Barriers and Facilitators to the Use of Personal Protective Equipment in Long-Term Care: A Scoping Review

J Am Med Dir Assoc. 2023 Jan;24(1):82-89.e2. doi: 10.1016/j.jamda.2022.11.012. Epub 2022 Dec 5.


Objective: To review existing literature evaluating barriers and facilitators to the use of personal protective equipment (PPE) by health care workers in long-term care (LTC).

Design: Scoping review.

Setting and participants: Health care workers in LTC settings.

Methods: Several online databases were searched and a gray literature search was conducted. Study inclusion criteria were (1) conducted in nursing homes or LTC settings, (2) focused on LTC health care workers as the study population, and (3) identified barriers and/or facilitators to PPE use. The Theoretical Domains Framework (TDF), which assesses barriers to implementation across 14 behavioral change domains, was used to extract and organize data about barriers and facilitators to appropriate use of PPE from the included studies.

Results: A total of 5216 references were screened for eligibility and 10 studies were included in this review. Eight of the 10 studies were conducted during the COVID-19 pandemic. Several barriers and facilitators to PPE use were identified. The most common TDF domain identified was environmental context and resources, which was observed in 9 of the 10 studies. Common barriers to PPE use included supply issues (n = 7 studies), the cost of acquisition (n = 3 studies), unclear guidelines on appropriate use of PPE (n = 2 studies), difficulty providing care (n = 2 studies), and anxiety about frightening patients (n = 2 studies). Having PPE readily available facilitated the use of PPE (n = 2 studies).

Conclusions and implications: Further research is necessary to identify barriers and facilitators more extensively across behavior change domains to develop effective strategies to improve PPE use and prevent infection transmission within LTC.

Keywords: Personal protective equipment; barriers and facilitators; health care workers; infection prevention and control; long-term care.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19*
  • Health Personnel
  • Humans
  • Long-Term Care
  • Pandemics / prevention & control
  • Personal Protective Equipment