title: Behind the mask: Determinants of nurse's adherence to facial protective equipment.
abstract: BACKGROUND
  As the predominant occupation in the health sector and as the health worker with the most patient interaction, nurses are at high risk for occupational transmission of communicable respiratory illness. The use of facial protective equipment (FPE) is an important strategy to prevent occupational transmission.
  
  
  METHODS
  A 2-phased study was conducted to examine nurse's adherence to recommended use of FPE. Phase 1 was a cross-sectional survey of nurses in selected units of 6 acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses.
  
  
  RESULTS
  Of the 1,074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of FPE. Multivariable analysis revealed 6 predictors of adherence: unit type, frequency of equipment use, equipment availability, training, organizational support, and communication. Following the survey, 100 observations in 14 intensive care units were conducted that revealed a 44% competence rate with proper use of N95 respirators and knowledge as a significant predictor of competence.
  
  
  CONCLUSIONS
  Whereas increasing knowledge should enhance competence, strategies to improve adherence to recommended use of FPE in a busy and complex health care setting should focus on ready availability of equipment, training and fit testing, organizational support for worker health and safety, and good communication practices.
authors.affiliation: Occupational Health Services Program, St Michael's Hospital, Toronto, ON, Canada. k.nichol@utoronto.ca
authors.forename: Kathryn
authors.initials: K
authors.lastname: Nichol
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
authors.forename: Philip
authors.initials: P
authors.lastname: Bigelow
authors.forename: Linda
authors.initials: L
authors.lastname: O'Brien-Pallas
authors.forename: James
authors.initials: J
authors.lastname: Scott
authors.forename: D Linn
authors.initials: DL
authors.lastname: Holness
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D003428:Cross Infection / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008397:Masks / Q000706:statistics & numerical data*; D008875:Middle Aged; D009726:Nurses; D009784:Occupational Diseases / Q000517:prevention & control*; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D055815:Young Adult