Determinants of personal protective equipment utilization among healthcare workers
DOI:
https://doi.org/10.53713/nhsj.v6i1.634Keywords:
PPE, Health workers, behavior, occupational safetyAbstract
Despite established guidelines, non-compliance with personal protective equipment (PPE) protocols remains a persistent challenge in healthcare settings, posing risks to occupational safety and infection prevention. This study examined factors associated with PPE use behavior among healthcare workers in inpatient units. An analytical cross-sectional study was conducted involving 260 healthcare workers. Data were collected via structured questionnaires and observational checklists. Associations between independent variables and PPE use behavior were assessed using chi-square tests. Inappropriate PPE use was observed in 60.8% of respondents. Bivariate analysis identified supervisory support (p = 0.011; OR = 2.315) and peer support (p < 0.001; OR = 4.470) as significant predictors of compliance. Conversely, age, education, knowledge, length of service, attitudes, comfort, and facility availability showed no significant association. Workplace social support, particularly from supervisors and colleagues, is a critical determinant of PPE compliance. Strategies to improve PPE adherence should prioritize strengthening organizational support systems rather than focusing solely on individual knowledge or resource availability.
References
Aboalnass, F. M., Alguthamy, W. H., Al-Hussein, A. A. N., Al-Mazargah, A. N. M., Al-Harisi, I. S. I., Alotaibi, S. S. H., ... & Alharbi, M. F. (2024). Health And Safety In Health Care Settings: Review On Protection Of Patients And Healthcare Workers. Cultura: International Journal of Philosophy of Culture and Axiology, 21(3s), 285-306. https://doi.org/10.5281/zenodo.18153409
Ada, Y. R., Surono, A., Supriyati, S., & Pribadi, A. P. (2025). Strategies to improve compliance with personal protective equipment use in the textile industry: a scoping review. BMC Public Health, 25(1), 2743. https://doi.org/10.1186/s12889-025-24037-9
Afandi, A., Kurniawan, D. E., Ardiana, A., & Purwandari, R. (2025). The effectiveness of training on occupational safety and health behavior among rubber tappers in Indonesia. International Journal of Occupational Safety and Health, 15(4), 439-453. https://doi.org/10.3126/ijosh.v15i4.70939
Afework, A., & Tamene, A. (2025). Uncovering the obstacles: a comprehensive analysis of barriers to hand hygiene adherence among healthcare providers: a systematic review. BMC Infectious Diseases, 25(1), 502. https://doi.org/10.1186/s12879-025-10924-4
Alayyannur, P. A., & Arini, S. Y. (2024). Occupational Health and Safety Problems in Various Sectors. Indonesian Journal of Occupational Safety and Health, 13(1), 1-3. https://doi.org/10.20473/ijosh.v13i1.2024.1-3
Baghdadi, A. (2024). Navigating occupational safety and health challenges in sustainable infrastructure projects: a comprehensive review. Frontiers in Built Environment, 10, 1414366. http://dx.doi.org/10.3389/fbuil.2024.1414366
Boakye, M. K., Adanu, S. K., Coffie, G. H., Adzivor, E. K., & Ayimah, J. C. (2022). Building construction artisans’ level of access to personal protective equipment (PPE) and the perceived barriers and motivating factors of adherence to its use. Journal of Environmental and Public Health, 2022(1), 4870731. https://doi.org/10.1155/2022/4870731
Buhler, W., Dittman, B., & Langley, R. L. (2025). Personal Protective Equipment. In Farm Toxicology: A Primer for Rural Healthcare Practitioners (pp. 23-50). Cham: Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-80441-0_4
Clavel, N., Castonguay, F. M., Laprise, C., Williams, S., Ethier, I., Bernier, M. C., & Beauharnais, C. (2025). Barriers and facilitators to implementing reusable personal protective equipment in hospitals, and their impacts on environment, care safety, costs, and supply chain resilience: a scoping review protocol. BMJ Open, 15(5), e096504. https://doi.org/10.1136/bmjopen-2024-096504
Drouard, S. H. P., Ahmed, T., Fernandez, P. A., Baral, P., Peters, M., Hansen, P., Hashemi, T., Sieleunou, I., Ogunlayi, M. I., Karibwami, A. D., Bergeron, J. R., Montufar Velarde, E. E., Yansane, M. L., Wesseh, C. S., Mwansambo, C., Nzelu, C., Uddin, H., Tassembedo, M., & Shapira, G. (2023). Availability and use of personal protective equipment in low- and middle-income countries during the COVID-19 pandemic. PLOS ONE, 18(7), e0288465. https://doi.org/10.1371/journal.pone.0288465
Ekrami, H. A., Dehaghi, B. F., Ghanbari, S., Haghighifard, N. J., & Mohammadi, M. J. (2024). Health risk assessment and occupational safety at hospitals in Southwest of Iran. Clinical Epidemiology and Global Health, 26, 101515. https://doi.org/10.1016/j.cegh.2024.101515
Fang, L., Zhang, Q., Zhou, N., Chen, J., & Lou, H. (2025). Influencing factors and mechanisms promoting proactive health behavior intention: an integration of the health belief model and the theory of planned behavior. Frontiers in Public Health, 13, 1629046. https://doi.org/10.3389/fpubh.2025.1629046
Finsel, J. S., Wöhrmann, A. M., & Deller, J. (2023). A conceptual cross-disciplinary model of organizational practices for older workers: Multilevel antecedents and outcomes. The International Journal of Human Resource Management, 34(22), 4344-4396. https://doi.org/10.1080/09585192.2023.2199939
Gašpert, T. (2025). Personal Protective Equipment (PPE). In Principles of Nursing Infection Prevention Control: Introduction and global context of Infection Prevention and Control (Volume 1) (pp. 109-118). Cham: Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-84469-0_9
Hintz, E. A., Betts, T., & Buzzanell, P. M. (2023). Caring for Patients without Personal Protective Equipment (PPE): Material Conditions as Multidimensional Cascading Triggers for Resilience Processes. Health Communication, 38(2), 371–380. https://doi.org/10.1080/10410236.2021.1953727
Hussein, A., Opoku-Mensah, F. A., Amoafo, I. Q., & Saifu, K. (2025). Fundamentals of occupational health and safety practices outside the workplace among health professionals in Ghana: an assessment of determinants of crash helmet use in the Tamale Teaching Hospital. BMC Public Health. https://doi.org/10.1186/s12889-025-25442-w
Juliasih, N. N., Dhamanti, I., Semita, I. N., Wartiningsih, M., Mahmudah, M., & Yakub, F. (2023). Patient Safety Culture, Infection Prevention, and Patient Safety in the Operating Room: Health Workers’ Perspective. Risk Management and Healthcare Policy, 16, 1731–1738. https://doi.org/10.2147/RMHP.S425760
Kadir, A., Dhesi, S. K., Amalinda, V. D., Yuantoko, T. D., Satrya, B. A., & Fitriadi, F. (2026). Occupational Health and Safety in Educational Settings: Barriers, Strategies, and Compliance Using a Mixed-Methods Approach. Safety, 12(1), 11. https://doi.org/10.3390/safety12010011
Khatooni, M., Momeni, M., Alizadeh, A., & Khalilzade, M. M. (2026). Professional Autonomy and Perceived Organizational Support as Predictors of Adherence to Ethical Codes Among Emergency Nurses. Journal of Emergency Nursing. https://doi.org/10.1016/j.jen.2025.12.002
Khoshakhlagh, A. H., Malakoutikhah, M., Park, J., Kodnoueieh, M. D., Boroujeni, Z. R., Bahrami, M., & Ramezani, F. (2024). Assessing personal protective equipment usage and its correlation with knowledge, attitudes, performance, and safety culture among workers in small and medium-sized enterprises. BMC Public Health, 24(1), 1987. https://doi.org/10.1186/s12889-024-19517-3
Khubchandani, J., Batra, K., Yockey, R. A., Webb, F. J., & Banerjee, S. (2024). Health care workers’ risk behaviors and health status: Hidden realities or new paradigms? Journal Of Medicine, Surgery, and Public Health, 2, 10. https://doi.org/10.1016/j.glmedi.2024.100097
King, E. C., Zagrodney, K. A., McKay, S. M., Holness, D. L., & Nichol, K. A. (2023). Determinants of nurse's and personal support worker's adherence to facial protective equipment in a community setting during the COVID-19 pandemic in Ontario, Canada: A pilot study. American Journal of Infection Control, 51(5), 490-497. https://doi.org/10.1016/j.ajic.2022.07.021
King, E. C., Van Belle, T. A., Zagrodney, K. A., McKay, S. M., Giosa, J., Holubiec, I., Holness, D. L., & Nichol, K. A. (2024). Factors influencing self-reported facial-protective equipment adherence among home care nurses and personal support workers: A multisite cross-sectional study. American Journal of Infection Control, 52(10), 1105-1113. https://doi.org/10.1016/j.ajic.2024.06.005
Lohiniva, A. L., Lehtinen, J. M., Arifulla, D., Ollgren, J., Nuorti, P., & Lyytikäinen, O. (2025). Factors influencing healthcare workers’ compliance with personal protective equipment guidelines in long-term care during the COVID-19 pandemic—A theory-based mixed-methods study. PLOS ONE, 20(4), e0321851. https://doi.org/10.1371/journal.pone.0321851
North, M. S. (2022). Chinese versus United States workplace ageism as GATE-ism: Generation, age, tenure, experience. Frontiers in Psychology, 13, 817160. http://dx.doi.org/10.3389/fpsyg.2022.817160
Pacutova, V., Geckova, A. M., de Winter, A. F., & Reijneveld, S. A. (2023). Opportunities to strengthen resilience of health care workers regarding patient safety. BMC Health Services Research, 23(1), 1127. https://doi.org/10.1186/s12913-023-10054-0
Qassim, A. A., & Abedelrahim, S. S. (2024). Healthcare Resilience in Saudi Arabia: The Interplay of Occupational Safety, Staff Engagement, and Resilience. International Journal of Environmental Research and Public Health, 21(11), 1428. https://doi.org/10.3390/ijerph21111428
Qureshi, M. O., Chughtai, A. A., & Seale, H. (2022). Recommendations related to occupational infection prevention and control training to protect healthcare workers from infectious diseases: a scoping review of infection prevention and control guidelines. BMC Health Services Research, 22(1), 272. https://doi.org/10.1186/s12913-022-07673-4
Sankar, S. S., Anandh, K. S., Rajendran, S., Ibrahim, C. K., & Szóstak, M. (2023). Examining the Relative Importance and Association between Safety Leadership Styles and Factors Affecting Organizational Safety Climate. Buildings, 13(8), 2062. https://doi.org/10.3390/buildings13082062
Santoro, P. E., Borrelli, I., Gualano, M. R., Proietti, I., Skroza, N., Rossi, M. F., Amantea, C., Daniele, A., Ricciardi, W., Potenza, C., & Moscato, U. (2022). The Dermatological Effects and Occupational Impacts of Personal Protective Equipment on a Large Sample of Healthcare Workers During the COVID-19 Pandemic. Frontiers in Public Health, 9, 815415. https://doi.org/10.3389/fpubh.2021.815415
Savari, M., Damaneh, H. E., Damaneh, H. E., & Cotton, M. (2023). Integrating the norm activation model and theory of planned behaviour to investigate farmer pro-environmental behavioural intention. Scientific Reports, 13(1), 5584. https://doi.org/10.1038/s41598-023-32831-x
Ssemuddu, J. B., Kajjoba, D., Olupot, P. W., Kirabira, J. B., & Okure, M. (2026). Structural equation modeling of safety integration and production pressure effects on safety performance in cement manufacturing. Scientific Reports. https://doi.org/10.1038/s41598-026-36696-8
Van Belle, T. A., King, E. C., Roy, M., Michener, M., Hung, V., Zagrodney, K. A., McKay, S. M., Holness, D. L., & Nichol, K. A. (2024). Factors influencing nursing professionals’ adherence to facial protective equipment usage: A comprehensive review. American Journal of Infection Control, 52(8), 964-973. https://doi.org/10.1016/j.ajic.2024.04.006









