Hospital health care workers’ use of facial protective equipment before the COVID-19 pandemic, implications for future policy


Ruth Barratt, Gwendolyn L. Gilbert

American Journal of Infection Control, published online December 11, 2023. DOI:


  • Emergency Department (ED) models of care are challenging for routine use of respiratory protection.
  • A gap exists between clinician knowledge and respiratory protection use in the ED.
  • Pediatrics in ED are perceived as a lower risk for respiratory infection than adults.
  • Infection prevention procedures may need to be adapted for the ED context.


Prepandemic routine use of facial (respiratory and eye) protective equipment (FPE) by health care workers was suboptimal. Understanding factors affecting routine use would facilitate escalation to high level use during infectious disease emergencies. This study explored health care workers FPE-related knowledge, attitudes and behaviors.


Mixed methods were used in a respiratory ward and adult and pediatric emergency departments (EDs), prior to the COVID-19 pandemic. Study design and thematic analysis were based on the theoretical domains framework. Emergent themes were categorized, using the COM-B behavior model, into capability(C), opportunity(O) and motivation(M), which influence behavior(B).


22 emergent themes, representing factors influencing FPE use, were mapped to theoretical domains framework domains. Personal experience and departmental cultures influenced motivation. Compared with respiratory ward staff, ED clinicians were less knowledgeable about FPE; the unique ED environment and culture inhibited opportunities and motivation for FPE use. Eye protection was infrequently used.


Optimal FPE use is challenged by ED care models and settings. Changes are needed to translate pandemic-related improvements into routine care of other respiratory infections.


This study identified key determinants of FPE behavior. A review of context-specific FPE guidance for ED by infection prevention and control professionals would help to promote practicable, sustainable compliance.