1728. Effectiveness and Healthcare Personnel (HCP) Perceptions of a Multi-Site Personal Protective Equipment (PPE) Free Zone Intervention
Session: Oral Abstract Session: The World Around Us: Reducing Exposures to Pathogens in the Healthcare Environment
Saturday, October 6, 2018: 9:30 AM
Room: S 156

Background: CDC provides guidelines for using contact precautions (CP) when caring for patients with antibiotic resistant bacteria or Clostridium difficile. However, HCP frequently report discomfort, difficulty of use, and interrupted workflow with CP. Modifying CP guidelines to balance these issues requires testing to assess benefits and maintenance of safe practices. A promising approach using a “PPE Free Zone” strategy within rooms of patients in CP has not been well-studied.

Methods: The PPE Free Zone comprised a 3-6 foot area inside door thresholds of CP patient rooms denoted by red tape placed on the floor. Within the zone, HCP were not required to don PPE. HCP were considered compliant if they performed hand hygiene (HH) and donned appropriate PPE before crossing the zone. Observers at 6 acute care facilities (ACF) were trained on observing HCP HH and use of PPE with CP. Observations were made before and after implementation of a PPE Free Zone. Intervention ACF conducted observations on 8 intervention units and 6 non-intervention units. Models of overall compliance and entry HH compliance were constructed using a generalized linear mixed effects model with a logistic link function. Pre-intervention observations from all 6 ACF and intervention phase observations from the 3 intervention ACF were used in models.

Results: We observed 4,510 room entries. HH adherence declined over time in both intervention and control units but declined less among intervention units from pre to post intervention (β: 0.71, p=0.007, Figure 1). Stratified by precautions type, the effect of the PPE Free Zone on HH was only significant for rooms in enteric precautions (p<0.001). Compliance with PPE use was not significantly different pre vs post intervention (p=0.133). When surveyed, HCP had positive views of the PPE Free Zone: 65% (n=172) agreed or strongly agreed the zone facilitates communication with patients, permits checking on patients more frequently, and saves time [n=169]  (Figure 2).

Conclusion: Although HCP viewed the zone positively and it had a significant effect on HH in enteric precautions rooms, the zone did not improve PPE compliance. Future interventions in the ACF setting should consider the complex sociotechnical system factors influencing behavior change.


Lindsay Visnovsky, PhD, MS1,2, Diane Mulvey, BSN, RN1,2, Yue Zhang, PhD2,3, Molly Leecaster, PhD1,2, Curtis J. Donskey, MD4,5, Sarah L. Krein, PhD6,7, Nasia Safdar, MD, PhD8,9, Heba Alhmidi, MD10, Lauren Barko, BS11, Candace Haroldsen, MSPH2, Emma Ide, BS11, McKenna Nevers, MSPH2, Catherine Shaughnessy, BS11, Kristina Stratford, B.S., CCRP1,2, Frank Drews, PhD, MS2, Matthew Samore, MD, FSHEA1,2 and Jeanmarie Mayer, MD1,2, (1)Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, (2)IDEAS Center, Salt Lake City VA Health Care System, Salt Lake City, UT, (3)Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, (4)Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (5)Case Western Reserve University, Cleveland, OH, (6)Hospital Outcomes Program of Excellence (HOPE), VA Ann Arbor Healthcare System, Ann Arbor, MI, (7)Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, (8)William S Middleton Memorial Veterans Hospital, Madison, WI, (9)Division of Infectious Diseases, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, (10)Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (11)University of Wisconsin, Madison, WI


L. Visnovsky, None

D. Mulvey, None

Y. Zhang, None

M. Leecaster, None

C. J. Donskey, None

S. L. Krein, None

N. Safdar, None

H. Alhmidi, None

L. Barko, None

C. Haroldsen, None

E. Ide, None

M. Nevers, None

C. Shaughnessy, None

K. Stratford, None

F. Drews, None

M. Samore, None

J. Mayer, None

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