DECREASED

INFECTION CONTROL DUE TO VISITOR NONCOMPLIANCE OF PPE

Decreased Infection Control Due to Visitor Noncompliance of PPE

Margarita Hernandez Lopez

James Madison University

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Decreased Infection Control Due to Visitor Noncompliance of PPE

In a hospital environment, one of the top priorities is infection control. Infection control

is implemented to prevent the transmission of infection to the patient, visitors, and healthcare

providers. One way to implement infection control is through the use of personal protective

equipment (PPE) in isolation precaution rooms. Isolation precautions “create a barrier between

people and germs” (Manneheim, 2018). The type of isolation precaution used is dependent on

the type of germ, which also determines what PPE to use. PPE is “equipment worn to minimize

exposure to hazards that cause serious workplace injuries and illness” (Occupational Safety and

Health Administration [OSHA], n.d). A type of isolation precaution is contact precautions where

germs are spread by touching. In contact precautions, PPE requires the use of gloves and gown

when caring for the patient” (Manneheim, 2018). When PPE is not used in isolation rooms, this

creates an increased risk for spreading infections in a hospital environment. In a survey of 31

visitors of C. diff patients, only 42% of them were willing to wear gowns and gloves in spite of

signs on the door and available PPE supply (Seibert, et al., 2018). Visitor noncompliance of PPE

can have a negative impact in the hospital setting by decreasing infection control. Clearly,

infection control in the hospital is vital to maintaining safety, and a breach in this protocol is a

serious issue.

Background

During clinical, I personally experienced moral distress when I witnessed a C. diff

patient’s visitor enter the room without PPE. I felt moral distress because the visitor clearly

lacked education on safety precautions and the patient’s diagnosis. C. diff infection is “a major

hospital-acquired infection that results in 500,000 cases and 29,000 deaths each year in the USA”
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(Seibert, et al., 2018). I am sure that if the patient knew facts about C. diff, he would choose to

wear PPE. The situation also caused me moral distress when thinking about the outcomes. By

not having PPE, the visitor had an increased risk of picking up the infection and potentially

spreading it throughout the hospital. The visitor failed to break the chain of infection by failing

to wear the appropriate PPE. In my personal experience, I failed to intervene and inform the

patient the importance of PPE due to lack of courage, feeling powerless, and no one else was

doing anything about it.

The facility implemented ways to inform visitors to use PPE. They used magnetic signs

stating Isolation and the type of isolation; the signs hung outside the patient’s door. Plenty of

PPE supplies were also available outside the patient’s room. Despite the use of signs and PPE

supplies, the patient’s visitor did not put PPE on. It caused me moral distress because he clearly

did not want to wear PPE and I did have the courage to educate him since he showed signs of

noncompliance.

According to the American Journal of Infection Control, nurses are one of the top experts

in PPE information (Seibert, et al., 2018). Nurses can help visitors comply with PPE through

education, demonstration, and personally practicing it themselves. During clinical,

the situation with visitor compliance of PPE occurred again with a different patient. During this

situation, I intervened and demonstrated the visitor how to put on PPE. As a result of this, the

visitor complied to PPE. This indicates that nurses, indeed, play an important role in determining

the visitor’s decision of complying with PPE. It is important to educate and have visitor PPE

compliance in order to maintain a safety environment by preventing the spread of infections or

germs.

Methods/findings
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In situations where moral dilemmas and moral stress occur, finding the most appropriate

and best answer can be challenging. To assess the moral distress I experienced, I used the JMU

Eight Key Questions. I will use these questions to evaluate and interpret my personal experience

related to infection control and visitor noncompliance of PPE. The Eight Key Questions include

fairness, outcomes, responsibilities, character, liberty, empathy, authority, and rights (James

Madison University, n.d.).

Responsibilities: my obligation is to ensure a safe environment by implementing the use

of PPE. It is the nurse’s duty as well as others in the healthcare team to educate and inform

visitors about PPE. Through interventions, nurses can better achieve long term outcomes by

breaking the chain of infection and maintaining safety in the hospital. According to the provision

6.3 of the ANA code of Ethics, nurses are responsible for a health care environment that is safe,

supportive, and issues are identified. Nurses can use the ANA code of ethics to aide them in

guidance towards the right action. The ANA code of ethics is a document that nurses can use as

reference when in an ethical situation. I used this document to further support that it is the

nurse’s responsibility to ensure a safe environment in the hospital.

Fairness: how can I treat everyone equally pertaining noncompliance of PPE. The first

time I witness a visitor not use PPE, I was too scared to speak up. The second time the issue

arised again, I spoke up and made a difference. To implement fairness in the future, I will speak

up regardless if it’s a patient, visitor, nurse, or doctor to promote infection control.

Character: in order to get others to comply with PPE, I must be a good role model for

others to follow. I will do this by wearing appropriate PPE when needed, practicing good

handwashing, disinfecting items, and adhering to infection control. I strongly believe that I

cannot be telling others what to do if I myself am not practicing the same guidelines.
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Liberty: I believe visitors have personal authority over themselves. As a student nurse, I

can educate them and demonstrate how to use PPE, but I can’t force them to comply with PPE.

In the end, the visitor has the right and liberty to choose for themselves.

Empathy: If I were patient and saw that a loved one did not wear appropriate PPE when

visiting, I would tell them to wear it. As the patient, I would know that my infection is highly

contagious and would not like my loved one to catch it and further spread it to those at home.

Authority: nurses are a legitimate authority in the healthcare setting. Nurses are well

informed of PPE information and can give advice to visitors about wearing PPE due to infection

control. To help visitors comply with PPE, nurses should demonstrate PPE use, educate, and

emphasis the importance of handwashing. By informing visitors about the benefits of PPE, we

can achieve best outcomes and protect the safety of others.

Conclusion

From this ethical situation, I learned about ways to intervene when visitors to do not

comply with PPE. I believe it is the nurse’s responsibility to help visitors adhere to PPE by

providing cues, demonstration, and education. By taking actions in implementing PPE, visitors

are more likely to comply with PPE. As a result of visitor compliance of PPE, there are less

hospital-acquired infections and protects the patient, visitors, and other health care providers

from contamination. If I were to be presented with a similar ethical dilemma, I would speak up,

educate, and demonstrate the use of PPE for better visitor compliance. I learned that I should act

and not avoid the issue. Avoiding the issue does not solve the problem nor addresses it. For

future reference, I will not be afraid to speak up and have the courage to address the issue. To

decrease the distress and appropriately resolve the issue, I could inform my charge nurse of the

situation and figure out a plan of action using teamwork.

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References

James Madison University. (n.d.). The Madison collaborative: Ethical reasoning in action.

Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml

Mannheim, J. K. (2015, October 29). Isolation precautions. Retrieved March 20, 2018, from

https://medlineplus.gov/ency/patientinstructions/000446.htm

Occupational Safety and Health Administration (n.d.). United states department of labor.

Retrieved March 20, 2018, from

https://www.osha.gov/SLTC/personalprotectiveequipment/

Seibert, G., Ewers, T., Barker, A. K., Slavick, A., Wright, M., Stevens, L., & Safdar, N. (2018).

What do visitors know and how do they feel about contact precautions? American

Journal of Infection Control,46(1), 115-117. doi:10.1016/j.ajic.2017.05.011

The American Nurses Association, Inc. (2010, November 15). Code of ethics for nurses with

interpretive statements. Available from

http://www.bc.edu/content/dam/files/schools/son/pdf2/ANA%20code%20of%20ethics.pd