PICOT Question: Do emergency department staffs comply with regulations for wearing PPE, and in case of non-compliance what are the reasons for non-compliance? Compliance of Emergency Department Staff with Wearing PPE

The recent global outbreak of the COVID-19 pandemic has drawn attention to nosocomial transmission issues in the health sector. Nosocomial is the transmission that happens within the healthcare settings.  This paper summarizes the literature review on the outbreak of infectious diseases, particularly the novel coronavirus, to determine components related to social and behavioral infection compliance measures among health workers within emergency departments. The paper aims to evaluate the self-reported compliance of health workers in an emergency department with personal protective equipment (PPE), including the various factors that contribute to compliance and non-compliance measures. The emergency department (ED) is the hub for many patient' entries. It is liable for receiving, grouping, gaging, stabilizing, and handling patients coming in with different urgency and complexity levels. 

Researchers have noted that hospitals receive over 140 million patients annually through the emergency department ED yearly, thus providing efficient services promptly to clients (Zhong et al., 2020). The situation has been worsened by the COVID-19 outbreak, with the first case in the United States reported in North America in January 2020. The emergency departments in hospitals have been in the frontline of receiving patients, isolating them, and providing the necessary care (Pandey & Sharma, 2020). The virus placed the emergency department staff in the spotlight as they work with other health workers to salvage the situation. Medical researchers have observed that the primary cause of nosocomial transmission among healthcare workers in facilities is poor compliance with the global recommendations of personal protective behaviors. 

Corona Virus spread mainly through respiratory droplets or contact with contaminated surfaces. The virus is widely distributed through aerosolized droplets released during sneezing, coughing, or breathing and possible airborne transmission (Phan et al., 2019). In early 2020, there was minimal information about the virus, with the fact being that most people were dying from it.  The healthcare and the emergency department staff played a vital role in detections, tracing contacts, and caring for the affected patients. Proper usage of PPEs by emergency department staff is a critical component in combating the virus (Rowan et al., 2020). Some of the safety measures that were put in place include wearing personal protective equipment (PPE), screening health workers regularly, thoroughly cleaning the health facilities, minimizing the number of people visiting the health center, and practicing social distancing (Lockhart et al.,2020). This led to the rapid increase of personal protective equipment used by the emergency department staff and the medical staff and the patients. The fast spread of the COVID-19 resulted in a temporary global shortage of PPEs, as noted by (Sharma et al.,2020). Examples of the PPEs include a face shield, gloves, respirators, and full bodysuits.

Some of the factors that enable compliance behaviors within the general population include the perceived rate of susceptibility, the severity of the affliction, and the perceived advantages of compliance, and adequate knowledge about the disease and its recommended behaviors. The major impediments to compliance among the public include feelings of discomfort and humiliation in some instances. Researchers have established that health workers in emergency departments perceive barriers and facilitators to compliance based on several issues. To begin with, protective practices among this group are influenced by their understanding of the outlined medical guidelines, the managerial support from their supervisors, the communication approaches and channels used to inform them about the guidelines, adequate resources in the department, their perception of the value of adhering to the guidelines, the comfort of PPEs, and the impact of PPE on patients. The workplace culture within the health facilities also influences the compliance rates among emergency department workers. 

Evidence has shown that health workers who have higher anxiety and concerns about infection risks were more likely to abide by the recommended behaviors. This implies that nurses with high or reasonable levels of fear of acquiring coronavirus while at work were more likely than their colleagues with no fear of being compliant (Asokan, 2020). Significantly nurses who had previous training experience and skills on infection control while caring for the affected patients demonstrated higher compliance levels. Frequent monitoring rounds from health superiors could also improve the levels of compliance in the department.

Researchers have also argued that non-compliance is orchestrated by several issues, including observed non-compliance from colleagues, resulting in variations