Personal protective equipment (PPE) is a fundamental means of safeguarding workers from physical, chemical, and biological hazards encountered on the job, thus playing a critical role in ensuring workplace safety and preventing occupational injuries [1]. In healthcare settings, the proper use of PPE is essential to protect healthcare workers from infection and prevent the spread of pathogens within hospitals [2]. Donning PPE is emphasized as a core component of Standard Precautions, an infection control strategy that treats all patients as potential sources of infection [3].

Over the past decades, outbreaks of the Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and Coronavirus Disease 2019 (COVID-19) have resulted in substantial morbidity and mortality worldwide, greatly increasing the risk of healthcare-associated transmission [4]. These large scale epidemics have underscored the importance of PPE through the increased attention to guidelines, training, and policy development [5]. In response, the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) have reinforced PPE use as a key element of pandemic preparedness and routine infection control by issuing updated recommendations for the protection of healthcare personnel and patients [6,7].

Despite these advances, inappropriate PPE selection and self-contamination during donning and doffing continue to be the major contributors to healthcare-associated infections [8,9]. Although correct PPE use effectively reduces infection risk among healthcare workers, consistent compliance to standardized protocols remains inadequate in clinical practice [9]. Evidence suggests that individual, environmental, and organizational factors influence PPE compliance [4].

Since the onset of COVID-19, the research on PPE has progressed by examining various influencing factors. Individual factors such as knowledge, perception, attitude, and job stress; organizational factors such as institutional support and communication; and environmental factors such as nursing work environment and safety climate have been identified as significant determinants of PPE use [10-12]. Studies have also explored self-contamination during PPE removal [13], the impact of PPE shortages, and reuse during the early pandemic period [14].

However, most extant investigations have focused on crisis situations and neglected routine PPE practices across diverse clinical departments. Given that patient acuity, infection risk, and working conditions vary by unit, there is a clear need for research that reflects nurses' everyday PPE use in non-pandemic settings. Understanding baseline PPE compliance and its determinants in ordinary clinical practice will provide vital evidence for strengthening infection control systems and informing policy development.

Accordingly, this study assesses nurses' PPE compliance under routine clinical conditions and analyzes the personal, organizational, and environmental factors influencing their compliance. The findings will support targeted interventions to enhance PPE practices and contribute to more effective infection prevention strategies in healthcare settings.

This study aimed to examine the relationships between variables related to PPE compliance and to identify the factors influencing compliance among nurses employed in general or tertiary hospitals. Specially, the analysis focus on factors at the individual level, the organizational level, and the environmental level to provide a comprehensive understanding of determinants affecting PPE compliance in clinical practice.

PPE compliance averaged 4.58 out of 5. Compliance was highest for masks, followed by gloves, facial shields, and gowns. These results are in stark contrast to early- to the mid-2010s studies, ranked compliance as gloves, masks, gowns, and facial shields [12,22]. This shift may reflect the impact of COVID-19 pandemic. During this period, PPE use was strongly emphasized and became routine in hospital settings. In particular, because COVID-19 was transmitted via respiratory droplets and aerosols, government and institutional mandates for mask wearing, heightened recognition of aerosol transmission risks, and expanded distribution of facial shields may have collectively contributed to marked improvements in respiratory and facial shields compliance [23]. Notably, compliance of the appropriate selection of long-sleeved gowns and facial shield was low in situations where the risk of exposure to blood and body fluids was high. This suggests that participants who frequently came into contact with patients via their hands tended to have a heightened awareness of the risk of transmission through hand-mediated contact with blood and body fluids. By contrast, there appears to be a relative lack of awareness regarding the potential for infection transmission and its severity through contact involving other skin areas or the face [3,10]. Therefore, nurses are recommended to perform a point-of-risk assessment (PCRA) based on the patient's condition and the nature of the nursing task to evaluate the likelihood and severity of exposure to blood and body fluids. Based on the PCRA, they should select and properly wear the appropriate PPE [24]. Apart from information delivery, there may be a need for educational programs that can lead to behavioral changes by promoting the correct selection and use of PPE in response to varying levels of exposure risk in clinical settings [25]. These programs may be more effective when they incorporate practical training and feedback into real-world scenarios [26].

According to the results of the multiple regression analysis, the most significant factor influencing compliance with PPE was the availability of PPE, a subfactor of safety climate. This finding is consistent with previous studies reporting that the ability to easily access PPE when needed may improve compliance with infection control practices [22]. Timely provision and accessibility of PPE are critical to ensure consistent compliance with infection control protocols [27]. Therefore, hospitals should establish systematic distribution and inventory management systems to ensure that PPE is readily available and tailored to users' physical characteristics and comfort. Additionally, at the policy level, it is necessary to incorporate PPE-related costs such as infection prevention management fees into national healthcare reimbursement systems to ensure sustainable support.

The second most influential factor was the organizational culture for infection control, which was found to be at a similar level to that reported in studies involving nurses at small- and medium-sized hospitals prior to the COVID-19 pandemic [28]. However, these levels were lower than those reported in studies conducted during the pandemic [29]. This difference may reflect a temporary rise in awareness during the global crisis, when infection control efforts intensified worldwide. By contrast, Korea had already reinforced its infection control infrastructure following the 2015 MERS outbreak through strengthened policies and accreditation standards, which likely contributed to a sustained baseline level of infection control culture [30]. Nevertheless, to achieve further improvement, ongoing efforts to strengthen organizational culture may be necessary. Previous studies have identified the organizational culture of safety within healthcare institutions as a critical factor influencing PPE compliance, complementing individual-level factors, such as awareness and attitudes toward PPE use [31]. To maintain an effective infection control culture, it may be important to establish robust communication systems among staff members, cultivate an institutional climate that prioritizes infection prevention, and foster a culture that promotes constructive and positive feedback [25,32].

Attitudes toward PPE were the third predictor of PPE compliance. This finding is consistent with previous studies reporting that a positive attitude toward PPE use increases the likelihood of proper compliance with infection control practices [33]. This suggests that beyond physical availability and organizational support, individual healthcare workers' willingness and motivation to use PPE are important determinants of compliance. Positive attitudes may enhance compliance through increased perceived benefits and reduced resistance to PPE use, even when use is inconvenient or uncomfortable [34]. However, positive attitudes toward PPE do not always result in consistent compliance, pointing to a potential attitude-behavior gap [8]. This gap suggests that despite recognizing the importance of PPE, compliance may remain low due to factors such as limited knowledge, lack of education and training, and discomfort during use [35]. To reduce this gap requires practical, scenario-based training and timely feedback within real clinical conditions. These inconsistent findings underscore the need for further research to examine the conditions under which attitudes translate into actual PPE use, as well as the interplay between individual- and organizational-level factors.

This study identified the factors influencing PPE compliance among clinical nurses in the post COVID-19 pandemic era. However, it is not without limitations. First, as the study relied on self-reported survey data, there was a potential for response bias due to participants' subjective perceptions. Future studies are encouraged to incorporate direct observations or objective assessment methods to complement these findings. Second, the tools used to measure PPE compliance were developed by the researchers and, thus, require further validation to ensure their reliability and construct validity. In addition, the compliance measurement tool used in this study underwent only content validity assessment, and future research should focus on developing instruments with established reliability and various forms of validity. Third, the study was conducted among nurses working in general hospitals or tertiary hospital, which limits the generalizability of the findings to all healthcare settings. Therefore, future research may benefit from including a broader range of healthcare institutions to allow for more comprehensive and generalizable conclusions.

Despite these limitations, this study makes a meaningful contribution by investigating PPE compliance among nurses working in diverse clinical departments responsible for direct patient care rather than focusing solely on high-risk units or specialties with high infectious disease exposure. Notably, the constant availability of PPE, the organizational culture for infection control, and attitudes toward PPE were identified as significant determinants. Based on these findings, it may be important to establish systematic strategies to enhance PPE compliance and to develop practical approaches to improve compliance. In particular, comprehensive strategies addressing individual, organizational, and environmental factors should be implemented to strengthen PPE compliance in hospital setting. Furthermore, by identifying a range of factors that influence PPE use, this study may offer foundational insights for the development of educational and interventional programs applicable to clinical practice.

This study aimed to comprehensively identify the determinants of PPE compliance among clinical nurses in the changing healthcare environment following the COVID-19 pandemic. The results revealed that PPE availability, organizational culture for infection control, and positive attitudes toward PPE significantly influenced compliance, collectively explaining 47% of the variance. To improve PPE compliance among clinical nurses, it is necessary that the constant provision of appropriate and user-friendly PPE, foster a strong organizational culture that supports infection control through constructive feedback and effective communication, and implement systematic educational programs to strengthen positive attitudes and safe PPE practices. As this study relied on self-reported data, future research should incorporate complementary methods, such as direct observation or objective evaluation, to obtain more accurate assessments. Additionally, targeted intervention programs should be developed and rigorously evaluated to improve PPE compliance among clinical nurses.