Abstract
BACKGROUND: Existing Centers for Disease Control (CDC) and American Academy of Pediatrics (AAP) guidelines promote HCW personal protective equipment (PPE) use to prevent respiratory virus transmission in pediatric clinics; however, adherence to recommendations is inconsistent. We evaluated the effectiveness of two strategies designed to cue HCW use of PPE in a pediatric primary care clinic. METHODS: We implemented two HCW-focused interventions: (1) prompt for front desk respiratory symptom screen with placement of droplet signs on examination room door for symptomatic patients and (2) universal masking of healthcare workers during all patient encounters. Each intervention was implemented over a 2-week period and preceded by a washout period. We obtained caregiver report of HCW hand hygiene and mask use during patient encounters and measured differences in the proportion of behavior observed compared with washout periods. RESULTS: We obtained 217 caregiver reports of clinician handwashing and mask use before, during and after the patient encounter. There was no difference in nurse pre- or post-encounter hand hygiene behavior before and after each intervention (Baseline 65.9%; Droplet: 73.3%, P = 0.34; Universal masking: 77.5%, P = 0.16 and Baseline 53.3%; Droplet: 66.6%, P = 0.14; Universal masking: 55%, P = 0.85, respectively). There was also no difference in pre- or post-encounter MD hand hygiene behavior before and after each intervention: (Baseline 86.9%; Droplet: 77.8, P = 0.17; Universal masking: 87.5%; P = 0.92 and Baseline 75%; Droplet: 71.1%, P = 0.62; Universal masking: 80.0%; P = 0.53, respectively). However, there was a significant difference in observed mask use during encounters among both RNs and MDs before and after each intervention: (Baseline: 17.4%; Droplet: 44.4%, P <0.05; Universal masking: 42.5%, P < 0.05 and Baseline: 20.6%; Droplet: 51.1%, P < 0.05; Universal masking: 62.5%, P < 0.05, respectively). CONCLUSION: Respiratory symptom screening with visual prompts to use PPE and universal masking may not significantly impact hand hygiene behavior in a setting with high hand hygiene use but may increase mask use. Such interventions could provide a useful and low cost tool to help prevent the spread of respiratory viruses in primary care settings. DISCLOSURES: S. E. Coffin, Merck, Inc.: Investigator, Research support.