education as a strategy for improving personal protective equipment compliance in the peri operative...
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Education as a strategy for improving personal protective equipment compliance in the peri operative setting
Photos by Anna Zhu Photography & Film
The team
Karolin King RN, Gcert Perioperative Nursing, Gdip Clinical Nursing (ACU)
Education Consultant (Periop), St Vincent’s Private Hospital (Melbourne)
Assoc Prof Karen-leigh Edward, PhD, RN, RPN, BN (Monash) Gdip Psychology (Monash) MHSc (RMIT) PhD (RMIT)
Associate Professor of Nursing, Nursing Research Unit, Australian Catholic University/St Vincent’s Private Hospital
Carolyn Moore, Gcert Infect Cont (UniSA) Gdip Ad Ed Train (UNE)
Infection Control Nurse, St Vincent’s Private Hospital (Melbourne)
Jo-Ann Giandinoto, RN, BN(Hons) (ACU), BBSc (LaTrobe)
Research Assistant, Nursing Research Unit, Australian Catholic University/St Vincent’s
Private Hospital (Melbourne)
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Background
• Blood and body fluid (BBF) exposure high in perioperative settings (ACORN 2014-15)
• Perioperative personnel worldwide often fail to use PPE (Chan, Ho & Day, 2008)
• Knowledge and risk appraisal varies from person to person (Osborne 2003)
• Time pressures, support from managers and colleagues all affect staff use of PPE (Moore, Edward, King & Giandinoto, 2014; Moore et al., 2005)
Education as a Strategy
• Can improve PPE use and modify behaviour-
consideration of approach and delivery
• Mode of delivery matters (Dierssen-Sotos et al., 2010; Helder, Brug, Looman, van Goudoever & Kornelisse, 2010)
• Time burden (short but regular/repeated)(Chatterjee, Heybrock, Plummer & Eischen, 2004)
• Expertise and credibility
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Educational Approach & Delivery
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Photos by Anna Zhu Photography & Film
Photos by Anna Zhu Photography & Film
St. Vincent’s Private East Melbourne Perioperative Services
Aims
• Assess current use of PPE by staff in peri operative setting
• Develop and implement an educational program
• Increase staff awareness of risk of BBF
exposure in peri operative setting
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Objectives
• Developing and delivering best practice infection control education
• Increasing OR/ PARU staff knowledge and risk assessment
• Determining any improvement in PPE usage 6 months following education
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Participating Site
• Large metropolitan private hospital with
450 beds
• 23 theatres across three sites
• 36,000+ theatre cases per year
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Method
• Pilot study using a randomised controlled trial design
• Two arms (control and education)
• Randomisation – opaque sealed envelopes selected randomly by participants
• Two time points (baseline and 6 months)
• Survey developed for the study - undertaken by all participants at each time point
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Education Package
Four modules with self assessment and quizzes related to PPE
1. Module one - background to personal protective equipment
2. Module two - scenarios
3. Module three - standard and additional precautions
4. Module four - risk assessment and PPE selection
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1,2,3-PPE
What is the nature of the interaction?
What are the risks for blood and bodily fluid exposure?
What PPE will reduce the risk of exposure?
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Data collection
• Included staff centred characteristics
• Job related variables
• Organisational factors
• Patient centred characteristics
• Self reported compliance with standard precautions
(Gershon et al., 1995; Gerschon et al., 2000)
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Results
80 RN’s invited to participate
Response rate of 69%- final sample of n=55
First time point (baseline):
Questionnaires completed for final analysis- n=31
Second time point (6 months):
Questionnaires completed for final analysis- n=17
Attrition rate = 45%
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Results
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baseline 6 months post intervention75
80
85
90
95
100
education interventioncontrol
Self-reported Compliance with Following Standard Precautions
Results
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baseline 6 months post intervention50
60
70
80
90
100
education interventioncontrol
Protective Eyewear Worn when Risk of Exposure to BBF
Results
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baseline 6 months post intervention50
60
70
80
90
100
education intervention
control
Awareness of Systems of Care following BBF Exposure
Impact of the education
• Positive impact in general for wearing PPE
• Some contradictions with particular types of PPE
• Greater awareness of reporting systems following exposure to BBF
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Limitations
• Small sample size
• Individual learning styles
• Data is reliant upon self reporting • Formal evaluation of education
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Education Delivery
• One mode of educational delivery - printed modules
• Multimodal approach more effective over time(Panhotra, Saxena & Al-Arabi, 2004)
• Shown to increase knowledge and intention to change practice
(Cook, Friedman, Lord & Bradley-Springer, 2009)
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Education and Behavioural Change
• Education only one factor (Ward, 2011)
• Need to understand behaviour and change
• Risk assessment clearly indicated as common in our findings
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Health Belief Model and Behaviour with PPE
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Health BehaviourWill wear PPE if exposed
to obvious risk - e.g. infected patient
Belief in personal health threat
Dependent on type of exposure
Perceived SusceptibilityNegligible risk of contracting disease from BBF exposure
Perceived SeverityBlood borne diseases can
be fatal
Belief in effectiveness of health behaviour
Dependent on design of PPE
Perceived Benefits
Receive protection
Perceived BarriersInaccessibility, discomfort,
interference with performing tasks
Education and the Process of Change
Lewin’s 3 StepChange Theory
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Lewin’s Change Model
UNFREEZING:
Challenging current ideas and motivate to change - Education
CHANGING:
Reinforcing PPE & establishing new
behaviours – Multimodal education
REFREEZING:
Making change permanent – Continuing education &
feedback
Conclusions
• Education:• appropriate and pertinent• knowledge of risk
• Single education intervention – limited
• Andragogical principles:• Multimodal approaches• Interactive, face to face sessions • Flexible models• Frequent repetition – on-going time frames
Organisational commitment essential
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