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Effectiveness of a multisite personal protective equipment (PPE)–free zone intervention in acute care

  • Lindsay D. Visnovsky (a1) (a2), Yue Zhang (a1) (a2), Molly K. Leecaster (a1) (a2), Nasia Safdar (a3) (a4), Lauren Barko (a5), Candace Haroldsen (a1) (a2), Diane L. Mulvey (a1) (a2), McKenna Nevers (a1) (a2), Catherine Shaughnessy (a5), Kristina M. Stratford (a1) (a2), Frank A. Drews (a2) (a6), Matthew H. Samore (a1) (a2) and Jeanmarie Mayer (a1) (a2)...



Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.


Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.


All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.


A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.


We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.


HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.


Corresponding author

Author for correspondence: Lindsay D. Visnovsky, Email:


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PREVIOUS PRESENTATION: Some of the data reported in this article were presented at IDWeek 2018, on October 3-7, 2018, in San Francisco, California.



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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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