Running head: PPE SUPPLY IN HOME CARE 1

PPE Supply in Home Care

Delaware Technical Community College - Stanton Campus

NUR 340-6W1: Nursing Research

Megan Couden

April 25, 2020

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PPE Supply in Home Care

Infection control practices are a hallmark standard of practice in healthcare. The Centers

for Disease Control and Prevention (CDC) defines standard precautions as the “minimum

infection control practices that apply to all patient care, regardless of suspected or confirmed

infection status of the patient, in any setting where health care is delivered” (CDC, 2018, para.

1). Two main elements included in the standard precautions are performing hand hygiene to

maintain cleanliness using soap and water or alcohol based sanitizing gels and wearing the

appropriate personal protective equipment (PPE) including gloves, gown, goggles, and masks

(CDC, 2018). Interruptions to standard precautions can result in harm to both clients and nurses

as the chain of infection is broken.

In home health care, nurses provide clinical skills for clients outside of a facility setting.

Standard precautions are expected to be followed to maintain infection control between the client

and health care worker to protect the client, the nurse, and the possible spread of infection

through cross contamination to other clients. In order for these guidelines to be followed, home

health care agencies are required by the Occupational Safety and Health Administration (OSHA)

to supply the homes of clients with the necessary protective items so they are readily available

during the provision of care (CDC, 2004). Unlike in an acute care facility, home health care

nurses work with clients independently with support and resources from a home health agency as

they follow a care plan established by the primary care physician and the multidisciplinary team.

Challenges in the home environment which nurses must overcome can include a lack of

resources including PPE and the availability of adequate facilities for practicing hand hygiene

(Leiss, 2014). The goals of home care are to promote the client’s optimal level of health while

providing medical care and to prevent hospitalizations as much as possible allowing the client to
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remain in the comfort of their homes (Ellenbecker, Samia, Cushman, & Alster, 2008). Without

the availability of necessary PPE and hand hygiene supplies in the client home, healthcare goals

are put in jeopardy.

PPE Supply Problem

The proposed research question to explore the effects of PPE supply in home healthcare

is important in addressing potential for breaks in infection control and increased risk for

healthcare workers and the clients for which they are providing care. In home healthcare, what is

the effect of available PPE supplies in the client homes compared to a lack of resources on client

safety and positive outcomes during home based nursing care? As a home care nurse working for

a home health agency, it is expected that upon arrival to the home, adequate facilities are

available for hand washing with hand soap, alcohol based sanitizing gels, and paper towels.

Additionally, the necessary PPE supplies including gloves, masks, gowns, and goggles should be

available to maintain standard precautions throughout care. With limited supply available, or no

supply at all, the nurse is forced to decide whether to provide care with lacking resources and

risk putting the client and nurse at greater risk of infection, or decide to leave the home until the

environment is safely equipped, thus abandoning the care of the client and placing hardship on

the caregivers until conditions are improved.

Literature Review

To first address the basics in researching PPE and standard precautions, the CDC

provides definitions and established guidelines for following proper infection control practices.

From the CDC website, multiple resources provide education by medical professionals on what

the expectations are for standard precautions (Jones, Green, & Mody, n.d.), how to select and use
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the appropriate PPE (CDC, 2004), and how to uphold expectations while providing care in the

healthcare environment (CDC, 2018).

Research into infection control standards with a focus on non-acute care settings was

discovered in a quantitative “mega” study performed by Drs. Pogorzelska-Maziarz and Kalp.

Through a large collection of surveys, this study identified a lack of infection prevention and

control resources in non-acute care facilities due to unique challenges within the environment

(2017). Further narrowing the focus of patient safety and quality care to within home healthcare,

an evidenced-based practice text for nurses compared infection control provided in homes with

that in a hospital facility. It was determined through quantitative research that there are similar

concerns for patient safety and quality of care in both home care and facility care; however,

interventions must be customized for success in the specific home environment (Ellenbecker, et

al., 2008). Another quantitative study continued to narrow the scope of research to home care

specifically. This research was a quantitative study by Jack Leiss who analyzed the survey

responses of home care nurses questioned about their safety climate, availability of PPE and

safety devices, whether they felt rushed to complete care, and what their work environment was

like. This study found a direct correlation between having a stronger safety environment and a

higher likelihood of using the appropriate PPE (Leiss, 2014). To address the fluctuations in

maintaining infection control standards in home health care, a qualitative study found in the

Antimicrobial Resistance & Infection Control journal identified grey areas in providing care in

differing home environments. Acknowledging that not all policies apply in every home, this

study determined that when healthcare workers have the ability to think outside the box,

infection control practices can be upheld albeit in non-conventional ways (Gesser-Edelsburg, et

al., 2018).
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Noting that the volume of current research is slightly limited, two personal interviews

were conducted with clinical managers at a home health agency regarding current infection

control practices and policies. Based on the interviews, PPE supplies are provided by the agency

director based on the individual needs of the client and number of nursing hours performed in the

home (T. Pariag, personal communication, April 14, 2020). Challenges preventing home supplies

include a change in client status requiring increased use, family’s personal use of nurse allocated

supplies, and human error with miscommunication preventing timely replenishment by the office

(T. Willis, personal communication, March 30, 2020). Interventions in place to assist with

supplying homes as quickly as possible include clinical managers keeping supplies in their

personal vehicles to bring to the home, borrowing supplies from other offices in the event of an

office shortage, and re-assessing client needs and adjusting the quarterly office budget to account

for changes. It was noted by one clinical manager that home care agencies are often “forgotten

about,” especially during times of global PPE shortages as with the current COVID-19

pandemic, making it more difficult to secure and supply homes with much needed PPE when the

normal supply channels are unavailable (T. Pariag, personal communication, April 14, 2020).

Analysis

The standards of care pertaining to infection control established by the CDC and enforced

by OSHA, to be followed by home health care agencies and home care nurses, is clearly defined.

When researching the question of how the presence (or lack) of those resources being available

in the home healthcare environment affects client safety and positive outcomes, it can be

determined that the presence of PPE is necessary in providing safe care. Conclusions consider

both qualitative and quantitative studies, guidelines enforced by the government, and surveys

from home health care nurses directly. Although the volume of current research is limited due to
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home healthcare being relatively new, and the basis for most of the studies being surveys, the

importance of having the necessary supplies in the home for use during care is clearly necessary

to maintain infection control.

Recommendations

Additional research studies will be important as the home health industry grows.

Education and support to home health agencies and nurses will benefit client outcomes as

strategies are implemented and studied. Adopting site specific needs of home environments by

home health agencies and maintaining constant communication for needs identified by home

care nurses are critical in ensuring the means of performing hand hygiene and using PPE is

available. In a largely uncontrolled healthcare environment within a client’s home, the potential

unavailability of supplies should be acknowledged and a protocol in place for nurses to fall back

on. Keeping a general supply kit in the nurse’s personal vehicle to draw from when necessary

could mean the difference in safely providing care when needs in the home fall short. A pilot

program titled Mobile PPE: How Nurses Maintain Standard Precautions in an Unpredictable

Environment could be developed with subsequent research done on how to safely store and

provide PPE and hand hygiene items from a personal supply cache. Studies can then assess

safety and client outcomes following the new program using quantitative data from the home

health agency on infection control outcomes. Quantitative and qualitative surveys can also be

given to both home care nurses and clients in regards to PPE use, safety, and satisfaction

compared to before the pilot program.

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References

Centers for Disease Control and Prevention. (2004, June 29). Guidance for the selection and use

of personal protective equipment (PPE) in healthcare settings. Retrieved from

https://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04.pdf

Centers for Disease Control and Prevention. (2018, June 18). Standard precautions. Retrieved

from https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-

practices/standard-precautions.html

Ellenbecker, C. H., Samia, L., Cushman, M. J., & Alster, K. (2008, April). Chapter 13: Patient

safety and quality in home health care. In R. G. Hughes (Eds.), Patient safety and

quality: An evidence-based handbook for nurses. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK2631/

Gesser-Edelsburg, A., Cohen, R., Halavi, A. M., Zemach, M., van Heerden, P. V., Sviri, S.,

Benenson, S., Trahtemberg, U., Orenbuch-Harroch, E., Lowenstein, L., Shteinberg, D.,

Salmon, A., & Moses, A. (2018, October 24). Beyond the hospital infection control

guidelines: A qualitative study using positive deviance to characterize gray areas and to

achieve efficacy and clarity in the prevention of healthcare-associated infections.

Antimicrobial Resistance & Infection Control, 7(124). doi: 10.1186/s13756-018-0418-x

Jones, K., Greene, L., & Mody, L. (n.d.). The basics of standard precautions. Retrieved April 14,

2020, from the Centers for Disease Control and Prevention website:

https://www.cdc.gov/infectioncontrol/pdf/strive/PPE101-508.pdf
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Langford, R. & Young, A. (2013). Making a difference with nursing research. United States of

America: Pearson Education

Leiss, J. (2014, November). Safety climate and use of personal protective equipment and safety

medical devices among home care and hospice nurses. Industrial Health, 52(6), 492-497.

doi:10.2486/indhealth.2014-0074

Pogorzelska-Maziarz, M. & Kalp, E. L. (2017, June 1). Infection prevention outside of the acute

care setting: Results from the MegaSurvey of infection preventionists. American Journal

of Infection Control, 45(6), 597-602. Retrieved from

https://www.ajicjournal.org/article/S0196-6553(17)30242-0/fulltext