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HCWs report infrequent use of protective equipment to prevent pertussis
Barriers remain in using personal protective equipment to prevent pertussis transmissions in ambulatory settings, according to recent study findings.
“Health care workers (HCWs) report frequently using personal protective equipment (PPE) for patients with suspected pertussis, yet most staff report that they do not use PPE for patients with any respiratory symptoms,” the researchers wrote in the Journal of the Pediatric Infectious Diseases Society. “Given the potential for missed pertussis diagnosis, this discrepancy could result in missed opportunities to prevent exposures to pertussis as well as other respiratory pathogens.”
Kristen A. Feemster, MD, of the division of infectious diseases at The Children’s Hospital of Philadelphia, and colleagues evaluated 331 questionnaires from HCWs from 18 clinics in a pediatric ambulatory network to determine barriers and facilitators for the use of infection prevention and control practices to prevent pertussis transmission in ambulatory pediatric settings.
Overall, less than 10% of HCWs reported ever having pertussis and almost all clinical HCWs had received the tetanus-diphtheria-acellular-pertussis vaccine (Tdap), and 70% of non-clinical HCWs reported getting the vaccine within the past 10 years. At least one documented occupational pertussis exposure during the past 5 years took place at half of the clinics.
When caring for a patient with suspected pertussis, more than 70% of clinical HCWs reported mostly or always wearing PPE, however, less than 30% reported wearing PPE when seeing a patient with any respiratory symptoms. Over 80% of clinical HCWs reported their PPE use could be improved. When patients with a cough entered the office, 61% of nonclinical HCWs reported mostly or always giving them a mask; however, almost 90% reported they could improve the practice of mask distribution.
Seventy-three percent of clinical HCWs reported they would prefer wearing a mask when treating a patient with suspected pertussis and have patients with a cough wear a mask when entering the office. Eight percent reported they favored only wearing a mask themselves. Having a divider at the front desk separating the patients and providing a mask to all patients presenting with a cough was favored by 43% of nonclinical HCWs. Thirty-seven percent reported they favored only giving the patient a mask.
No association was found between clinical HCWs at sites with reported pertussis and reported PPE use when seeing a patient suspected of having pertussis (OR=1.71; 95% CI, 0.97-3.03). Perception of mask availability near a patient’s exam room (OR=5.41; 95% CI, 1.76-16.62), knowledge and skills required to use PPE for prevention of pertussis transmission (OR=4.62; 95% CI, 1.40-15.24) and lack of perceived barriers (OR=3.18; 95% CI, 1.28-7.92) increased the likelihood of PPE use.
“Prior studies have identified modifiable factors to improve PPE use in patient settings; however, our results show that these previously identified factors may not be associated with increased PPE use among HCWs in ambulatory sites,” the researchers wrote. “Instead, we identified other elements that could be targeted in interventions to improve PPE use, such as promoting an environment where PPE use is perceived as standard clinical care and improving HCW training on appropriate PPE use.”
Researchers wrote that future studies are still needed to evaluate the impact of PPE use and its effectiveness is protecting HCWs.
“Additionally, future work is needed to define how to effectively limit pertussis exposures while balancing the competing demands of limited space and efficient patient flow with the increased use of physical barriers and PPE use,” they wrote.
Disclosure: The study was funded by The Children’s Hospital of Philadelphia. Feemster reports financial ties with Abbott Laboratories and Pfizer, Inc. No other researchers report financial disclosures.
