Generally, the COVID-19 wards showed a higher total adherence with 85% of PPE use compared to the non-COVID-19 wards with a total adherence of 76%. Particularly, the increased adherence in the areas of hand hygiene and wearing PPE had a major impact on the overall adherence. For PSA doffing, there was no significant difference in adherence between COVID-19 (95%) and non-COVID-19 wards (93%) when removing the PPE.
The hand hygiene adherence of HCWs in the COVID-19 wards was performed clearly above the national standard (median of 79% for all indications on intensive care units) [8] appropriate for a response to the pandemic challenge of SARS-CoV-2.
The adherence to the different recommendations “no wearing of jewelry on the hands and wrists”, “HD before donning PPE”, and “final HD after patient care” was significantly lower among HCW in non-COVID-19 compared to COVID-19 wards. The execution of HD in the process of doffing PPE, especially at the end of the process, is necessary in order not to contaminate oneself with pathogens [9]. In Wuhan, it was shown that a lack of hand hygiene increased the risk of transmitting SARS-CoV-2 from patients to HCW after hand contamination [6].
Although the COVID-19 wards performed better, we were surprised to detect deficits in fitting the masks (either SFM or FFP2) in a high proportion of all the observed wards. A leakage, especially by FFP2 masks and the incorrect wearing of SFM e.g. wearing the mask under the nose, could scotch any preventive effect. Probably the knowledge of the details on how to wear a mask correctly and the exercise on how to wear it in routine practice is still lacking. Our observation shows similar results to a quantitative fit test compliance study in which 38.2% of subjects failed the test [10].
Deficits in the everyday handling of PPE have been observed before (especially in fitting, considering the correct sequence and correct use) and were found in 90% of the personnel [5]. The most common errors occurred in the correct removal of gowns (65%) and contact with potentially contaminated surfaces (48%) [5].
A reason for better hand hygiene adherence and performance in donning and doffing protective equipment could be due to the greater experience of the COVID-19 wards in dealing with respiratory tract diseases and PPE. In addition, increased situation-related higher awareness and risk awareness could also be a reason for better adherence in handling PPE.
In summary, we observed deficits in PPE use among all observed HCWs. Experienced HCWs showed higher adherence in the use of PPE than less experienced ones. However, despite the high awareness of the HCW regarding the dangers of SARS-CoV-2, it is surprising that they could not adhere to the fitting of FFP2-masks in COVID-19 and SFM in non-COVID-19 wards in which undetected SARS-CoV-2-positive patients or HCW might have been present at time. Thus, there is still a clear need for training in the correct and indication-appropriate use of PPE in general and wearing masks in particular, to protect HCW from infection by droplet or even aerosol transmissible pathogens.