Factors Affecting the Use of PPE (Personal Protective Tools) in Nurses in Hospital

The purpose of this study was to analyze the factors that influence the use of PPE (Personal Protective Equipment) in the Nurses in the Hospital TK II Putri Hijau Medan in 2020. This type of research is an analytic study with a cross sectional approach. The research was conducted at the Putri Hijau Kindergarten II Hospital, Medan. The population in this study were 152 nurses with a total sample size of 60 people based on the sample count using the Slovin formula. Collecting data in the study using a questionnaire and processed into SPSS with univariate, bivariate and multivariate analysis. Based on the results of research with the chi square statistical test, it is known that the variables age, years of service, knowledge, attitudes, availability of PPE, supervision and social support have a relationship with p <sig α (0.05). Multivariate analysis shows that the working period variable (p = 0.004, Exp (B) 13.169), namely the working period has 13 times the effect on the use of PPE, attitudes (p = 0.003, Exp (B) 14.931) namely attitudes have 14.9 times the effect on use PPE, and social support (p = 0.012 Exp (B) 8,592), namely social support has an effect of 8.5 times on the use of PPE. Based on the results of the study, it can be concluded that the variables of tenure, attitudes and social support are the factors that most influence nurses in using PPE completely.


Introduction
Based on the Republic of Indonesia Minister of Health Regulation No.3 of 2020 the Hospital is a health service institution that provides complete individual health services that provide inpatient, outpatient and emergency services. By providing health services consisting of medical services and medical support, nursing and midwifery services and non-medical services. To support the health services provided to the general public, nursing services to patients must also be equipped with SOPs for each nurse, such as using complete PPE in providing services to patients, both outpatients and inpatients.
The main factors causing work accidents in Indonesia are behavioral factors in 31,776 cases (32.06%) and 57,626 cases (58.15%) due to unsafe actions (International Labor Organization, 2017). Unsafe action is an action that can endanger workers and other people and lead to accidents caused by various things such as not wearing personal protective equipment (PPE), not following work procedures, not following work safety regulations or working carelessly (Pratiwi, 2012).
Personal protective equipment is proven to be able to help nurses improve health services, therefore knowledge of basic personal protective equipment must be fully controlled by nurses so that the level of patient satisfaction is getting better. The need for increased supervision of nurses in the use of PPE when carrying out nursing actions.
The results of observation and initial survey interviews with the head nurse of the TK II Putri Hijau Medan Hospital in 2019, concluded that there were still many nurses who had not used PPE completely, especially in the ICU, IGD, OK and inpatient rooms, which was around 70%, while those who used PPE complete with a range of 30%. Medical officers who do not use PPE completely at the hospital are at risk of contracting infectious diseases in carrying out their duties, namely around 18 nurses have experienced infections, one of which is nosocomial infection in 2019 in the inpatient room which can be caused by exposure to needles, infusions, catheters that have been used on patients, contracted directly from patients with severe injuries, burns, patients undergoing treatment with breathing apparatus, by air and water.
Nosocomial infection is an infection that affects patients after approximately 72 hours in the hospital and this occurs when the toxin causes local or systemic infection. Based on the observations of researchers from several inpatient rooms, there were still some nurses who did not use PPE completely, one of which was not using masks and handscoons when taking medical actions on patients. From the observational data, nurses have not complied with using PPE completely due to the heavy workload level so that it makes nurses lazy to use PPE when taking action, nurses think that the use of PPE is not important, and nurses do not realize that there are risks of danger if they do not use PPE The hospital is the place most likely to get infection because it contains a high population of microorganisms with virulent strains that may be resistant to antibiotics.
The results of the Preliminary Survey conducted by the researcher showed that of the 10 respondents who had been interviewed there were 4 people who used Personal Protective Equipment (PPE) where the knowledge of Personal Protective Equipment (PPE) was still lacking because of using Personal Protective Equipment (PPE) incorrectly and has a lack of attitude in the use of Personal Protective Equipment (PPE) because it is only used when Personal Protective Equipment (PPE) is available and when there is supervision. Meanwhile, 6 people who did not use Personal Protective Equipment (PPE) due to a lack of knowledge and application of the use of Personal Protective Equipment (PPE) and inadequate attitude in using Personal Protective Equipment (PPE) every time they took medical action, seemed to underestimate the dangers that would occur in herself. Based on the results of the interview, it was found that there was no serious sanction for not using PPE, the nurse was only reprimanded and told to repeat the procedure that was not carried out. The absence of serious sanctions can make nurses violate the established SPO.

Methods
This type of research is a quantitative research data collection by questionnaire with a cross section approach. This research was carried out in the inpatient room of the TK II Putri Hijau Medan Hospital. The time of the research was conducted from February to July 2020. The population in this study was based on the number of permanent nurses inpatient at the Putri Hijau Kindergarten II Hospital, Medan, which amounted to 152 people. The sample size was 60 people using the Slovin formula

Results and Discussion
The variables tested in this first stage binary multiple regression (logistic regression) were all independent variables that were declared significant p <0.05 in the bivariate analysis, namely age, years of service, knowledge, attitudes, availability of PPE, supervision and social support that were inputted. Into the binary logistic regression test, while education was not included in the regression test because the results of the bivariate analysis were invalid. The results of variable analysis with binary multiple regression test (logistic regression) in the first stage used the candidate sig value test <0.25 with the enter method.

Analysis of the Effect of Age on the Use of PPE on Nurses in the Hospital TK II Putri Hijau Medan
Age affects a person's perceptive power and mindset. As you get older, your mindset will also develop, so that the knowledge you get is getting better. At middle age, individuals will play a more active role in society and social life and make more preparations for the success of adjusting to old age, besides that, middle-aged people will spend more time reading (Wawan & Dewi, 2010) Based on the results of the study, it was found that respondents who were <35 years old with the use of complete PPE were 23 people (38.3%) and respondents who used incomplete PPE were 20 people (33.3%). While respondents aged ≥35 years used complete PPE as many as 16 people (26.7%) and respondents who used incomplete PPE were 1 person (1.7%). The results of the chi-square statistical test obtained a ρ value of 0.008 and therefore the value of ρ value (0.008 <0.05), so there is a relationship between age and the use of PPE on nurses in the TK II Putri Hijau Hospital.
According to researchers based on the results of the study, it is known that age has a relationship with the use of PPE in inpatient nurses at the TK II Putri Hijau Hospital, it is known that of the 43 nurses who are less than 35 years old, it is known that half of each uses PPE completely. And do not use the complete PPE while doing work or taking medical actions on patients. It is known that some respondents who are less than 35 years of age do not use the complete PPE, possibly because the nurse has never had a work accident during medical treatment so that the use of PPE is not equipped according to the needs or applicable conditions, such as not wearing a handscoon, or also wear a mask without covering the nurse's nose and mouth completely. So that the level of needs and benefits of PPE has not influenced the nurse to use PPE completely and properly. Meanwhile, nurses who are more than 35 years old are known to use PPE completely and well. It is known that older nurses in general the insights and experiences they have gained during their work affect the complete and good use of PPE in their work as medical personnel.
The results of this study are in line with research conducted by G. Apriluana (2016). The results showed that there was a relationship between age and the behavior of using PPE on health workers at Banjarbaru Hospital. Based on the results of the study, it was found that more respondents aged> 35 years (62.5%) had good behavior in using PPE than less (37, 5%). Likewise, more respondents aged ≤ 35 years (85.7%) had good behavior in using PPE than had less behavior (14.3%) (Apriluana et al., 2016)

Analysis of the Effect of Working Period on the Use of PPE on Nurses in the Hospital TK II Putri Hijau Medan
According to Agus (1992) in Achiyat (2005), tenure is the length of work, which is closely related to the experiences that have been obtained while carrying out tasks. Those who are experienced are considered to be more capable in carrying out their duties, the longer a person's tenure is, their skills will be better because they are able to adjust to their work (Achiyat, 2005) Based on the results of the study, it was found that the respondents who had a working period <5 years with the use of complete PPE were 6 people (10.0%) and respondents who used incomplete PPE were 15 people (25.0%). Meanwhile, respondents who worked ≥5 years with the use of complete PPE were 33 people (55.0%) and respondents who used incomplete PPE were 6 people (10.0%). Based on the results of the chi-square statistical test, it was obtained a ρ value of 0,000 and therefore the value of ρ value (0,000> 0.05), so there is a relationship between the working period and the use of PPE on nurses inpatient care at TK II Putri Hijau Hospital, Medan in 2020.
The result of multiple logistic regression test shows that the working period variable with the sig = 0.004 Exp (B) 13.169, which means that the tenure has a significant effect of 13 times on the use of PPE, so it can be assumed that the tenure of a nurse has an effect of 13 times for using PPE completely at the Hospital TK II Putri Hijau Medan in 2020.
According to the researchers, based on the results of the study, it is known that the working tenure of a nurse has a relationship with the complete use of PPE on nurses in the inpatient room of the Hospital TK II Putri Hijau Medan, the results of multiple regression tests show that the tenure of a nurse has an effect of 13 times for the complete use of PPE. Based on observations made by the researchers, there were still some nurses who provided nursing care in inpatient rooms who did not use complete PPE. It is known that the working tenure of nurses with a working period of less than 5 years is less likely to use complete PPE compared to those who are incomplete, while for nurses whose working period is more than 5 years is inversely proportional, it is seen that the majority use PPE completely, this is This may be due to a new nurse who has no experience or has never had an accident / health problem due to incomplete use of PPE while working compared to a nurse with a longer working period where the insight and experience in her work are required to use PPE completely and correctly so that the level of work accidents and the impact of work accidents that have an impact on safety or health can be avoided.
The results of this study are in line with research conducted by A. Asmi (2017). Based on the results of the partial analysis, it was found that the contribution of nurses' tenure at Bhayangkara Hospital Makassar had a contribution of 67% in the use of Personal Protective Equipment (PPE) when providing care (Asmi, 2017)

Analysis of the Influence of Knowledge on the Use of PPE on Nurses in the Hospital TK II Putri Hijau Medan
Knowledge is an important domain for the formation of one's actions (overt behavior), behavior based on knowledge will be more lasting than behavior that is not based on knowledge (Notoatmojo). So that knowledge has a very large role in shaping behavior (Notoatmodjo, 2012).
Based on the results of the study, it is known that respondents who have less knowledge with the use of complete PPE are 4 people (6.7%) and respondents who use incomplete PPE are 10 people (16.7%). While respondents who had good knowledge with the use of complete PPE were 35 people (58.3%) and respondents who used incomplete PPE were 11 people (18.3%). Based on the results of the chi-square statistical test, it was obtained a ρ value of 0.003 and therefore the value of ρ value (0.003 <0.05), so there is a relationship between knowledge and the use of PPE on nurses in the Hospital TK II Putri Hijau Medan in 2020.
According to the researchers, based on the research results, it is known that the knowledge of a nurse has a relationship with the complete use of PPE on nurses in the inpatient room of the Hospital TK II Putri Hijau Medan. These results show that nurses who have less knowledge where most of them do not use PPE completely compared to nurses with good knowledge using PPE completely. According to researchers, a nurse who has good knowledge and understanding of PPE and the urgency of using it during work will have a high level of awareness so that it can comply with the use of PPE in work and create a safety culture.
The establishment of a safety culture through compliance with the use of PPE always begins with the cognitive domain of the workforce. Knowledge of the benefits of an object or information encourages a person to be able to use or apply it in everyday life. Thus, increasing knowledge about the benefits of an object or available information is expected to increase the use of that object or information. With good knowledge of each nurse, they are expected to be able to understand the intent and purpose of using personal protective equipment while working. It is also hoped that nurses can be aware of every risk and danger that will occur at any time if they do not wear personal protective equipment, namely the danger of accidents and the risk of occupational diseases which are also known as nosocomial infections.
In this study, it shows that nurses with good knowledge use more personal protective equipment from nurses whose knowledge is less, this is in accordance with the theory which states that the better a person's knowledge, the better the level of awareness and discipline of a person in receiving or implementing a message or information. that was delivered (Notoatmodjo, 2012).
The results of this study are in line with research conducted by Komalig & Tampa'i (2019), the results of the study show that there is a relationship between knowledge of health workers and adherence to the use of PPE, where it is known that health workers who have poor knowledge of PPE and work safety will not comply with The use of PPE by 17 respondents (27.4%) and poor knowledge will obey as many as 4 respondents (6.5%). Health workers who have good knowledge related to PPE and work safety will not comply with the use of PPE by 6 respondents (9.7%) and good knowledge will obey as many as 35 respondents (56.5%) (Komalig & Tampa'i, 2019)

Analysis of the Influence of Attitudes on the Use of PPE on Nurses in the Hospital TK II Putri Hijau Medan
Attitude is a reaction or response that is still closed from someone to a stimulus or object. According to Newcomb in Notoatmodjo, stating that an attitude is a readiness or willingness to act and not an implementation of a particular motive. Attitude is not yet an action or an activity. That attitude is still a closed reaction, not an open reaction or overt behavior (Notoatmodjo, 2017).
Based on the results of the study, it was found that of the 60 respondents who were studied, it was found that the respondents who had less attitudes with the use of complete PPE were 6 people (10.0%) and respondents who used incomplete PPE were 14 people (23.3%). While respondents who had a good attitude with the use of complete PPE were 33 people (55.0%) and respondents who used incomplete PPE were 7 people (11.7%). Based on the results of the chi-square statistical test, it was obtained a ρ value of 0,000 and therefore the value of ρ value (0,000 <0.05), so there is a relationship between attitudes and the use of PPE in nurses inpatient care at TK II Putri Hijau Hospital, Medan in 2020.
The results of multiple logistic regression test showed that the attitude variable with the value of sig = 0.003 Exp (B) 14.931, which means that attitudes have a significant effect of 14 times on the use of PPE, so it can be assumed that the attitude of a nurse gives 14 times the effect of using PPE with inpatient services at the TK II Putri Hijau Medan Hospital in 2020.
From this study, although the results obtained from the attitudes of nurses towards the use of PPE were good, there were still many respondents who had a lack of attitude towards the use of PPE and did not use PPE in accordance with the standards of using PPE that were expected in the inpatient room. This is of course influenced by several factors, including the knowledge of the PPE the nurse has, because this is what underlies how she behaves towards PPE available in the inpatient room.
Attitudes are feelings, thoughts and tendencies of a person which are more or less permanent about certain aspects of their environment. Attitude is an evaluative inclination towards a stimulus or object that has an impact on how a person deals with that object. This means the attitude of showing approval or disapproval, like or dislike of someone towards something (Mubarak, 2012).
According to the researchers, from the research results it can be seen that the knowledge of a nurse has a relationship with using PPE completely in the Hospital TK II Putri Hijau Medan, the results of multiple logistic regression tests can be seen that attitudes have an effect of 14.9 times on the use of PPE. It is known that the less visible attitude of the respondents in using PPE is mostly incomplete and only a small proportion of respondents use the PPE completely. The inversely proportional to the respondent's good attitude, it was found that most of the respondents used PPE completely in providing nursing care to patients in the inpatient room and only a small proportion of respondents had a good attitude by using incomplete PPE. These results can be assumed that a good respondent's attitude will increase the action in using PPE completely.
The results of this study are in line with research conducted by Komalig & Tampa'i (2019), which states that attitudes have a relationship with adherence to using PPE for health workers at the Central Surgical Installation of RSUP. Prof. Dr. dr. D. Kandau Manado. A good respondent's attitude will increase compliance with the use of PPE. Attitude is an order between the components of thought, feelings and is a predisposition for actions that interact with each other in understanding, feeling and behaving towards objects that are around them. A bad attitude will also contribute to the behavior of using PPE (Komalig & Tampa'i, 2019)

Analysis of the Effect of the Availability of PPE on the Use of PPE in Nurses in the Hospital TK II Putri Hijau Medan
The best way to prevent accidents is to eliminate the risk or control the source as tightly as possible. But this is not possible, so workplace institutions are required to provide and complete personal protective equipment (Dedek, 2008)

in Khairiah 2012).
Based on the results of the study, it is known that the complete PPE is not available with the use of complete PPE as many as 8 people (13.3%) and respondents who use incomplete PPE are 14 people (23.3%). While the complete PPE was available with the use of complete PPE as many as 31 people (51.7%) and respondents who used incomplete PPE were 7 people (11.7%). The results of the chi-square statistical test obtained a ρ value of 0.001 and therefore the value of ρ value (0.001 <0.05), so there is a relationship between the availability of PPE and the use of PPE in nurses inpatient at TK II Putri Hijau Hospital, Medan in 2020.
The availability of facilities is one of the factors that influence the formation of compliance. The availability of personal protective equipment in the workplace must be a concern of hospital management and nurses to encourage changes in nurses' attitudes. All personal protective equipment facilities that are required for health workers must be available in accordance with the hazards present in the work place.
According to the researchers, based on the results of the study, there was a relationship between the availability of complete PPE with the use of PPE on nurses at the Hospital TK II Putri Hijau Medan. It is known that most of the nurses stated that the availability of PPE in the inpatient room was completely available with the majority of respondents using PPE incompletely. According to researchers, the availability of PPE in inpatient rooms is carried out by several processes, namely PPE is ordered or taken to the goods / equipment procurement unit in Putri Hijau Kindergarten II Hospital, and then distributed to inpatient rooms. The availability of PPE also sometimes causes problems such as running out of stock of goods / equipment needed for medical treatment or disordered items to the distributor that have not reached the hospital, so the availability of PPE is constrained or not completely available. The availability of PPE needed by a nurse is readily available, but there are some tools that are still lacking, such as protective shoes, aprons that are used alternately or according to the need for medical treatment. Besides that, the availability of PPE in the inpatient room for each nurse, such as masks and hands coons, is in accordance with the number of nurses in the inpatient room, but you can still find nurses who do not use PPE completely in carrying out their work, this can happen which can be caused by the level of activity, the nurse is not comfortable using the PPE in carrying out medical treatment / action. On the other hand, the actions or behavior of the nurses themselves are not maintaining work safety and security so that the nurses do not use PPE completely.
The results of this study are in line with research conducted by Sudarmo (2017). The results showed that respondents who stated that PPE availability in the workplace was available, obedient 45 (69.3%) and disobedient 20 (30.7%) while those who stated that PPE supplies in the workplace did not behave obediently 15 (93.7%) and non-compliant 1 (6.3%). The statistical results of the logistic regression test, the value of the availability of PPE on the compliance of surgical nurses in using PPE at IBS Ulin Hospital Banjarmasin, obtained a pvalue (0.003) <0.05. Thus it can be concluded that partially the variable availability of PPE has a significant effect on the compliance of surgical nurses in using PPE at IBS RSUD Ulin Banjarmasin (Sudarmo et al., 2017)

Analysis of the Effect of Supervision on the Use of PPE in Nurses in the Hospital TK II Putri Hijau Medan
Supervision in general can be defined as a way for an organization to achieve effective and efficient performance. Supervision is a form of observation that is generally carried out in a comprehensive manner, by making comparisons between what is controlled and what should be done (Fahmi, 2012) Based on the results of the study, it is known that respondents who received less supervision with the use of complete PPE were 5 people (8.3%) and respondents who used incomplete PPE were 10 people (16.7%). While respondents who received good supervision with the use of complete PPE were 34 people (56.7%) and respondents who used incomplete PPE were 11 people (18.3%). The results of the chi-square statistical test obtained a ρ value of 0.005 and therefore the value of ρ value (0.003 <0.05), so there is a relationship between supervision and the use of PPE on nurses in the Hospital TK II Putri Hijau Medan in 2020.
According to the researchers, based on the results of the study, there was a relationship between supervision and the use of PPE on nurses in the Hospital TK II Putri Hijau Medan. It is known that most of the nurses stated that the supervision had been carried out well with the majority using PPE completely, compared to the small number of nurses who stated that the supervision was lacking with the majority using PPE incompletely. From this it can be seen that the supervision carried out on the performance of nurses in the inpatient room is carried out directly by the head of the nursing section and the head of the room by directly controlling the activities of nurses in handling patients in the inpatient room, but this supervision is only carried out periodically, so that it can be done. It is described that the nursing actions carried out by nurses in the handling of patients who are not under supervision by not using PPE completely and this occurs in the handling of patients in a recovering condition, whereas in patients who are intensively controlled the use of PPE is still used completely without the presence or absence of supervision from the head. the room, the head of care or the doctor who treats the patient.
The results of this study are in line with research conducted by Sandra F. Sawy (2019). Based on the results of the study, it was found that there was an influence on the motivational factor of supervision with the use of PPE nurses at dr. Zainoel Abidin Hospital Banda Aceh with p-value (0.002). Based on the results of the study, about 35 nurses chose in the good category for monitoring the use of PPE (79.5%). The results of the study were supported by Yurianti (2015) entitled The Relationship between the Supervisory Function of the Head of the Room and the Performance of the Nurses in Providing Nursing Care in the Inpatient Room of the Sunan Kalijaga Hospital, Demak obtained a probability value or p-value (0,000) (Sawy, 2019)

Analysis of the Influence of Social Support on the Use of PPE on Nurses in the Hospital TK II Putri Hijau Medan
According to Notoatmodjo, concrete support is provided by institutional leaders at all levels and in all related sectors in order to realize health sector development. This policy support can be in the form of laws, regulations, or decrees of the leadership of government or private institutions. In order for a program or activity to run well, it is necessary to have a clear system, mechanism or work procedure that supports it, therefore a work system for work organizations that involves health needs to be developed (Notoatmodjo, 2012) Based on the results of the study, it was found that the social support of respondents who did not support the use of complete PPE was 5 people (8.3%) and respondents who used incomplete PPE were 14 people (23.3%). While the social support of respondents who supported the use of complete PPE was 34 people (56.7%) and respondents who used incomplete PPE were 17 people (11.7%). Based on the results of the chi-square statistical test, it was obtained a ρ value of 0,000 and therefore the value of ρ value (0,000 <0.05), so there is a relationship between social support and the use of PPE in nurses inpatient at TK II Putri Hijau Hospital, Medan in 2020.
The result of multiple logistic regression test shows that social support variable with sig = 0.012 Exp (B) 8,592, which means that social support has a significant effect of 14 times on the use of PPE, so it can be assumed that social support has an effect of 8 times for using PPE. Inpatient at the TK II Putri Hijau Medan Hospital in 2020.
According to the researcher, from the research results it is known that unsupportive social support can be seen that most respondents do not use PPE completely, only a small proportion of respondents use PPE completely even though it does not get support. This is also inversely proportional to the respondents who received support, most of them using the complete PPE and only a small proportion who did not use the PPE completely. The regulatory policy issued by the agency to all employees to use PPE completely will be achieved if this is supported by the leaders of each department or support from colleagues. So that every act of nursing care given to patients can be implemented properly by continuing to carry out the policies of the agency by using complete PPE.
The results of this study are in line with research conducted by Barat & Ningsih Based on the results of the study, there is a relationship between policies and the behavior of using PPE on nurse nurses in the District Hospital Mamuju 2018. Regulations / policies regarding the procedures for using PPE support from the leadership in the hospital are very important, because with this policy, nurses will be able to know more about the importance of using PPE, so that they can prevent work accidents when performing medical procedures on patients (Barat & Ningsih, 2018).

Analysis of the factors that most influence the use of PPE on Nurses Inpatient at Putri Hijau Kindergarten II Hospital, Medan
Based on the results of the Multivariate Test, it is known that there are 3 research variables that are the most significant. The significant variable is years of service with a sig = 0.004 Exp (B) 13.169, which means that tenure has a significant effect of 13.1 times on the use of PPE, attitudes with a sig = 0.003 Exp (B) 14.931, which means that attitudes have a significant effect of 14.9 times on the use of PPE and social support with a sig = 0.012 Exp (B) 8,592, which means that social support has a significant effect of 8.5 times on the use of PPE.
Law No. 25 of 1997 concerning Manpower Article 108 states that "every worker has the right to obtain protection for occupational safety and health, morals and morals, treatment in accordance with human dignity and religious values", so the protection of employees from harm especially when carrying out activities in the workplace, the company management needs to do it. One of the efforts to protect these workers is the use of Personal Protective Equipment (PPE). The use of PPE in the workplace itself is regulated through Law No.1 of 1970 (Yusnita, 2017).
According to the researcher, based on the research results, it can be seen that of all the variables studied, it was found that there were 3 dominant variables affecting nurses using PPE in full, namely attitudes, years of service and social support, where of the three variables the most influencing attitude was 14.9 times against the use of PPE. This result is in accordance with the theory put forward by L. Green that predisposing factors influence a person's behavior in health education or health organizations, one of which is the attitude of the respondent. Attitude shows or is an emotional reaction to social stimuli. Attitude is not an action or activity but a predisposition to an action or behavior. Attitude can show approval or disapproval, like or dislike someone towards something. In this case it can be associated that the attitude can describe a nurse in using PPE completely or incompletely. According to the observations of the researchers, a nurse can still be found in the hospital in handling patients in inpatient rooms who do not use PPE completely, one of which is due to the dislike of nurses in using PPE completely because the PPE used does not match both the size and the basic material of the PPE.
Personal protective equipment (PPE) is a tool used to protect workers so they can protect themselves. Personal protective equipment (PPE) includes the use of a respirator, special clothing, protective goggles, safety caps, or similar devices which when used properly will reduce the risk of injury or illness due to hazards. Personal protective equipment is the final method used after attempts to undertake other methods. Personal protective equipment (PPE) provided by employers and used by workers, must meet the requirements for manufacture, testing and certificates. Workers have the right to refuse to wear them if the Personal Protective Equipment (PPE) provided does not meet the requirements (Anizar, 2009).
According to researchers, the use of PPE is very important to be used completely by a nurse in an inpatient room or in a hospital environment, where personal protective equipment has great benefits such as being able to avoid contracting diseases, infections or protecting a nurse from a work accident. Caused by medical errors. Where one case of nosocomial infection can be transmitted to medical personnel from a patient who is or is undergoing treatment in a hospital. Diseases that can occur due to nosocomial infections are bloodstream infections, pneumonia, urinary tract infections and surgical wound infections. Nosocomial infections are most often caused by bacteria that have developed resistance to antibiotics. This bacterial nosocomial infection can occur in patients who are receiving treatment or patients with low immunity. So that as a preventive measure, the complete use of PPE can inhibit or prevent nosocomial infections in medical personnel. During this pandemic, it is also highly recommended for all medical personnel to prepare themselves using PPE completely because it is part of the preventive measures for the source of disease or viruses. The role of hospital management, especially the hospital PPI Committee, is to always encourage and evaluate the use of PPE for every medical personnel with successive communication starting from the top to the bottom. As well as following up by giving appreciation or reward to medical personnel who use PPE completely and giving a warning or written sanction to medical personnel who do not use PPE completely so that the complete and correct use of PPE can run well and according to the applicable SOP in the hospital.

Conclusion
It was found that most of them stated that supervision was good and a small proportion stated that supervision was lacking. The results of the bivariate analysis showed that there was a supervisory relationship with the use of PPE (Personal Protective Equipment) for nurses in inpatient care at the TK II Putri Hijau Hospital, Medan with a p-value of 0.005. The results showed that most of them stated good social support and a small proportion of them lacked social support. The results of the bivariate analysis show that there is a relationship between social support for the use of PPE (Personal Protective Equipment) for nurses at the Inpatient Care of the Putri Hijau Kindergarten II Hospital in Medan in 2020 with a p-value of 0,000. The results of the multivariate analysis showed that the factors that most influenced the use of PPE (Personal Protective Equipment) in inpatients at the TK II Putri Hijau Medan were years of service, attitudes and social support compared to age, knowledge of the availability of PPE and supervision.