Health and care workers' perceptions of PPE and physical distancing for COVID-19: A qualitative evidence synthesis.

Background: Despite the effectiveness of personal protective equipment (PPE) and physical distancing interventions for COVID-19 infection prevention and control (IPC), low uptake among health and care workers persists. Aim: To synthesise evidence from primary qualitative research exploring the perceptions and experiences of health and care workers on the use of PPE and physical distancing in the context of COVID-19. Setting: Healthcare settings including care homes. Method: An electronic database search was conducted using search terms based on the inclusion criteria, and the search strategy was peer-reviewed by a team of information scientists. Thirty qualitative studies were sampled after eligibility screening independently by two review authors. Synthesis was performed using the thematic synthesis approach. The confidence in each review finding was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations; Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Results: Fifteen analytical themes were identified. Health and care workers valued the use of PPE in patient care. The sense of value was heightened by perceived susceptibility to infection with COVID-19, the need to deliver optimal patient care and the desire to protect family members. Service delivery, clinical workflows, the absence of visual cues for spatial separation and physical infrastructure hindered adherence to physical distancing guidelines. Conclusion: The gap between IPC guidelines and their implementation is an important health system barrier to PPE use and physical distancing in healthcare settings. Contribution: This review provides useful insights on key considerations for planning and implementing IPC in healthcare settings.