GLOVES 1. Wear gloves when touching blood, body fluids, secretions, excretions, mucous membranes, non-intact skin. 2.87 Highly Adhered 2. Change gloves between tasks and procedures on the same patient after contact with potentially infectious material. 2.71 Highly Adhered 3. Remove gloves after use, before touching non- contaminated items and surfaces, and before going to another patient. 2.86 Highly Adhered GLOVES 2.81 HIGHLY ADHERED FACIAL PROTECTION (eyes, nose, mouth) 4. Wear mask when performing operations/procedures that might induce spraying of blood, body fluid, secretions and excretions. 2.80 Highly Adhered 5. Wear protective eye patch or goggle when performing operations/procedures that might induce spraying of blood, body fluid, secretions and excretions. 2.10 Moderately Adhered FACIAL PROTECTION 2.45 HIGHLY ADHERED GOWN AND CAP 6. Wear protective suit or gown when performing operations/procedures that might induce spraying of blood, body fluid, secretions and excretions. 2.30 Moderately Adhered 7. Wearing protective cap or shoe shade to protect hair or shoes in instances that might induce the spraying, flowing or leaking of blood, body fluid, secretion or excretion. 2.07 Moderately Adhered GOWN AND CAP
2.18 MODERATELY ADHERED TOTAL PPE 2.53 HIGHLY ADHERED
RESULTS Analyses of respondents extent of adherence being classified to as highly adhered, moderately adhered and highly adhered were evaluated using weighted mean. Table 2 indicates adherence among Staff Nurses of ITRMC to the use of Personal Protective Equipment categorized as glove-use during procedures, using of facial protection (eyes, nose, and mouth) and wearing gowns and caps which was adapted to WHO guidelines for Standard Precaution. With reference to the above result under the GLOVE category, first item which is wearing of gloves when touching blood, body fluids, secretions, excretions, mucous membranes, non-intact skin has a weighted mean of 2.87, next item which is changing of gloves between tasks and procedures on the same patient after contact with potentially infectious material has a weighted mean of 2.71 and last item which is removing of gloves after use, before touching non-contaminated items and surfaces, and before going to another patients which has a weighted mean of 2.86. The general average mean which result to a range of 2.81 was interpreted as highly adhered. The next category under PPE pertains to FACIAL PROTECTION. It was clearly stated that respondents do highly adhered into wearing mask when performing operations/procedures that might induce spraying of blood, body fluid, secretions and excretions as an evidenced of 2.80 weighted mean. The following item which is wearing protective eye patch or goggle when performing operations/procedures that might induce spraying of blood, body fluid, secretions and excretions has a weighted mean of 2.10 which was interpreted as moderately adhered. Regardless of this, the general average mean resulted to 2.45 and therefore was interpreted as highly adhered. On GOWN and CAP category, wearing of protective suit or gown when performing operations/procedures that might induce spraying of blood, body fluid, secretions and excretions has a weighted mean of 2.30 and wearing protective cap or shoe shade to protect hair or shoes in instances that might induce the spraying, flowing or leaking of blood, body fluid, secretion or excretion which has a result of 2.07, both represent an interpretation of moderately adhered. The general average mean which result to a range of 2.18 clearly denotes moderate adherence.
DISCUSSION GLOVE USE ADHERENCE In this study, full adherence among staff nurses of ITRMC was observed when it comes to glove use every time they have clinical interaction to patients. The overall compliance of glove utilization which ranges to 2.81 significantly demonstrates that staff nurses of ITRMC have a great risk assessment skill in terms to contacting blood and body fluids, performing tasks and procedures as well as touching non-contaminated items and surfaces and before going to another patient. Nurses highest compliance rate to glove use is similar to that found in other studies. According to Flores, Wilkinson (1992) observed glove use compliance rates averaged 80% to 90%, with the nurses glove compliance rate ranging to 91.4% being higher than the doctors rate which was 73.2 %. [Flores, A., Pevalin, D. (2007) Glove use and compliance with hand hygiene. Nursing Times; 103: 38, 4648.] FACIAL PROTECTION ADHERENCE Due to contemporary health threats from respiratory infections (severe acute respiratory syndrome (SARS), avian influenza, bioterrorism events, H1N1), there is a heightened concern about respiratory communicable diseases in health care. It was recently indicated that adherence to Facial Protective Equipment (respirators, surgical masks, eye/face protection) for the prevention of acquiring communicable respiratory illness has become the focus of research. Literatures have shown that adherence to FPE was the most problematic among other types of PPE in health care. [Behind the mask: Determinants of nurses adherence to facial protective equipmentKathryn Nichol PhD*, Allison McGeer MD, Philip Bigelow PhD, Linda OBrien-Pallas PhD, James Scott PhD, D. Linn Holness MDOccupational Health Services Program, St Michaels Hospital, Toronto, ON, Canada doi:10.1016/j.ajic.2011.12.018] There are studies that substantiated that eye protection was the most challenging PPE category. Eye injury is one of the s that nearly three out of very alarming events happened among health care personnel. Statistics shows that nearly three out of five workers who experienced eye injuries were found not to be wearing eye protection at the time of the accident or were wearing the wrong kind of eye protection for the job. Add to this the fact that that thousands of workers are blinded each year from work-related eye injuries that could have been prevented when proper compliance and usage is observed. (http://www.infectioncontroltoday.com/articles/2011/10/addressing-the- challenges-of-ppe-non-compliance.aspx) In this study, we can ascertain that our respondents have a high adherence in terms of wearing mask when performing operations/procedures that might induce spraying of blood, body fluid, secretions and excretions. Contrary to this, wearing of protective eye patch or goggles resulted to a weighted mean of 2.10 which suggest moderate adherence among the respondents. Barriers which may affect nurses compliance in wearing eye protections may include non-availability of resources at the time of need or inadequacy of supplies. Say for example at OR-ITRMC, nurses may have a good access to Control Supply Room where they can just easily gathered equipment (eye patch or specialized goggles) in emergency situation which causes splashing of blood, body fluids, secretion and excretion from patients. In spite of this, other departments, particularly on wards located distantly from CSR may have difficulty gathering equipment during emergency call. In the study of Nichol et al (2008), they identified five factors as key predictor to nurses compliance to the recognized use of facial protection. These factors include full- time work status, more than 5 years tenure as a nurse, at least monthly use of facial protection, a belief that media coverage of infectious illnesses impacts risk perception and work practices, and lastly, the organizational support for health and safety. [Individual, environmental, and organizational factors that influence nurses' use of facial protection to prevent occupational transmission of communicable respiratory illness in acute care hospitals Journal Article2008Nichol K, Bigelow P, O'Brien-Pallas L, McGeer A, Manno M, Holness DL American Journal of Infection Control DOI: 10.1016/j.ajic.2007.12.004] GOWN AND CAP ADHERENCE Gowns should be worn during delivery, surgical procedure and cleaning if splashing is anticipated. An isolation gowns as specified by standard and Transmission-based Precautions, are used to protect HCW exposed body areas from contamination of clothing with blood, body fluids and other potentially infectious materials. Gowns are always been worn in combination with gloves and other PPE as well.[http://www.cdc.gov/hicpac/2007IP/2007ip_part2.html] On the other hand, goggles or protective eyewear should be worn when there is risk of splash or spilling of blood or body fluids. The aforementioned result shows moderate adherence of staff nurses to wearing of gowns and protective eye wears. Utilization of gowns and eye protections should be emphasized to staff nurses especially when performing surgical procedures which could lead to splashing of large amounts of blood, body fluids and other infectious materials. Based on the study of Sharma et al (2003), there is a very high risk of facial and blood contamination in major gynecologic surgeries placing doctors and HCW at risk of obtaining viral infectious diseases. Use of masks and protective goggles is strongly recommended to avoid body fluid contamination and acquiring disease in obstetrics. [Facial and body blood contamination in major gynecologic surgeries. Sharma JB, Gupta A, Malhotra M, Arora R .Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. DOI: 10.1111/j.1341-8076.2003.00137.x] PPE ADHERENCE IN GENERAL Use of Personal Protective Equipment is essential to health and safety. They reduce the risk of exposure of the Health Care Workers skin or mucous membranes to blood, body fluids and other potentially infectious materials. Selection of PPE must be based on an assessment of the risk of transmission of microorganisms to the patient or the HCW, and the risk of contamination to the HWC clothing and skin, mucous membranes by patients blood, body fluids, secretions and excretions (except tears and sweat). The advantage of using appropriate PPE is twofold, giving protection to both patients and those caring for them. (http://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04.pdf)
A numbers of literatures have documented barriers to PPE compliance that is, lack of time, the perception that using PPE interferes with the ability to perform the job,, physical discomfort (dexterity) / difficulty communicating when wearing masks, and the non-availability of PPE resources in times of need.