Adherence to Personal Protective Equipment Use in Home-Care Service Agencies During COVID-19 in Japan: A Cross-Sectional Survey.

ABSTRACT

OBJECTIVES: To assess adherence to personal protective equipment (PPE) use among home care workers during usual care at the agency level during the COVID-19 pandemic in Japan and determine whether agency-level action toward infection prevention and control (IPC) is associated with adherence to PPE use. DESIGN: A nationwide cross-sectional study. SETTING AND PARTICIPANTS: Home care service agencies in Japan were randomly selected from all agencies nationwide. METHODS: An online survey was conducted between January and February 2021. The administrators at home care service agencies responded to the following items adherence to PPE (disposable masks, gloves, and aprons) use during diaper change among their home care workers, agency-level actions toward IPC, including monitoring of infection outbreak among users, existing manual for IPC, training opportunities on IPC for care workers, and other agency and administrator characteristics. RESULTS: Of the 1942 agencies, 197 were included in the analysis (response rate 10.1%). Although 145 (73.6%) of the agencies always used both masks and gloves during diaper change, 32 (16.2%) agencies fully adhered to wearing masks, gloves, and aprons. Agencies monitoring infectious disease outbreaks among service users were more likely to adhere to PPE use (adjusted odds ratio 5.97, 95% confidence interval 1.30-27.31). CONCLUSIONS AND IMPLICATIONS Low adherence to PPE use, especially apron use, during diaper change among home care service agencies during the COVID-19 pandemic in Japan was revealed, despite the widespread availability of a manual for IPC and/or training opportunities. To ensure safety and quality home care services for both users and home care workers, agencies should not simply create manuals or training systems as a structure; instead, they should implement effective processes for appropriate PPE use.