Barriers to the use of PPE to Prevent Pertussis Exposures in the Pediatric Primary Care Network

Julie Fierro, Jefferson School of Population Health

Dr. James Plumb (capstone committee chair)

Dr. Kristen Feemster (committee member)

Dr. Susan Coffin

Maria Middleton and Adrienne Smallwood

Dr. Chris Feudtner


The resurgence of pertussis has led to healthcare worker (HCW) exposures in pediatric ambulatory settings. Although guidelines to prevent transmission of infectious pathogens exist, they are not uniformly implemented. Our objective was to identify facilitators and barriers of personal protective equipment (PPE) use to prevent pertussis transmission in ambulatory pediatric settings. Our cross-sectional study of HCWs at 18 of 25 clinics (72%) within a pediatric primary care network used survey methodology assessing knowledge, attitudes, and beliefs about PPE. The questionnaire contained two vignettes. Two versions of each vignette were randomly distributed allowing for an experimental design assessing barriers to PPE use. 343 of 467 (73%) HCWs completed the survey; 234 (68%) clinical and 109 (32%) non-clinical. 71% of clinical HCWs reported mostly or always wearing PPE when caring for a patient suspected of having pertussis; only 27% used PPE for patients with any respiratory symptoms. 61% of non-clinical HCWs reported mostly or always providing masks to patients with a cough. In multivariable analysis, reported PPE use by clinical HCWs when caring for patients with suspected pertussis was associated with attitudes toward PPE (OR 5.4, 95% CI 1.8, 16.6), knowledge and skills regarding PPE (OR 4.6, 95% CI 1.4, 15.2), and a lack of perceived barriers (OR 3.2, 95% CI 1.3, 7.9). HCWs who did not perceive PPE use as a social norm were less likely to report PPE use (OR 0.2, 95% CI 0.1, 0.6) or distribution (OR 0.02, 95% CI 0.00, 0.2). Reported PPE use was not influenced by perceived risk of infection or accessibility of masks. In conclusion, HCWs report frequently using PPE for patients with suspected pertussis; however, most do not use PPE for patients with any respiratory symptoms. Our results suggest modifiable factors to improve PPE use to prevent pertussis transmission in ambulatory pediatric settings.

Presentation: 31 minutes