title: The use of personal protective equipment for control of influenza among critical care clinicians: A survey study.
abstract: BACKGROUND
  Intensive care units (ICUs) are potential high-risk areas for transmission of viruses causing febrile respiratory illness, such as influenza. Healthcare-associated influenza is prevented through healthcare worker (HCW) vaccination and effective use of U.S. Centers for Disease Control and Prevention recommended infection control practices, including use of personal protective equipment (PPE). Although effective PPE use may significantly reduce healthcare-associated influenza transmission, PPE adherence among ICU HCWs for preventing nosocomial influenza infection has not been evaluated.
  
  
  OBJECTIVE
  To characterize ICU HCW behavior, knowledge, and attitudes about recommended precautions for the prevention of healthcare-associated influenza infections.
  
  
  METHODS
  A survey of 292 internal medicine housestaff, pulmonary/critical care fellows and faculty, nurses, and respiratory care professionals working in four ICUs in two hospitals in Baltimore, MD.
  
  
  RESULTS
  Of those surveyed, 88% (n = 256) completed the survey. Only 63% of respondents were able to correctly identify adequate influenza PPE, and 62% reported high adherence (>80%) with PPE use for prevention of nosocomial influenza. In multivariable modeling, odds of high adherence varied by clinician type. Respondents who believed adherence was inconvenient had lower odds of high adherence (odds ratio 0.42, 95% confidence interval 0.22-0.82), and those reporting likelihood of being reprimanded for nonadherence were more likely to adhere (odds ratio 2.40, 95% confidence interval 1.25-4.62).
  
  
  CONCLUSIONS
  ICU HCWs report suboptimal levels of influenza PPE adherence. This finding in a high-risk setting is particularly concerning, given that it likely overestimates actual behavior. Both suboptimal adherence levels and significant PPE knowledge gaps indicate that ICU HCWs may be at a substantial risk of developing and/or transmitting nosocomial respiratory viral infection. Improving respiratory virus infection control will likely require closing knowledge gaps and changing organizational factors that influence behavior.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA. edaughe2@jhmi.edu
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Daugherty
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
authors.forename: Lewis
authors.initials: L
authors.lastname: Rubinson
authors.forename: Andrew
authors.initials: A
authors.lastname: Bilderback
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
mesh_terms: D000328:Adult; D003422:Critical Care; D005260:Female; D006282:Health Personnel; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D011482:Protective Devices