title: Barriers to the Use of PPE to Prevent Pertussis Exposures in a Pediatric Primary Care Network.
abstract: BACKGROUND
  The resurgence of pertussis is contributing to mounting healthcare worker (HCW) exposures, especially within pediatric outpatient settings. Infection prevention and control (IPC) guidelines for ambulatory sites exist, but are not uniformly implemented. Our aim was to identify facilitators and barriers to the use of IPC practices to prevent pertussis transmission in ambulatory pediatric settings.
  
  
  METHODS
  HCWs at 18 of 25 (72%) clinics in a pediatric ambulatory network completed a theory-based questionnaire about pertussis and personal protective equipment (PPE). The questionnaire contained randomly distributed versions of two vignettes to create an experimental design assessing barriers to PPE use.
  
  
  RESULTS
  Three hundred forty-three of 467 (73%) HCWs completed the survey: 234 (68%) clinical and 109 (32%) nonclinical. Seventy-one percent of clinical HCWs reported wearing PPE when caring for a patient with suspected pertussis; only 27% used PPE for patients with any respiratory symptoms. Among clinical HCWs, reported PPE use when caring for patients with suspected pertussis was independently associated with attitudes toward PPE (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.8, 16.6), knowledge and skills (OR 4.6, 95% CI 1.4, 15.2), and lack of perceived barriers (OR 3.2, 95% CI 1.3, 7.9). HCWs who did not perceive PPE use as a norm were less likely to report using PPE (OR 0.2, 95% CI 0.1, 0.6) or distributing masks to patients with cough (OR 0.02, 95% CI 0.00, 0.2). Reported PPE use was not influenced by perceived infection risk or mask accessibility.
  
  
  CONCLUSIONS
  Our results identified barriers to PPE use and targets for education to prevent pertussis transmission in ambulatory pediatric settings.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Fierro
authors.affiliation: Division of Infectious Diseases Leonard Davis Institute of Health Economics, The University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors.forename: Maria
authors.initials: M
authors.lastname: Middleton
authors.affiliation: Division of Infectious Diseases Leonard Davis Institute of Health Economics, The University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors.forename: Adrienne N
authors.initials: AN
authors.lastname: Smallwood
authors.affiliation: Infection Prevention and Control.
authors.forename: Susan
authors.initials: S
authors.lastname: Rettig
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia Department of Pediatrics.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.affiliation: Division of Infectious Diseases Infection Prevention and Control Department of Pediatrics.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.affiliation: Division of Infectious Diseases Department of Pediatrics.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Feemster
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000517:prevention & control*; D010372:Pediatrics / Q000379:methods* / Q000706:statistics & numerical data; D000067393:Personal Protective Equipment / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D014917:Whooping Cough / Q000517:prevention & control*
keywords: ambulatory; infection control; pediatrics; personal protective equipment; pertussis.