What Causes Failures in Personal Protective Equipment Use in Hospitals?

MedicalResearch.com Interview with:

Sarah L. Krein, PhD, RN Research Career Scientist VA Ann Arbor Healthcare System Ann Arbor, MI 

Sarah L. Krein, PhD, RN
Research Career Scientist
VA Ann Arbor Healthcare System
Ann Arbor, MI

MedicalResearch.com: What is the background for this study?

Response: We conducted this study to better understand the challenges faced by health care personnel when trying to follow transmission based precaution practices while providing care for hospitalized patients.  We already know from other studies that there are breaches in practice but our team was interested in better understanding why and how those breaches (or failures) occur so we can develop better strategies to ensure the safety of patients and health care personnel.

MedicalResearch.com: What are the main findings? 

Response: Our observational study involving 325 room observations at 2 study hospitals identified several common active failures in personal protective equipment (PPE)  use or precaution practices by healthcare personnel.

Failures included deviations from safe operating practices or procedures (violations), failures of intention (mistakes), and failures of execution (slips). Violations included health care personnel entering rooms without some or all recommended PPE; mistakes were often observed during personal protective equipment removal and when challenging logistical situations were encountered, such as badge-enforced computer log-in; and, slips involved healthcare personnel inadvertently touching their face or clean areas with contaminated gloves or gowns. Each of these active failures has a significant likelihood of self-contamination. However, perhaps more importantly, we found that the circumstances surrounding failures in precaution practices varied not only across but within the different failure types. 

MedicalResearch.com: What should readers take away from your report?

Response: Although, active failures in personal protective equipment use and transmission-based precautions, potentially leading to self-contamination, were commonly observed, the variety of circumstances in which breaches in precaution practices occur suggests that multiple strategies are needed to reduce these types of events. As such, while education or training may be helpful in some situations, we also need to focus on developing and implementing environmental and organizational changes to facilitate the use of proper practices by health care personnel as part of routine hospital care.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should focus on developing and testing interventions, including a specific emphasis on redesigning both products and practices related to PPE use and transmission based precautions, to assist health care workers while caring for patients requiring certain precautions and ensure safe care delivery.


Krein SL, Mayer J, Harrod M, et al. Identification and Characterization of Failures in Infectious Agent Transmission Precaution Practices in HospitalsA Qualitative Study. JAMA Intern Med. Published online June 11, 2018. doi:10.1001/jamainternmed.2018.1898 

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Last Updated on June 13, 2018 by Marie Benz MD FAAD