Background: Although self-contamination has been identified through relevant studies on the safe utilization of personal protective equipment (PPE) by healthcare personnel and the prevention of healthcare-associated infection transmission, there is a lack of in-depth understanding of self-contamination. This study aimed to review previous research on self-contamination and clarify the concept. By understanding this concept, healthcare personnel can improve their conscientiousness regarding self-contamination and gain a foundation for the requisite interventions to reduce self-contamination in healthcare settings. Method: MeSH terms such as “Health Personnel,” “Students, Health Occupations,” and keywords related to PPE combined with “contaminat*” and “self-contamination” to retrieve literature in OVID, EMBASE, Cochrane, CINAHL, and PsycINFO databases without time limits through December 2023 (Figure 1). The concept of self-contamination’s antecedents, attributes, and consequences were explained based on Rodgers’ evolutionary Results: After eliminating duplicates from the 2,195 studies that were initially searched, the authors reviewed the articles and determined eligibility independently. A total of 25 articles, published between 2006 and 2023, were included and analyzed. Antecedents to self-contamination were classified into three groups for each component (Figure 2). First, PPE factors included 1) types of PPE and/or ensemble choices, and 2) problems with PPE designs and/or their functions. Second, user factors involved 1) mistakes (errors of intent), 2) violations (deviations from recommendations), and 3) slips (natural flaws in humans). Third, organizational factors covered 1) unstandardized PPE protocol, 2) suboptimal and inconsistent PPE training, and 3) inadequate clinical environment. In total, five major concept attributes were the conveyance of organisms, unintentional behavior, preventable action, incidental contact, and difficulty discerning. Consequences were categorized into: 1) raising concerns about occupationally acquired infections, and 2) the potential transmission of the infection to the environment or other people (cross-contamination). Conclusion: While studies have raised questions about whether self-contamination causes infection, self-contamination was obvious among healthcare personnel when dealing with PPE. Considering the wide range of causes and potential results of self-contamination, multifaceted interventions, including improvement of the PPE design, tailoring protocols, and training for specific ensembles, should be implemented over an extended time period with suitable intervals to optimize interventions’ effectiveness.

Background: Although various difficulties and self-contamination concerns have been continuously reported regarding the use of personnel protective equipment (PPE) among healthcare personnel (HCP), better PPE options are unavailable in healthcare settings. This study aimed to thoroughly examine HCP’s PPE experience to develop improved PPE. Method: By sending cooperation requests to eight academic societies (e.g., Korean Society of Infectious Disease, Korean Society of Critical Care Nursing), four hospitals (e.g., National Medical Center), and Korea Disease Control and Prevention Agency, 250 HCP who had direct patient contact with emerging infectious diseases were recruited. The questionnaire with 65 main questions (211 maximum including sub-questions and 19 open-ended questions) was developed in detail (e.g., use frequency, priority check among the options) based on literature reviews and verified by an expert panel. Through an online survey link, participants completed the questionnaire between December 6-11, 2023, and received a $53 incentive. Descriptive statistics were performed for data analysis. Results: Among 250 participants, most were female (80%), in their thirties (46.4), nurses (78%,), working at general hospitals (56%), and averaged 121.1 months of clinical experience (Table 1). Among 6 PPE sets (Figure 1), 29% of participants used Set #2 (i.e., disposable water-proof gown, gloves, goggles/face shield, hair cap, and N95 mask) and 26% used Set #3 (i.e., Level D, gloves, goggles/face shield, shoe cover, N95 mask, and hair cap). 64% of HCP preferred Set #2 due to practical aspects (e.g., simple, convenient, safer than Set #1, and easy donning/doffing). Most PPE sets were largely used for 30 minutes to 1 hour (except level D, to 2 hours). Most prioritized difficulties of PPE use were: disposable mask dampness; pressure pain on the wearing area for N95 masks; powered air purifying respirator (PAPR) wear takes a long time; sweating for gloves, waterproof gowns, and level D/C coveralls; skin exposed through torn gloves; blurry visibility for goggles/face shield; hearing difficulty for hoods; and a slippery bottom for shoe covers. Moments for self-contamination concerns were: adjusting PPE that has slipped down (e.g., masks, gowns, gloves, goggles/face shield, and hoods); doffing hood procedure (e.g., PAPR); and skin contact of shoe cover surfaces during doffing. Most difficulties when using PPE combinations were unfamiliarity with donning/doffing procedures. Participants wish to develop various PPE sizes which can be easily donned/doffed intuitively (e.g., well-ventilated integral PPE). Conclusion: Collaboration with manufacturers based on our results is necessary to develop better PPE options for HCP’s safety and satisfaction.

Background: With the emergence of new infectious diseases, infection control nursing (ICN) in hospitals has become increasingly significant. Consequently, research on ICN has been actively performed. We examined the knowledge structure and trends addressed in Korean ICN research. Methods: From 5 web-based Korean academic databases (DBpia, KISS, KMbase, KoreaMed, and RISS), 2,244 studies published between 2013 and 2022 were retrieved using ICN-related search terms (eg, “nurse” or “nursing” along with “infection control,” “infection prevention,” “healthcare-associated infection,” or “standard precautions”). After deleting duplicates, the authors assessed titles and abstracts and included 250 research abstracts in this study. Using NetMiner 4.4 software (Cyram, Seoul, Korea), words from abstracts of published articles were extracted and refined, then text network analysis and topic modeling were performed. A text network was structured based on the co-occurrence matrix of key words (semantic morphemes) and was analyzed to identify the main key words. Through topic modeling using the Latent Dirichlet Allocation algorithm, latent topics in the research abstracts were extracted. The authors verified the key words comprising the topic and the result of classifying the documents by topic and named topics. Results: The number of studies, which increased following the outbreak of Middle East respiratory syndrome in 2015, has declined over time but peaked in 2021 with the COVID-19 pandemic. The text network composed of the key words of the research abstracts was generated and visualized (Fig. 1). As a result of text network analysis, the 5 most common key words were ‘nurse,’ ‘infection control,’ ‘nursing care,’ ‘practice,’ and ‘perception’ in terms of degree and betweenness centrality. Other prominent main keywords were also identified: ‘knowledge,’ ‘compliance,’ ‘education,’ ‘intervention,’ ‘intention,’ and ‘safety.’ With the application of topic modeling to the research abstracts, 5 topics were derived and named as follows (Fig. 2): “infection control in nursing care for patient safety,” “infection control measures for healthcare personnel safety,” “burdens and obstacles for infection control among nurses,” “infection control for multidrug-resistant organisms,” and “knowledge, attitude, practice for infection control among nurses.” Conclusions: By applying text-network analysis and topic modeling, we obtained insights into Korean ICN research trends. To explore global ICN research trends, further study is necessary to analyze internationally published studies reflecting each country’s nursing work conditions.

Disclosure: None

Background: The COVID-19 pandemic revealed the fundamental vulnerability of long-term care hospitals (LTCHs) related to infection control and prevention (ICP). We examined the experiences of nurses who worked at a hospital where a COVID-19 outbreak occurred from February 24 to March 16, 2021. Method: This qualitative research was performed with 9 nurses who were engaged during the COVID-19 outbreak. We prepared a semistructured questionnaire based on the main question, “How was the experience among the nurses during the outbreak, and what difficulties did they encounter while resolving the situation?” The data were collected through in-depth, individual interviews from May to August 2021 after the approval of the institutional review board, and the results were analyzed thematically. Results: The average age of the participants was 52.1 years, and they had an average of 15.2 years of clinical experience. We extracted 4 themes and 16 subthemes from the results. The first theme, “sudden onset of the outbreak,” included the following subthemes: (1) found myself accustomed to COVID-19 and desensitized; (2) unavoidable occurrence despite compliance with ICP guidelines; (3) LTCHs are gradually recognized as a breeding ground for COVID-19 by the public; and (4) fear of spreading the infection in the hospital and of becoming a spreader. The second theme, “heavier workload,” included (1) daily overtime and extra shifts in violation of self-quarantine recommendations due to the shortage of nurses; (2) a barrage of phone calls from family members, other departments, public health centers, and hospitals where confirmed cases were transferred; (3) nursing assistants and private caregivers who do not have ICP knowledge as well as patients who do not cooperate due to cognitive impairment; and (4) accomplishing additional tasks while wearing personal protective equipment with some suffocation. The third theme, “emotions and lessons,” included (1) unsatisfied with the initial responses; (2) awareness of the entire infectious disease; (3) increased compassion and attachment for patients; and (4) take pride in the job and the profession as a nurse. The fourth theme, “necessary support and attention,” included (1) need to install isolation rooms and replenish infection control supplies; (2) need for ICP specialists in LTCHs; (3) need for continuous national-based monitoring on ICP for LTCHs; and (4) need to improve working environment and acknowledge nurses in LTCHs. Conclusions: Overall, participants expressed their experiences with the insufficient infection control and response system toward COVID-19 in the LTCH. To enhance ICP in LTCHs, customized policies, regulations, and financial support for infection control activities and ICP professionals must be established.

Funding: None

Disclosures: None

Background: Operation room (OR) nurses are at a high risk for bloodborne pathogen (BBP) exposures because they are constantly in contact with blood and body fluid (BBF) through surgical sites, and they frequently use sharp surgical instruments and sutures during surgeries. We explored occupational experiences with BBP exposures among OR nurses in South Korea. Methods: With an institutional review board’s approval, this qualitative research was performed with 12 OR nurses who had worked for >3 months and had experienced BBP exposures. Based on the main research question “How is the experience of BBP exposure among OR nurses?” the semistructured questions for in-depth interview were prepared. Narrative data were collected through 1-hour individual interviews from June to September 2020 and were analyzed using a thematical analysis method. Results: The average age of the participants was 34.4 years with an average 9.75 years of clinical experience. The main theme extracted was “The nurses are alerted to their safety after experiencing the aftereffects and emotional trauma from BBP exposures,” with 4 subthemes and 14 concepts. The first subtheme, “OR nurses risking exposure to BBF,” included (1) hurried doctors and hasty nurses; (2) sharp surgical instruments everywhere; (3) deprioritized self-protection due to ongoing surgery; (4) inattentive to BBF risk; and (5) uncomfortable, foggy goggles and receded safety devices. The second subtheme, “BBP exposures occurred in a flash,” included (1) sharp injury occurred in a split second; (2) temporarily treat sharp wounds while hiding frightened feelings; and (3) OR nurses concentrated on surgery by suppressing anxiety and sharp wounds. The third subtheme, “Burdened time that could be overwhelmed alone,” included (1) BBP exposures moments that I wish to reverse; (2) anger over dangerous environments and the turmoil of anxiety; (3) exhausted body and facial discoloration due to taking postexposure prophylaxis; and (4) exposure to BBP that I want to hide from family and friends. The fourth subtheme, “Voice for everyone’s safety,” included (1) establishing a safety culture, which requires everyone’s efforts, and (2) necessity of practical resources for decreasing BBP exposures. Conclusions: The participating OR nurses felt that they were working with a high risk to BBF exposures and called for institutional interventions to reduce the risks, including surgeons’ attentive collaboration. Korean hospitals should make greater efforts to establish safety culture in ORs and to provide repeated, tailored education to prevent BBF exposures. They should also supply high-quality protective equipment and safety-engineered devices for OR nurses.

Funding: No

Disclosures: None

Background: Contact isolation (ie, patient isolation with contact precautions) has been frequently used for preventing healthcare-associated infections caused by epidemiologically important pathogens (eg, vancomycin-resistant enterococcus [VRE]) via direct or indirect contact with patients. Based on ineffective components of routine contact isolations (eg, fewer healthcare provider visits), some studies have reported an association between the likelihood of adverse events and contact isolation. Objective: Given no strong evidence for this association due to most studies’ invalid study designs and systematic misclassification, we compared adverse events between a VRE isolation cohort and a matched comparison cohort, using a propensity score matching cohort study design. Methods: This study was conducted at a 1,337-bed, tertiary-care, university-affiliated, Korean hospital equipped with a full electronic medical record (EMR) system for all patient records. With institutional review board approval, all relevant EMR records were extracted for the study period 2015–2017. All contact isolation information of VRE patients were confirmed through EMR manual review by 1 trained research nurse. For propensity score matching, risk factors for adverse events (ie, decubitus ulcer, fall, and cardiopulmonary resuscitation [CPR]) were selected based on literature reviews: length of stay, age, gender, diabetes mellitus, hypertension, albumin, Charlson comorbidity index, Braden scale score, and Hendrich II fall risk. For each VRE case, the 1:1 matched case was selected through the nearest neighbor matching with calculated propensity scores. The retrospective observation period was from the cohort entry date (ie, contact isolation start date) to the cohort exit date (ie, discharge or discontinue of contact isolation). A time-to-event analysis with a Cox proportional hazard model was conducted using SAS version 9.4 software. Results: Among the 98,527 inpatients (323 VRE positive; 98,204 VRE negative), the VRE cohort (N = 141 of 216, 65% of total VRE patients admitted to general wards without adverse event history before contact isolation) and the matched comparison (no isolation) cohort (N = 141, 0.1%) showed no differences in characteristic comparisons (Table 1). The Cox proportional hazard model was not applicable for CPR because no CPR case was available in the matched comparison cohort. The hazard ratios for adverse events showed no statistically significant difference for both cohorts: decubitus ulcer (hazard ratio [HR], 1.049; 95% CI, 0.328–3.352; fall (HR, 0.418; 95% CI, 0.051–3.349) (Table 2). Conclusions: Based on the full EMR records for 3 years, our propensity-score–matched cohort study reported no association between the likelihoods of adverse events and contact isolation.

Funding: This work was supported by the Collaborative Research Program of Medical Science and Nursing Science from Seoul National University College of Medicine (Grant no. 800-20180001 & 810-20180001).

Disclosures: None.

Background: Isolation precautions (IPs; ie, patient isolation with transmission-based precautions) are essential in hospital infection control interventions to prevent the transmission of healthcare-associated infections. Because IPs require healthcare personnel (HCP) to use personal protective equipment (PPE; eg, gown, gloves, and mask) to enter patient isolation rooms and perform hand hygiene (HH) frequently, IPs are often regarded as cumbersome tasks and may lead to fewer HCP visits. This observation study examined the time burden of IPs (ie, PPE use and HH) from time spent on HCP tasks, including patient treatment and care, in patient isolation rooms. Methods: With institutional review board approval, participating hospitals were recruited. At each hospital, assigned infection control nurses observed HCP tasks at patient isolation rooms of interest and recorded each task’s duration, using a stopwatch or timer and an observation form. For each observation block (ie, a duty period at 1 observation unit, regardless of the number of observed isolation rooms), unit-related information was collected, including the numbers of hospitalized patients, admission patients, discharge patients, isolation patients, and nurses. For each block, IP proportions were calculated by total time spent on IP divided by the total time spent on all tasks. Descriptive statistics, t test, ANOVA, and regression analyses were conducted using STATA version 16.0 software. Results: Three university-affiliated hospitals (838 average hospital beds, range 811–855) participated from April 2 to May 18, 2019 (for 7–9 days). In total, 2,901 tasks were monitored and the total time spent was 164,973 seconds; most tasks were done by nurses (89.2%) and females (86.8%). Although the most time-intensive task was procedures (eg, intravenous infusion) followed by medication, PPE use was the most frequent task followed by HH (Table 1). Regarding IP proportions, an overall average of 23.6% of total task time was spent on IPs (16.1% for PPE use and 7.5% for HH) in patient isolation rooms (Table 2). Notably, tasks in the tuberculosis isolation room of hospital B showed a greater HH proportion (13.7%) than PPE proportion (13.5%) because HCP usually use N95 masks only. Wards, compared to intensive care units (ICUs), showed higher PPE proportions (19.2%), potentially due to PPE stock in the nurse station and less PPE education compared to ICUs. Conclusions: Our study results demonstrated the substantial amount of time spent on IP compliance among all task durations in patient isolation rooms. To improve IP compliance, this time burden needs to be considered with greater system support, such as more nursing staff.

Funding: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (Grant no. 2017R1D1A1B03036377).

Disclosures: None