Risk assessment and the use of personal protective equipment in an emergency department: differing perspectives of emergency and infection control clinicians. A video-vignette survey

Background

The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defence during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice.
Methods

An online scenario-based video-survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control (IPAC) clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher’s exact test.
Results

Participants agreed that most items were required for both scenarios. Eye protection, mask use and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than IPAC clinicians, to regard items/actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy emergency department.
Discussion

Our findings likely reflect differences in professional roles, competing priorities and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility and resource constraints.
Conclusions

To be feasible, practicable and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflect the complexities of their practice.