sure scenarios with the potential for long work hours, high patient loads, and profound physical and emotional stress. The current limited surge capacity of emergency departments and healthcare facilities will be overstretched. Infection control knowledge and capacity will thus need to be fostered throughout the organization so that as many personnel as possible will have immediate knowledge that they can impart to emergency responders, temporary workers, and volunteers who may be actively involved in emergency care. Although this chapter can not explore all of the specific issues, it is hoped that the strategies presented can be used in tailoring future efforts to improve worker safety.

The chapter begins with an overview of studies regarding PPE use by healthcare workers and the context of PPE use in the healthcare setting. Four strategies for improving worker safety are then discussed in detail with a focus on collaborative efforts and commitments by employers and healthcare workers to: provide leadership and commitment to worker safety, emphasize education and training, improve feedback and enforcement, and clarify relevant work practices.

USING PPE: IDENTIFYING THE CHALLENGES

Despite expert recommendations and high-risk conditions, healthcare workers exhibit low rates of PPE use (Hammond et al., 1990; Kelen et al., 1990; Afif et al., 2002). Although the use of PPE is often examined by observational studies or survey questionnaires of individual workers, assessments of the explanations for noncompliance and the solutions to these issues need to focus beyond the individual and address the institutional issues that prevent, allow, or even favor noncompliance.

Studies on this issue have focused on adherence to standard precautions1 and few studies have examined interventions to improve adherence rates. Although the knowledge base on compliance with standard precautions is not extensive, pandemic influenza will likely present even further complications.

Madan and colleagues (2001) observed emergency department personnel in a New Orleans hospital and recorded an overall compliance rate of 38 percent with the application of barrier precautions. Of the 104 nurses and physicians studied, 41 percent used protective gowns, while

1

The report uses the broader term standard precautions (see Chapter 1), except in describing research in which the authors specifically use the term universal precautions.



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