Use of Personal Protective Equipment in Contact Precautions for Multidrug-Resistant Microorganisms in Intensive Care Units: Impact of a Multimodal Strategy, a Multicenter Study

Healthcare-associated infections caused by multidrug-resistant (MDR) microorganisms are a serious global health problem and are associated with increased length of stay, costs, and patient morbidity and mortality. One of the measures to prevent the spread of MDR in healthcare services is the correct use of personal protective equipment (PPE). To evaluate healthcare professionals’ adherence to PPE use before, during, and after implementation of a multimodal strategy. A quasi-experimental multimodal intervention study conducted in six adult ICUs of public hospitals in the metropolitan region of São Paulo, divided into three phases: observational (08/01/2023–10/31/2023), intervention (11/01/2023–04/30/2024), and post-intervention (05/01/2024–10/31/2024). In the first phase, professionals maintained their usual PPE practices. During the intervention phase, educational training was conducted, educational videos and folders were made available, reminder posters were posted in the units, and feedback on evaluation results was provided. In the post-intervention phase, the implemented measures were maintained. The evaluated elements were: bed/room signage; availability of PPE and 70% alcohol gel; sequence of donning and/or doffing PPE; disposal of PPE; hand hygiene after PPE removal; and disinfection of materials after patient use. PPE use was considered “compliant” when all elements were adequate. Observations were performed by the same collaborators throughout the study. A total of 2,324 observations were performed. Mean adherence to correct PPE use by study phase was 42.67%, 58.5%, and 77%, respectively (p < 0.001). All professional categories showed improvements in PPE use practices, with nurses demonstrating the highest adherence across study periods: 67.67%, 72.67%, and 89.33%, respectively (p < 0.05). All evaluated elements showed increased adherence over the course of the study. Bed/room signage was the item with the highest adherence, while the sequence of PPE removal had the lowest adherence in the first phase (56.67%), increasing to 91.5% in the post-intervention period (p < 0.001). The multimodal intervention significantly contributed to improved ICU healthcare professionals’ practices regarding PPE use.