role, with those in Other roles (ie, nonphysician/nonnursing roles such as therapists or dieticians) reporting fewer [personal protective equipment] PPE-related errors during the 2-week study timeframe.
• Registered nurses reported completing job tasks that placed them at a higher risk of potential exposure to SARS-CoV-2 when compared to physicians and other workers.
• The odds of having at least 1 PPE-related error were 5.74 times greater for respondents who had a higher risk of potential exposure to SARS-CoV-2 as opposed to those who had a lower risk of exposure (based on job tasks), controlling for job role and perceived risk.
  

ICT: Could you explain how the study defined "high-risk" health care professionals and the types of errors in infection precautions they reported?

EH: This study did not define “high-risk” health care personnel. We defined those who had a higher risk of potential exposure to SARS-CoV-2. Those with a higher risk of potential exposure reported performing a specific list of aerosol-generating procedures on patients suspected of having or known to have COVID-19 in the prior two weeks. Examples of procedures included performing a manual (bag) ventilation, breaking the ventilator circuit, and performing or assisting with intubation or being present in the room during an intubation.

ICT: Were there any unexpected or surprising results in your study's findings regarding adherence to PPE guidelines?

EH: Health care personnel who had a higher risk of potential exposure to SARS-CoV-2 were 5.74 times more likely to report at least 1 error in infection precautions in the previous 2 weeks, such as failure to don protective gear. It is important to note that the combination of repetitive job tasks and demands may have contributed to PPE errors, and our findings highlight the need for training.

ICT: Can you discuss the significance of hand hygiene as the most frequently performed incorrectly infection precaution and its implications for patient safety?

Janet Glowicz PhD, RN: Without additional information about the type of error that occurred, it is difficult to judge the implications for patient safety. With hundreds of indications to clean one’s hands during the provision of medical care health care workers in any role can benefit from ongoing training about keeping their hands clean. Clean hands are the foundation of infection prevention. Health care facilities that have vibrant safety cultures encourage workers to remind one another to clean their hands.

ICT: What are the next steps or recommendations for health care facilities and organizations based on the insights gained from this research?

EH: Generally, results show that less common health care personnel roles also need training and education during a public health emergency. CDC has training resources for health care personnel on infection prevention practices through Project Firstline.

Results prompt the need to identify more systems-level approaches to support worker knowledge and engagement. An example of a systems-level approach or intervention in the case of hand hygiene adherence may be the purposeful placement of dispensers that are convenient and noticeable for health care personnel. It is important to examine work processes for different jobs and strategically determine how work organization can be modified to support accessible health and safety practices among various groups and tasks.