Pediatric Emergency Medicine Fellow University at Buffalo, Jacob's School of Medicine University at Buffalo, Jacob's School of Medicine
Background: Face masks are shown to be effective in decreasing transmission of the SARS-Cov-2 virus, especially when used in combination with good hand hygiene, crowd reduction, and social distancing. Accordingly, numerous health organizations recommend that masks must be worn in public places including hospitals. Despite this recommendation, the public has not fully adopted masking. Many caregivers wear masks inconsistently or use ill-fitting masks that do not cover both the mouth and nose, decreasing efficacy.
Objective: The primary aim of this quality improvement project was to use plan-do-study-act (PDSA) cycles to increase the proportion of caregivers in a pediatric emergency department (ED) who correctly and consistently wore a mask.
Design/Methods: In total, 252 participants were included in the study. At baseline and after each intervention, 63 caregivers were randomly selected to assess the proportion correctly wearing a mask. Data for each caregiver were collected from four different observers: Primary investigator, bedside nurse, attending physician, and secondary provider (e.g. resident, fellow, nurse practitioner). Correct masking was defined as the mask 1) on when the observer entered the room, 2) remaining on for the entirety of the interaction, 3) consistently covering both nose and mouth, 4) not obviously upside down or inside out, and 5) free of any major tears. Caregivers were determined to have consistent, correct masking if they met all five criteria for each of the four observers. Three low-cost interventions were carried out over a one month period. One-way ANOVA with subsequent Bonferroni post-hoc analysis was used to compare the proportion of caregivers with consistent correct masking with each of three interventions.
Results: At baseline, only 39.7% of caregivers correctly and consistently wore a mask while in the ED. This increased to 60.3% (p=0.07) after posting signs in each ED room and to 63.5% (p=0.01) after adding a photo of eyes in each room. When front desk staff gave each family a handout upon entry, with a depiction of correct versus incorrect masking, the rate increased to 73.0% (p<0.001). The total cost of these interventions was $38.65. Conclusion(s): Instituting a series of inexpensive interventions can significantly increase the rate of caregivers who correctly and consistently wear a mask in the ED during the COVID-19 pandemic.
Authors/Institutions: Alana Koehler, John R Oishei Childrens Hospital of Buffalo, East Aurora, New York, United States; Michael Johnson, John R. Oishei Children's Hospital, Buffalo, New York, United States; Scott Bouton, John R Oishei Childrens Hospital of Buffalo, East Aurora, New York, United States; Jill C. Fennell, John R Oishei Childrens Hospital of Buffalo, East Aurora, New York, United States