Adherence to personal protective equipment use among physicians-in-training during the 2009 influenza A (H1N1) pandemic — Utah, 2009

Healthcare personnel (HCP) are potentially at increased risk of occupational exposure to influenza. HCP nationwide have acquired healthcare-associated 2009 pandemic influenza A(H1N1) (pH1N1) infections, some preventable with personal protective equipment (PPE) and administrative controls. HCP use of PPE is especially important in a comprehensive influenza control strategy when vaccination is unavailable. We assessed PPE adherence among physicians-in-training at one program where a pH1N1 outbreak occurred. We sent electronic questionnaires to 210 physicians-in-training in August-September 2009 and reviewed program records. Based on hospital policies and frequency scale responses on use of PPE components, we categorized respondents into high and low PPE adherence groups to determine adherence rates. We determined predictors of PPE adherence through bivariate analyses. Of 88 (42%) respondents, 53 (60%) reported close contact with a pH1N1 or influenza-like illness (ILI) patient and provided PPE adherence information. Of those, 19 (36%) and 34 (64%) were classified as high and low PPE adherence. The most common reasons for not using recommended PPE were not knowing the patient had pH1N1 or ILI and reporting PPE was unavailable near patients' rooms. High PPE adherence predictors included being present at an aerosol-generating procedure on a pH1N1 patient (p=0.006) and being on an ICU rotation (p=0.04), while being on an inpatient ward rotation (p=0.02) predicted low PPE adherence. Most influenza-exposed physicians-in-training reported low PPE adherence. Recommendations include improving timely placement of signage to indicate isolation precautions, making PPE more readily available near patient rooms, and emphasizing PPE use when caring for non-critically ill influenza patients.