The range of factors that impact PPE-related behaviors and compliance were organized in the 2008 Institute of Medicine (IOM) report and in other studies into three categories:

  1. individual factors, such as knowledge, beliefs, attitudes, perception of risk, history, and sociodemographics;

  2. environmental factors, including availability of equipment and negative-pressure rooms; and

  3. organizational factors, such as management’s expectations and performance feedback, workplace policies, and training and education programs.

Discussion in the 2008 report focused on the concerted efforts needed by individual healthcare personnel, managers, and institutions to improve the safety culture in healthcare facilities. This culture requires “an organization-wide dedication to the creation, implementation, evaluation, and maintenance of effective and current safety practices” (IOM, 2008, p. 8). Although organizational and cultural factors in the context of patient safety have received a great deal of attention in recent years, less attention has been focused on healthcare worker safety. In industrial settings, such as chemical and power plants, a focus on achieving high safety performance has been found to result from a sustained emphasis on safety factors at all levels of the organization: the individual level (e.g., attitudes, training), microorganizational level (e.g., management support, safety representatives, accountability), and macroorganizational level (e.g., communication, organization of technology, work processes) (Hofmann et al., 1995). Much can be learned from “high-reliability organizations” (e.g., nuclear power industry; certain military operations, including aircraft carriers; commercial aviation), which are given that term because of their highly complex and hazardous missions and few safety-related failures. Characteristics of these organizations include commitment to safety articulated from the highest level of the organization; resources, incentives, and rewards to carry out the commitment; continuous emphasis on safety; safety as the priority even at the expense of production or efficiency; communication across all levels that is frequent and candid; openness about errors and issues as well as regular reporting; and valuing organizational learning and improvements (Gaba et al., 2003; Roberts, 1990; Rochlin, 1999; Singer et al., 2003; Weick et al., 1999). In many industrial work situations PPE use is considered a mandatory practice with a specific type of PPE or PPE ensemble re-



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