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Int. J. Curr. Res. Chem. Pharm. Sci. (2023). 10(8): 27-34
© 2023, IJCRCPS. All Rights Reserved 27
INTERNATIONAL JOURNAL OF CURRENT RESEARCH IN
CHEMISTRY AND PHARMACEUTICAL SCIENCES
(p-ISSN: 2348-5213: e-ISSN: 2348-5221)
www.ijcrcps.com
(A Peer Reviewed, Referred, Indexed and Open Access Journal)
DOI: 10.22192/ijcrcps Coden: IJCROO(USA) Volume 10, Issue 8 - 2023
Review Article
Inappropriate use of personal protective equipment
among health workers: A review of associated factors
*Emmanuel Ifeanyi Obeagu1, Getrude Uzoma Obeagu2,
Chidimma Maureen Chukwueze3and Anthonia Onyinye Ngwoke4
1Department of Medical Laboratory Science, Kampala International University, Uganda.
2School of Nursing Science, Kampala International University, Uganda.
3Department of Medical Laboratory Science, Enugu State University of Science and Technology,
Enugu, Nigeria.
4Department of Human Physiology, Faculty of Basic Medical Sciences, Enugu State University of
Science and Technology, Enugu, Nigeria.
*Corresponding authour: Emmanuel Ifeanyi Obeagu, Department of Medical Laboratory Science,
Kampala International University, Uganda.
E-mail: emmanuelobeagu@yahoo.com,0000-0002-4538-0161
Abstract
The study found that the discomfort of wearing F95 face masks and other PPE, willful refusal to wear N95 face
masks, an excessive number of patients in the wards, and contracting a hospital-acquired infection as a result of using
or wearing PPE are the individual factors associated with inappropriate PPE use among health workers. Also
discovered: PPE access restrictions, training in infection prevention and control, a lack of PPE, and knowledge of the
proper times to wash one's hands are all health system-related factors linked to inappropriate PPE use by health
workers. The overwhelming number of patients on the wards (individually), the lack of PPE (health system), and the
restricted access to PPE are found to be the main causes of inappropriate PPE use among health workers. When on the
job, health professionals are advised to wear the PPE that is available and to do so in accordance with the industry's
ethical standards. Finally, the paper suggests that because it endangers both patients' and health workers' lives,
patients should, whenever possible, refuse to be treated by healthcare professionals who are not wearing PPE, such as
gloves.
Keywords: inappropriate use, personal protective equipment, health workers, Covid-19
DOI: http://dx.doi.org/10.22192/ijcrcps.2023.10.08.004
Int. J. Curr. Res. Chem. Pharm. Sci. (2023). 10(8): 27-34
© 2023, IJCRCPS. All Rights Reserved 28
Introduction
Health care workers on the front lines, known as
healthcare professionals (HCPs), are essential to
the management of patients as well as the
implementation of effective infection prevention
and control (IPC) procedures in healthcare
facilities [1-2].
They consequently have a significantly higher
risk of contracting the virus and may help spread
it [3-5].
The transmission of COVID-19 and the risk of
infection in healthcare settings can be reduced
through the use of infection prevention and
control (IPC) techniques like the use of the
appropriate PPE, proper handwashing, and hand
hygiene [6-7]. Particularly during the current
COVID-19 pandemic, it is strongly advised that
healthcare workers wear the proper PPE, and
national and international safety protocols for this
population should be strictly adhered to. Health
care workers are both protected and have lower
infection risks when UPs are followed [8].
Each year, nosocomial infections are acquired by
over 521,311 healthcare professionals worldwide.
Three million health care workers (HCWs) are
percutaneously exposed to blood-borne viruses
every year, including hepatitis B, hepatitis C, and
HIV [9]. Additionally, the US Centers for Disease
Control and Prevention reported that healthcare
workers accounted for roughly 11% of all
confirmed COVID-19 cases in the United States,
while the Italian Regional Reference Laboratories
reported that 10% of the 162,000 cases of
COVID-19 in the nation were related to the
industry [10]. The demand for PPE has grown
significantly around the world since the first
COVID-19 outbreak report in December 2019.
Many healthcare settings in Africa, in particular,
have trouble getting access to the right PPE to
safeguard their health [8]. As a result, many
healthcare professionals are still concerned about
the possibility of contracting SARS-COV-2 due
to the lack of WHO-recommended PPE, and they
are also ill-prepared to care for patients who have
COVID-19 or other causes of infection [11]. In
Sub-Saharan Africa, Health Care Practitioners
(HCPs) frequently face difficult choices regarding
whether to care for and treat COVID-19 patients
in the absence of efficient PPE. African countries
account for the majority of hospital acquired
infections. Hospital acquired infections, including
COVID-19, were present in about 11% of HCPs
in Africa who were retrospectively studied [12].
Evidence from nations with the highest COVID-
19 mortality rates suggests that the risk of
coronavirus infection among healthcare workers
is significantly higher than that of the general
population, with rates ranging from 15 to 20
percent [13].
Individual Factors Associated with
Inappropriate Use of Personal Protective
Equipment (PPE) among Health Workers
Individual beliefs
PPE use is not an exception to the rule when it
comes to individual beliefs, which are one of the
most significant factors in health service uptake
generally [14]. Numerous references have been
made to the fact that individual traits and values,
particularly in Africa, have a significant impact
on the use of PPE and are influenced by
individual presumptions, preferences, and
concerns. Therefore, individual rather than
governmental responsibility for PPE use and for
anticipated hesitancy should receive equal weight
[15].
Low skill and lack of training
Earlier this year, Alao et al. [16] identified factors
like low skill and lack of training as obstacles to
nurses using PPE. Additionally, it has been
demonstrated that personal traits like beliefs,
attitudes, and values affect nurses' rates of
compliance with self-protection behaviors.
Previous research has shown that nurses may be
unprepared with PPE and unaware of the most
recent information regarding safe patient care
Int. J. Curr. Res. Chem. Pharm. Sci. (2023). 10(8): 27-34
© 2023, IJCRCPS. All Rights Reserved 29
when caring for patients with novel infectious
diseases (such as severe acute respiratory
syndrome (SARS) or H1N1) [16].
Feelings at work
An evaluation of the use of personal protective
equipment by healthcare workers and their
psychological readiness for the COVID-19
pandemic in Eastern Ethiopia was the goal of this
facility-based cross-sectional study. A random
selection was made of the health care workers
(HCW) employed by the chosen healthcare
facilities. This study included a total of 418
HCWs who were chosen at random. When
compared to their counterparts, study participants
who regularly used hand sanitizer, were trained in
COVID-19 prevention techniques, felt hopeless
about eventually contracting the disease at work
(AOR = 2.6, 95 percent CI: 1.4-4.7), and felt
unsafe at work when following standard
precautions (AOR = 0.46, 95 percent CI: 0.27-
0.79) used PPE more effectively. In addition,
compared to physicians, nursing/midwifery
professionals used good personal protective
equipment (AOR = 3.7, 95 percent CI: 1.8-7.7).
This study showed a positive correlation between
the use of PPE and being a male, a nurse or
midwife, frequently sanitizing hands and medical
equipment, and feeling like one might eventually
contract COVID-19 at work. Furthermore, the
study found a negative correlation between
HCWs' use of PPE and their sense of safety at
work when following standard precautions [17].
Doubts on quality and effectiveness of PPE,
potential risks during doffing and poor
comfort with PPE use
Likewise, Fan et al. Another study was carried out
by [18] to evaluate the challenges faced by health
care professionals (HCP) when using personal
protective equipment (PPE) in clinical practice
during the COVID-19 outbreak in Wuhan, China.
Twenty of the 120 medical personnel from the
Wuhan First Hospital's First Affiliated Hospital of
Chongqing Medical University offered to take
part in a focus group discussion with infection
control nurse leaders. They were there to offer
medical assistance. Observed challenges included
uncertainty regarding the caliber and efficacy of
PPE, potential hazards during donning, and low
comfort with PPE use [18].
Training on PPE use
Using an online self-administered survey, a cross-
sectional study of Egyptian HCWs was carried
out. Depending on their score, participants were
categorized as "Compliant" or "Non-compliant.".
A total of 404 responses were analyzed, with a
56.4% female gender distribution and a mean age
of 36.6 8.4 years. 53.2% of participants were non-
compliant HCWs. Females (51.3 percent, p =
0.05), doctors (54.2 percent, p = 0.005), and
medical specialties (34.7 percent, p eight
hours/day (71.3 percent, p) reported higher
compliance with proper PPE use.
Lack of access to PPE
Health workers' inability to use safety equipment
is a major deterrent; as a result, safety equipment
needs to be made more readily available, trained
users need to use it, and it needs to be improved
[20]. To overcome the PPE barrier, it is crucial to
make PPEs accessible, train HCWs in their use,
and optimize the ergonomics of both the PPE and
its user [20].
Risk perception with PPE use
The Savoia et al. [21] conducted a cross-sectional
study of Italian physicians to examine the
variables related to PPE usage and access during
COVID-19. The findings of their study showed
that health workers' perceptions of the risk of
contracting an infection from PPEs hindered the
use of PPE.
Health System-Related Factors Associated
with Inappropriate Use of Personal Protective
Equipment (PPE) among Health Workers
Lack of healthcare equipment
The biggest obstacle for nations trying to lower
morbidity rates is a weak healthcare
Int. J. Curr. Res. Chem. Pharm. Sci. (2023). 10(8): 27-34
© 2023, IJCRCPS. All Rights Reserved 30
infrastructure, which includes a dearth of medical
supplies [23]. Increased morbidity and mortality
are a result of poor health or the presence of risk
factors, especially in vulnerable groups, primarily
first responders. The claim that unsatisfactory
health care systems have a significant impact on
the health-care workforce has been supported by
numerous studies. In a recent review, factors like
low skill, a lack of training, limited access to PPE,
and environmental factors were identified as
obstacles to nurses using PPE [16].
Health center policy on PPE use
Aguwa and others. [24] evaluated the use of
personal protective equipment (PPE) by health
workers and the related factors in a tertiary health
institution in South East Nigeria prior to the Ebola
outbreak. They used a semi-structured self-
administered questionnaire to collect data from
health workers using a descriptive cross-sectional
methodology. The findings of their study showed
that, despite nearly half (45%) having received
training on personal protective equipment, the
majority (96%) had never seen a policy on such
equipment. This suggests that there is no hospital
policy regarding the use of PPE.
COVID-19 management guidelines and
training on COVID-19
Containing the deadly COVID-19 pandemic
requires the effective implementation of
prevention and control measures by health
professionals [25]. a facility-based cross-sectional
study that sought to evaluate the use of PPE by
healthcare workers and their psychological
readiness for the COVID-19 pandemic in Eastern
Ethiopia. A random selection was made of the
health care workers (HCW) employed by the
chosen healthcare facilities. The study included a
total of 418 HCWs who were chosen at random.
In comparison to their counterparts, study
participants who used hand sanitizer regularly,
had access to COVID-19 management guidelines
(AOR = 2.83, 95 percent CI: 1.46-5.47), and had
received training on COVID-19 prevention
techniques (AOR = 2.6; 95 percent CI: 1.4-4.7)
were more likely to have worn personal protective
equipment (PPE). The study found a correlation
between the use of PPE and having COVID-19
management guidelines and training [17].
Inappropriate PPE sizes, the design of the PPE
and its complexity of use and space layout
between clean and contaminated area
Likewise, Fan et al. Another study was carried out
by [18] to determine the challenges faced by
health care professionals (HCP) when using
personal protective equipment (PPE) in clinical
settings during the COVID-19 outbreak in
Wuhan, China. Twenty medical professionals
from the First Affiliated Hospital of Chongqing
Medical University presented to the Wuhan First
Hospital to offer medical aid, and among them, 20
HCP, volunteered to take part in a focus group
discussion with infection control nurse leaders.
Inappropriate PPE sizes, the PPE's design and
use's complexity, and the layout of the space
between the clean and contaminated areas were
among the observed challenges. The use of PPE
can also be positively or negatively impacted by
other factors, including the equipment,
management, processes, readiness, and HCP [18].
Prior training on proper PPE use and exposure
to COVID-19 patients
Using a self-administered online survey, a cross-
sectional study of Egyptian HCWs was carried
out. According to their results, participants were
either deemed "Compliant" or "Non-compliant.".
The analysis included 404 responses, with a total
of 56.4% of the responses being female and a
mean age of 36.6 8.4 years [26-32]. A total of
53.2% of participants were non-compliant HCWs
[33-37]. Most reported a shortage of N95
respirators (91.3%), used extended PPE (88.1%),
and worked longer than eight hours per day
(71.3%).
Availability of PPE
In a different investigation, the use of personal
protective equipment by laundry staff employed
by government hospitals in Hawassa City,
Southern Ethiopia, was evaluated in 2019. Focus
Int. J. Curr. Res. Chem. Pharm. Sci. (2023). 10(8): 27-34
© 2023, IJCRCPS. All Rights Reserved 31
group discussions and key informant interviews
were the two qualitative methods used to gather
data for this study. The present study identified
organizational-level barriers as the main
deterrents to the use of personal protective
equipment, such as the absence of necessary PPE
and an unfriendly work environment [38-44].
Conclusion
The most striking individual factor associated
with health workers using PPE inappropriately is
the overwhelming number of patients in the ward.
The need for health services is simply too great
for the health workers to handle, and this has a
significant impact on how quickly PPE like
gloves and face and nose masks can be changed
between patients.
Simply put, the hospital does not have enough
personal protective equipment (PPE) for the
medical staff, and when it is available, it is not
always easily accessible. One of the reasons why
patients are occasionally advised to purchase PPE,
such as gloves, from private healthcare facilities
outside of the hospital is due to this.
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DOI: 10.22192/ijcrcps.2023.10.08.004
How to cite this article:
Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu, Chidimma Maureen Chukwueze and Anthonia
Onyinye Ngwoke. (2023). Inappropriate use of personal protective equipment among health workers: A
review of associated factors. Int. J. Curr. Res. Chem. Pharm. Sci. 10(8): 27-34.
DOI: http://dx.doi.org/10.22192/ijcrcps.2023.10.08.004
