You Are Here:Home/Resources/DNS Navigator/DNS Navigator Details
Personal protective equipment (PPE) is currently a topic of discussion on a global level. The COVID-19 pandemic has brought infection control procedures and the use of PPE under intense scrutiny, especially in long-term care. On a daily basis, we hear about the shortcomings of PPE supply and use, along with the lack of proper infection control in healthcare. Do not let the negative publicity paralyze you. As a leader, it is imperative to analyze what occurs in the facility and find ways to improve. By investigating competency and compliance, directors of nursing or other nurse leaders, such as infection preventionists, can improve PPE utilization in their facilities.
History of PPE
Since Leonardo DaVinci invented the first respirator to prevent contamination from chemical warfare in the 16th century, healthcare personnel (HCP) have been attempting to protect themselves from illness (Segal, 2016). As understanding of pathogens increased, PPE have evolved in response. PPE as we know it today originated in the 1970s when the Centers for Disease Control and Prevention (CDC) published the manual Isolation Techniques for Use in Hospitals. In the 1980s, PPE use intensified due to the human immunodeficiency virus (HIV) pathogen, which led to universal precautions being introduced in 1985 to prevent the transmission of infection. In addition to the gowns and gloves already being utilized, facemasks and eye shields were implemented to protect mucous membranes. In 1989, the Occupational Safety and Health Administration (OSHA) proposed a rule on occupational exposure to bloodborne pathogens. The rule on bloodborne pathogens was then finalized and published in 1991. The CDC issued an isolation guideline in 2007 which addressed PPE, including the donning and doffing procedures (Segal, 2016).
Transmission-Based Precautions and PPE
Almost 200 years ago, physicians discovered that deadly pathogens were transmitted from patient to patient via the hands of nurses and physicians, and that washing hands between appointments with patients would dramatically reduce the mortality rate (World Health Organization, 2009). While tremendous strides in hand hygiene compliance have been made since the 19th century, there is still room for improvement—as the Centers for Medicare & Medicaid Services (CMS) noted during its Call with Nursing Homes on May 13, 2020 (CMS, 2020). The CMS Northeast Division Director for Survey and Reinforcement named three areas of practice that surveyors have noted need improvement, and hand hygiene was at the top of the list.
Factors Affecting Compliance with Hand Hygiene
Properly washing hands and performing hand hygiene is an essential skill every healthcare worker (HCW) must possess. The AAPACN Hand Hygiene Competency Tool can assist nurse leaders documenting achievement of competence with this skill. However, competence does not necessarily translate into compliance.
A systematic review of the research studying hand hygiene of HCW in the hospital setting found several factors affect compliance (Erasmus, et. al, 2010). While the nursing home setting is unique and poses different challenges from the acute care setting, the findings from this study can enlighten the Infection Preventionist (IP) and other nurse leaders as to factors they may consider when working toward improving hand hygiene compliance in the nursing home. See the table below for some helpful factors to consider.
Nursing homes can have the most beautiful policies and procedures for infection prevention and control in the world, but if staff aren’t following through on them, they are a waste of paper, notes Deb Patterson Burdsall, PhD, RN-BC, CIC, FAPIC, an infection prevention and control consultant and faculty member at the Association for Professionals in Infection Control and Epidemiology (APIC) in Arlington, VA.
“So monitoring and auditing infection prevention processes in the facility is a critical component of quality care,” says Burdsall. “Unfortunately, the focus on infection prevention has not always been well-supported because infection surveillance, monitoring whether proper supplies are available and used correctly, and watching whether staff are performing hand hygiene and correctly using personal protective equipment all take time, which means the effort costs money.”
Often nurses think that the Payroll-Based Journal (PBJ) electronic staffing data submission system is an issue for payroll or the business office, notes Suzy Harvey, RN-BC, RAC-CT, managing consultant for BKD in Springfield, MO. “However, now that PBJ will impact ratings in the Five Star Quality Rating System, the director of nursing services (DNS) needs to be aware of PBJ and involved in the process.”
The Centers for Medicare & Medicaid Services (CMS) offers several reports that can help DNSs be sure their PBJ data is accurate, timely, and ready for prime-time viewing as staffing measures and Five-Star staffing star ratings on Nursing Home Compare. Industry experts suggest DNSs take the following steps:
This month, the Centers for Medicare & Medicaid Services (CMS) began using Payroll-Based Journal (PBJ) electronic staffing data to calculate the nursing and physical therapy (PT) staffing measures, as well as the Five Star Quality Rating System staffing ratings, on Nursing Home Compare, according to CMS survey-and-certification memo QSO-18-17-NH. CMS updated the Five Star Technical Users’ Guide to include the technical specifications for the updated staffing measures and ratings’ methodology, and effective June 1, providers will no longer have to complete the staffing section of the CMS-671 although the rest of the form will still need to be completed for survey.
Many directors of nursing services (DNSs) should see some changes in their staffing measures and Five Star staffing ratings, says Suzy Harvey, RN-BC, RAC-CT, managing consultant for BKD in Springfield, MO.
To access this resource, please login or sign up for a membership.