Research Article

iMedPub Journals 2019

Journal of Healthcare Communications
www.imedpub.com ISSN 2472-1654 Vol.4 No.1:2

DOI: 10.4172/2472-1654.100152

Personal Protective Equipment Knowledge Abuobaida E.E. Abukhelaif*

and Practices among Nurses Working at Al- Department of Pathology, Faculty of Medicine,
Baha King Fahad Hospital, Saudi Arabia Al-Baha University, Saudi Arabia

*Corresponding author:
Abuobaida E.E. Abukhelaif

Abstract  [email protected]

Background: Infection prevention and control is an integral component of nursing

Assistant Professor, Department of
care delivery in any setting to reduce risks for morbidity and mortality in patients
Pathology, Faculty of Medicine, Al-Baha
and care givers at all levels. Nurses share responsibility with other health care
University, Saudi Arabia.
personnel for infection risk reduction in patients across entire continuum of care
and play vital role in reducing risks for infection through a variety of direct care
activities. Citation: Abukhelaif AEE (2019) Personal
Protective Equipment Knowledge and
Aims & Objective: This was a cross sectional descriptive study aimed at
Practices among Nurses Working at Al-Baha
determining the knowledge, practice and factors that influence compliance with
King Fahad Hospital, Saudi Arabia. J Healthc
usage of Personal Protective Equipment (PPE) among nurses working at Al-Baha
Commun Vol.4 No.1:2
King Fahad Hospital, KSA.
Material and Methods: A cross-sectional survey conducted between October and
December 2017 among staff nurses working at Baha KFH. One hundred eighty five
nurses were enrolled in this study. Data were collected and analyzed using SPSS
software.
Results: Most of the studied nurses were female, young in the age group of less
than 40 years, carry bachelor’s degree and work as staff nurses for more than
3 years (78.4% 81.1%,74.6% & 61.6%) respectively. There is strong evidence of
positive relationship between awareness of the respondents with PPE, gloves
(as an effective barrier for infection control), hand mediated transmission and
catheter care practices with most of the nurse's demographic characteristics
however there was no association between the age and wearing of gloves.
Conclusion: Nurses had excellent knowledge with and appropriate use of PPE as
vital in safeguarding HCWs and spread of infection.
Keywords: Infection control; Knowledge, Nurses; PPE

Received: March 11, 2019; Accepted: March 25, 2019; Published: April 05, 2019

Introduction or surfaces in the patient environment, and respiratory hygiene/

cough etiquette which are designed to reduce the risk of acquiring
Health care professionals and patients are at high risk to be occupational infection from both known and unexpected sources
exposed to potentially infected blood and body fluids that can in the healthcare setting [3]. At 1996 the Center for Disease
lead to serious or even lethal infections [1]. Nurses in particular Control and Prevention (CDC), put forward guidelines, a revised
are repeatedly exposed to various infections during the course of version of a preventive concept against nosocomial infections.
carrying out their nursing activities [2]. This can be minimized by It advocates basic standard precautions for all healthcare
applying standard precautions as hand hygiene, use of personal delivery and additional specific measures to protect healthcare
protective equipment (e.g., gloves, gowns, masks), safe injection workers and patients from exposure to potentially harmful
practices, safe handling of potentially contaminated equipment

© Under License of Creative Commons Attribution 3.0 License | This article is available in: http://healthcare-communications.imedpub.com/archive.php 1
 ARCHIVOS
Journal of Healthcare DE MEDICINA
Communications 2019
ISSN
ISSN 1698-9465
2472-1654 Vol.4 No.1:2

microorganisms [4-6]. being invasive in nature. Some of these activities include, vaginal
examination, handling of second and third stage of labour,
Despite the adoption of these guidelines by healthcare worker
suturing of episiotomies, and removal of retained placenta.
in several countries, compliance with aseptic precautions is
Paediatric ward admits patients with both medical and surgical
known to be “poor and lacking” [7-10]. Numerous studies shown
conditions.
that factors that contribute to non-compliance with standard
precautions include lack of understanding and knowledge among Sampling procedure
health care workers on how to properly use protective barriers,
lack of time, lack of resources, and lack of proper training. Purposive sampling was used for selecting the wards and in each
Other reported that better knowledge of universal precautions selected ward a list of names for the nurses was obtained from
among health care workers was one of the predictors of better the team leader. Simple random sampling was then applied to
compliance [11-20]. obtain eligible participants. All the eligible participants were
selected and those who consented to participate were recruited
Nurses at King Fahad Hospital-Al-Baha (KFH – Baha) are responsible into the study.
for directing and coordinating nursing care in all departments in
line with the nursing clinical application standards. This cover Data collection
observing and reporting patient condition, providing nursing Data was collected using self- administered semi structured
care, recording pulse and temperature, administering drugs and questionnaire that composed of information about demographic
other medicines and providing support to patients and relatives. and occupational characteristics of the respondents like:
In King Saudi Arabia (KSA), as in several other countries, each (gender, age, education and years of experience), as well as
hospital has a multidisciplinary Infection Control Committee, their knowledge and practices regarding compliance with usage
which provides advice on the issues of control of infection, of Personal Protective Equipment (PPE). The questionnaire was
defines standards, and recommends policies. Several studies have developed grounded on the associated literatures and statistical
evaluated disinfection and sterilization procedures in hospitals, experts in our college assess its validity and reliability. The
knowledge and practices of hospital staff, and compliance with subjects were asked to rate their believe, awareness and practices
universal precautions, but similar data are few if not available about PPE using rating as "Excellent", "Good" or "Ok". Knowledge
in KSA. Information on this topic is necessary to assess whether questions using rating as " Disagree, "Ok", "Agree" and "Strongly
nurses are prepared to assume their responsibilities in preventing agree". These questionnaires were checked for completeness
hospital infections. Studies on standard precautions are increasing and consistency upon collection.
over the world [3,6,7,10], studies from Saudi Arabia that assessed
nurse knowledge and compliance towards SPs are scarce. Hence
Data analysis
this study was conducted, with the objective to determine with Statistical Package on Social Science (SPSS) version 16 was used
usage of Personal Protective Equipment (PPE) among nurses to analyze the data. Descriptive statistics were used to analyse
working at Al-Baha King Fahad Hospital, KSA. characteristics of participants. Chi-square and correlation was
used to establish significance and relationship between variables.
Methodology
This was a cross sectional descriptive study aimed at determining
Presentation of Results
the knowledge, practice and factors that influence compliance The results have been presented in form of frequency tables and
with usage of Personal Protective Equipment (PPE) among nurses bar graphs and a narrative explanation accompanying each form
working at Al-Baha King Fahad Hospital, KSA. of presentation.

Study population Findings

The study population were nurses working in medical, surgical, A total of 185 nurses consented and the response rate, adjusted
maternity and pediatric wards, who had worked for a minimum for non-delivery of questionnaires, was 92.5%.
period of six months. The study targeted nurses since they are
Table 1 represents demographic characteristics of the studied
amongst the healthcare providers who are in majority and are
sample, among the respondents, 145 (78.4%) were female and 40
involved in a number of nursing activities which render them
(21.6%) were male; most of the studied nurses were young in the
at risk of acquiring and transmitting HAIs. These activities
age group of less than 40 years, had bachelor’s degree and work
include, wound management, initiation of intravenous infusions,
as staff nurses for more than 3 years in percentages of (81.1%,
administration of injections, management of labour, waste
74.6% & 61.6%) respectively.
disposal and instrument processing. The medical wards admit
patients with various disease conditions some of which are Personal protective equipment (PPE)
infectious. Patients in surgical wards are at increased risk of
acquiring hospital acquired infections because of the nature The primary use of personal protective equipment (PPE) is to
of surgical interventions they go through most of which are protect healthcare workers (HCWs) and reduce opportunities for
invasive. Midwifes in maternity wards are at increased risk of transmission of microorganisms in healthcare facilities. It does not
acquiring hospital acquired infections because the nursing and reduce the level of hazard itself nor guarantee total protection.
midwifery activities involve blood and body secretions as well as They should be used as the supplement to the administration and

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 ARCHIVOS
Journal of Healthcare DE MEDICINA
Communications 2018
ISSN
ISSN 1698-9465
2472-1654 Vol.3 No.4:40

engineering control in the care of the infective patients. demographic characters of respondent nurse groups regarding
age, sex, education and work experience years being more in
The overall awareness amongst the entire questionnaire
females, ages less than 40 years, bachelor and post-graduation
respondents was 172 (93%) as shown in Table 2 below.
and more than 3 years experiences, (P value <0.005).
Regarding the correlation of PPE with the demographic
characteristics of respondent nurses as shown in Table 3 there Wearing gloves
is strong evidence of positive relationship [p – value of (0.024, Routine use of disposable gloves has been recommended for all
0.043, 0.001, 0.030)] between awareness of the respondents patient contacts. Gloves ideally should be removed after seeing
with PPE as an effective barrier for infection control and their a patient and the hands washed thoroughly before re-gloving to
gender, age, education and work experience respectively. see a new patient. Out of the total staff, 86 per cent claimed to
wear fresh gloves before patient examination and procedures
Hand mediated transmission but only 57 per cent of the staff actually did it during observations
Hands are the most common vehicle of transmission of organisms. (Figure 2). Out of 185 nurses staff 126 (68.1%) claimed that they
And 91.6 per cent of the nurse staff agreed that hand mediated always wore gloves before patient examination (Table 5).
transmission is one of the major sources of cross infection. As
shown in Figure 1 the majority (85.4%) of the studied sample Discussion
were agreed that hands mediated transmission (spread) of
To our knowledge, this is the first research study contracted in Al-
infection is a main contributory factor to the infection risks for
Baha king Fahad hospital among any group of health care workers,
hospital in-patients.
investigating the issue of compliance with Standard Precautions
Table 4 shows that there was an evidence of significant to avoid occupational exposure to pathogens. Present study was
difference between hand mediated transmission of infection and carried out to assess the knowledge, practice and attitude of
nursing staff related to infection control measures [21-24].
Table 1 Demographic characteristics.
Infection control is a key factor of practice for all healthcare
Character Components Frequency Percent
professionals, not only for their health but also to reduce
Male 40 21.6 nosocomial infections and thus improve the patient safety [25].
Gender Standard precautions are a set of basic infection prevention
Female 145 78.4
20 - 30 year 66 35.7
31-40 years 84 45.4
Age
Over 40 years 35 18.9
Diploma or less 47 25.4
Bachelor and
Education 138 74.6
post
Less than 3 years 71 38.4
Work experience More than 3
114 61.6
years

Table 2 Overall awareness to PPE.

Frequency Percent
Excellent 141 76.2
Good 31 16.8
Ok 13 7.0 Figure 1 Hand mediated transmission is one of the major sources
Total 185 100.0 of cross infection.

Table 3 Statistical Relation between the respondent Awareness of using PPE and their Demographic Characteristics.
PPE
Excellent Good Ok
Character P value
141 (76.2%) 31(16.8%) 13 (7%)
Male 24 (17.0 %) 11 (35.5%) 5 (38.5%)
Gender
Female 117 (83.0%) 20 (64.5%) 8 (61.5%) 0.024
20 - 30 year 55(39.0%) 6 (19.4%) 5 (38.5%)
31-40 years 57 (40.4%) 22 (71.0%) 5 (38.5%)
Age 0.043
Over 40 years 29 (20.6%) 3 (9.7%) 3 (23.1%)
Diploma or less 28 (19.9%) 15 (48.4%) 4 (30.8.0%)
Education 0.001
Bachelor and post 113 (80.1%) 16 (51.6%) 9 (69.2%)
Less than 3 year 51 (36.2%) 14 (45.2%) 6 (46.2%)
Work experience 0.030
More than 3 years 90 (63.8%) 17 (54.8%) 7 (53.8%)

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 ARCHIVOS
Journal of Healthcare DE MEDICINA
Communications 2018
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ISSN 1698-9465
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Table 4 Statistical Relation between the respondent Knowledge of Hand Mediated Transmission and their Demographic Characteristics.
Disagree Agree
Character P value
27 (14.6%) 158 (85.4%)
Male 15 (55.6 %) 25 (15.8%)
Gender Female 12 (44.4%) 133 (84.2%) 0.000
20 - 30 year 3(11.1%) 63 (39.9%)
31-40 years 15 (55.6%) 69 (43.7%)
Age 0.001
Over 40 years 9 (33.3%) 26 (16.3%)
Diploma or less 11 (40.7%) 36 (22.8%)
Education 0.000
Bachelor and post 16 (59.3%) 122 (77.4%)
Less than 3 year 9 (33.3%) 62 (39.2%)
Work experience 0.000
More than 3 years 18(66.7%) 96 (60.8%)

Table 5 Association of demographic characteristics and wearing gloves.

Sometimes Frequently Always
Character P value
28 (15.1%) 31 (16.8%) 126 (68.1%)
Male 13 (46.4%) 9 (29%) 18 (14.3%)
Gender Female 15 (53.6%) 22 (71%) 108 (85.7%) 0.001
20 - 30 year 6(21.4%) 11 (35.5%) 49(38.5%)
Age 31-40 years 17 (60.7%) 11 (35.5%) 56 (38.5%) 0.190
Over 40 years 5 (17.9%) 9 (29.0%) 21 (23.1%)
Diploma or less 4 (14.3%) 1 (3.2%) 42 (33.3%)
Education 0.013
Bachelor and post 24 (85.7%) 30 (96.8%) 84 (66.7%)
Less than 3 year 8 (28.6%) 9 (29.0%) 54 (42.9%)
Work experience 0.030
More than 3 years 20 (71.4%) 22 (71.0%) 72 (57.1%)

were females. Female nurses had a higher perception of being at

risk by virtue of working in a hospital than their male counterparts
and this difference was statistically significant p=0.002. In our
study most of the studied nurses were young in the age group of
less than 40 years, had bachelor’s degree and work as staff nurses
for more than 3 years in percentages of (81.1%, 74.6% & 61.6% )
respectively, in comparison with some other studies in the area in
which three quadrants of the studied nurses had diploma degree
and nearly half of them attended training programs in infection
control. Moreover, their years of experience was more than 15
years at workplace [28]. These results come in agreement with
similar studies that revealed dominance of females, majority of
nurses in their study had bachelor's degree and most of nurses
attended infection control programs [29-31].
Regarding PPE, the mandatory use of PPE defined by health
Figure 2 Wearing Gloves. authorities in Saudi, our study showed the overall awareness
amongst study respondents was 93%, this was not in accordance
with may studies in Egypt [32,33]. Routine use of disposable
practices intended to prevent transmission of infectious diseases gloves has been recommended for all patient contacts. Gloves
from one person to another. Because it is not always known if require hand hygiene before wearing and be removed after
a person has an infectious disease or not, standard precautions seeing a patient and the hands washed thoroughly before
should be applied to every person every time to ensure that re-gloving to see a new patient. In our study nurses showed
transmission of diseases do not occur [3]. satisfactory knowledge 86% on this regard, this finding was in
concordance with a study reported that compliance with hand
By means of their knowledge and practice to protect themselves
hygiene performance is high [34] but was not in concordance
and patients from exposure to potentially infection, nurses show
with three studies who reported that compliance with hand
an important part in infection management [26,27]. Our study
hygiene performance is low [35-38].
discovered that, among 185 nurses consented and participated
in this study, 21.6% were males and 78.4% were females. Nursing
is a female dominated profession hence most of the participants

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 ARCHIVOS
Journal of Healthcare DE MEDICINA
Communications 2018
ISSN
ISSN 1698-9465
2472-1654 Vol.3 No.4:40

Conclusion Recommendation
Our study concluded that nurses had excellent knowledge with Continuous monitoring of nurses' practice parallel with providing
and appropriate use of PPE as vital in safeguarding the HCWs and adequate resources, decrease of work load by increasing the
spread of infection. However, practice was unsatisfactory about number of nursing staff and emphasizing training courses is
infection control standard precautions. crucial issues that improve the compliance with infection control
standard precautions.

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