Compliance to Infection Prevention and Control Practices Among Healthcare Workers During COVID-19 Pandemic in Malaysia

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.

Genomic surveillance reveals COVID-19 outbreak clusters in a tertiary center in Malaysia: A cross-sectional study

Background

Genomic surveillance activity is a useful tool in epidemiologic investigations and monitoring of virus evolution. This study aimed to describe the COVID-19 outbreaks through SARS-CoV-2 virus genomic surveillance by whole genome sequencing.

Methods

A cross-sectional study was conducted using archived clinical samples of confirmed laboratory-positive COVID-19 from June 2021 to June 2022 from a tertiary center in Malaysia. The samples were subjected to whole genome sequencing. A phylogenetic tree was constructed using the maximum likelihood method in MEGA 11 software. The clinical data were obtained through paper, electronic, and hospital information systems.

Results

A total of 86 clinical samples were successfully sequenced. The phylogenetic tree revealed seven clusters, consisting of 24 cases. Three clusters were associated with health care workers and health care-associated individuals. The SARS-CoV-2 Delta variants were observed in the first three clusters and subsequently replaced with the Omicron variants.

Conclusions

Whole genome sequencing is robust and reliable, enhancing epidemiologic investigations, leading to the identification of clusters and preventing the spreading of COVID-19 among health care workers. Monitoring of the SARS-CoV-2 variants is necessary to study the viral dynamics and maintain the effectiveness of public health interventions.

Knowledge and Practices of Nurses on the Prevention and Control of Healthcare-acquired Infections in a Private Tertiary Hospital in Baguio City

Background

Healthcare-acquired infections (HAIs) are adverse events brought about by non-compliance of the healthcare staff to set of infection prevention and control (IPC) standards. Consequently, additional medical costs, increased mortality and morbidity rates, and decreased quality of life among patients can happen. As valuable players in preventing and controlling HAIs, nurses must have good knowledge and strict compliance with infection control; however, recent evidence suggests that nurses may need more knowledge or better integration into practice. Nurses' degree of knowledge and practice in preventing and controlling HAIs and factors influencing them should be determined to provide solutions appropriately.

Objectives

The study specifically sought answers to the following questions: (1) What is the level of knowledge of nurses in the prevention and control of HAIs? (2) What is the degree of practice of nurses in the prevention and control of HAIs? (3) Is there a significant relationship between nurses' knowledge level and degree of practice in the prevention and control of HAIs? (4) What are the facilitating and hindering factors that affect nurses' practice in the prevention and control of HAIs?

Methods

The study utilized a quantitative descriptive correlational design. The study was conducted from May to June 2023 at a private tertiary hospital in Baguio City. The study included 128 nurses who fit the inclusion criteria. The respondents were asked to answer three questionnaires, and the data were statistically treated using mean, Spearman Rank correlation, frequency, percentage, and rank distribution.

Results

The study found that nurses possess good knowledge and a suboptimal degree of practice in preventing and controlling HAIs. The results showed that no significant relationship existed between nurses' knowledge level and degree of practice in preventing and controlling HAIs. Perceived personal benefits and organizational encouragement were seen to primarily facilitate the prevention and control practices of nurses. The primary hindrance identified was work-load due to staff shortage, poor dissemination of guidelines, and personal discomfort associated with the use of PPE.

Conclusions

A good level of knowledge is a derivative of learnings obtained through various educational modalities and these strategies are considered effective means of knowledge formulation. However, created knowledge without actual application into practice results in overuse of unhelpful interventions. To avoid the unnecessary effects of ineffective knowledge translation, a multifactorial consideration is necessary to identify other factors that may influence the practices of nurses on HAI prevention and control because knowledge does not solely improve or worsen actual practices. Identified facilitating factors should be supported, and hindering factors should be addressed. Further recommendations based on the study results include strengthening existing programs and policies, and developing accessible materials to improve the present practices of nurses.

Factors influencing healthcare workers' perceived compliance with infection prevention and control standards, North Bank East region, The Gambia, a cross-sectional study

BACKGROUND

This study evaluated Health Care Workers' (HCWs) knowledge, attitude, perceived compliance, and potential influencing factors related to Infection Prevention and Control (IPC) standards in the North Bank East region of The Gambia.

METHOD

The study was an analytic cross-sectional study, conducted in 2021 using a multistage sampling technique. Thirteen health facilities were sampled from the North Bank East Region of The Gambia. The sample size was calculated using the Cochrane formula, based on a healthcare worker population of 408, with a 95% confidence interval. Adjustments were made for a 10% non-response rate and a compliance level of 50%. A final sample size of 218 was used for the study. Descriptive statistics, chi-square, and logistic regression were done at a 95% confidence limit and an alpha level of 0.05. A p-value of 0.05 was considered statistically significant.

RESULTS

Among the 218 healthcare workers, the majority demonstrated adequate knowledge (86.24%) and a positive attitude (78.4%) toward Infection Prevention and Control (IPC). About half (50.5%) of the HCWs did not comply with IPC standards. Good attitude of HCWs [aOR = 3.13, 95%CI: 1.17-8.41, p-value = 0.023], accessibility of Personal Protective Equipment [aOR = 2.34, 95%CI: 1.01-5.38; p-value = 0.046], and monitoring of IPC practice [aOR = 3.95, 95%CI: 1.84-8.45; p-value = < 0.001] were independently associated with HCWs perceived compliance with IPC standards.

CONCLUSION

Although 188 (86.24%) HCWs displayed adequate knowledge of IPC standards, perceived compliance remains insufficient in Gambian healthcare facilities. To address this, the Ministry of Health should prioritize educational campaigns, and regular training to reinforce HCW knowledge, ensure Personal Protective Equipment (PPE) accessibility, and implement ongoing IPC practice monitoring among healthcare workers.

A Cross-Sectional Examination of Missed Infection Control Practices Among Nurses in the Jordanian Hospitals

BACKGROUND

Missed infection control practices may negatively impact quality healthcare and patient safety in acute health care settings. Hence, more research is urgently needed especially in Arab countries. To investigate the elements and reasons of missed infection control activities among nurses in Jordan. The sociodemographic correlates with missed infection control activities were also examined.

METHODS

A cross sectional design was utilized in this study. A convenience sample of 960 nurses from seven hospitals in the North of Jordan was used. The Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey was employed to collect the data. Data were analyzed using descriptive inferential, and multivariate regression analysis.

FINDINGS

The majority of the participants worked as registered nurses (78.4%). The highest missed infection control activities were: screening new admissions for Multi Resistant Organisms (MRO), wearing gloves for both preparing and administration of all antibiotics, and informing staff and visitors for the need for transmission-based precautions (when managing a patient with a MRO). The least missed infection control activities reported by nurses were performing hand hygiene after touching patients, and before drug administration. The reasons of missed infection control measures most frequently reported by nurses were: urgent patient situation, followed by inadequate number of clerical staff, and unexpected rise in patient volume and or acuity.

CONCLUSION

This research suggests that interventions to reduce missed infection control measures should focus on the education and training of nursing staff as well as a adopting nurse: patient ratio in managing nursing workload, which should not exceed 1:4.

Monkeypox Vaccine Hesitancy Among Healthcare Workers in Pakistan

Objective

This study aimed to investigate healthcare workers (HCWs) acceptance of the HMPXV vaccine in Pakistan and identify influencing factors.

Methods

A cross-sectional survey of 4257 HCWs assessed vaccine acceptance across demographics, ethnicity, marital status, specialty, medical conditions, and education. Logistic regression identified predictors of acceptance.

Results

The overall HMPXV vaccine acceptance among HCWs was 73.1%. The gender distribution shows that a majority of participants are female (56.60%) while males constitute 43.40% of the sample. Interestingly, vaccine acceptance is higher among females (68.43%) compared to males (31.57%). Ethnicity in the sample reveals that Punjabi participants are the most common at 45.25%, followed by Pashtun (26.06%), Sindhi (14.41%), Balochi (12.72%), and Other (1.46%). Age categories are compared to the 18-30 age group. The odds of vaccine acceptance are lower for individuals aged 31-40 (OR 0.48, 95% CI 0.19-1.25) and for those over 60 (OR 0.80, 95% CI 0.41-0.97). Conversely, the odds are higher for those aged 41-50 (OR 1.93, 95% CI 0.27-3.01) and 51-60 (OR 0.54, 95% CI 0.19-1.67). Gender comparison reveals that females have higher odds of vaccine acceptance (OR 0.26, 95% CI 0.21-1.24) than males. Among ethnicities, Sindhi participants (OR 1.21, 95% CI 0.23-1.88) have slightly higher odds of vaccine acceptance than Punjabi participants. Marital status doesn't significantly influence vaccine acceptance, but married individuals have slightly higher odds (OR 1.75, 95% CI 0.87-5.06). In terms of specialty, Surgery/Allied professionals have lower odds of vaccine acceptance (OR 0.48, 95% CI 0.13-1.70) compared to Medicine/Allied professionals.

Conclusion

Strategies addressing demographic disparities and countering misinformation are crucial for enhancing HMPXV vaccine uptake among HCWs. Targeted interventions are necessary for effective vaccination coverage in healthcare settings.

The relationship between fear of COVID-19 and adherence to personal protective measures in a sample of Iranian healthcare providers: a cross-sectional study

BACKGROUND

Studies have been conducted worldwide to investigate the level of adherence to personal protective measures or fear of COVID-19 among healthcare providers. However, few studies have examined the relationship between adherence to personal protective measures and fear of COVID-19. There is also a need for more information on this topic from Iran. This study investigated the relationship between adherence to personal protective measures against COVID-19 and fear of COVID-19 in the healthcare providers at Pastor Hospital of Bam, Iran, in 2022.

METHODS

This cross-sectional study was conducted in August and September 2022 with 199 healthcare providers of Pastor Hospital of Bam, Iran. The study included medical, nursing, and paramedical staff at Pastor Hospital at the time of the study. Incomplete responses and failure to return the questionnaire to the researcher were exclusion criteria. The fear of COVID-19 scale and a checklist of personal protective measures were used to collect data. Descriptive statistics, t-tests, analysis of variance, and Pearson's correlation coefficient were used to analyze the data.

RESULTS

Of the 199 participants, 67.3% were female, and their mean age was 31 ± 4.55 years. The mean score for adherence to personal protective measures was 14.46 ± 3.39 (out of 23), and the mean score for fear of COVID-19 was 17.04 ± 4.58 (out of 35). Adherence to personal protective measures was higher among females than males (14.96 ± 2.99 vs. 13.43 ± 3.92, p = 0.003), in individuals who had attended infection control courses than in those who had not (15.57 ± 2.88 vs. 13.30 ± 3.50, p < 0.001), and in those working in intensive care units than those in other wards (p = 0.009). A positive correlation was found between fear of COVID-19 and adherence to personal protective measures (r = 0.16, p = 0.03).

CONCLUSIONS

Healthcare providers demonstrated average levels of adherence to the personal protective measures and fear of COVID-19. Fear scores were also positively correlated with adherence scores. Specific workshops are necessary to familiarize all healthcare workers with personal protective measures against COVID-19 and universal precautions.

Compliance of healthcare workers in a psychiatric inpatient ward to infection control practices during the COVID-19 pandemic: a participant observation study supplemented with a self-reported survey

BACKGROUND

As an emerging infectious disease with a heterogenous and uncertain transmission pattern, coronavirus disease 2019 (COVID-19) has created a catastrophe in healthcare-associated infections (HAIs) and posed a significant challenge to infection control practices (ICPs) in healthcare settings. While the unique characteristics of psychiatric patients and clinical settings may make the implementation of ICPs difficult, evidence is lacking for compliance with ICPs among healthcare workers (HCWs) in a psychiatric setting during the COVID-19 pandemic.

METHODS

A cross-sectional multi-method study based on participant unobtrusive observation coupled with the completion of a self-administered ICP survey was conducted to assess compliance with ICPs among HCWs in a psychiatric inpatient ward in a regional hospital. An online checklist, called eRub, was used to record the performance of HCWs in hand hygiene (HH) and other essential ICPs. Furthermore, a well-validated questionnaire (i.e., Compliance with Standard Precautions Scale, CSPS) was used to collect the participants' self-reported ICP compliance for later comparison.

RESULTS

A total of 2,670 ICP opportunities were observed from January to April 2020. The overall compliance rate was 42.6%. HCWs exhibited satisfactory compliance to the wearing of mask (91.2%) and the handling of clinical waste (87.5%); suboptimal compliance to the handling of sharp objects (67.7%) and linen (72.7%); and poor compliance to HH (3.3%), use of gloves (40.9%), use of personal protective equipment (20%), and disinfection of used surface/area (0.4%). The compliance rates of the nurses and support staff to HH were significantly different (χ2 = 123.25, p < 0.001). In the self-reported survey, the overall compliance rate for ICPs was 64.6%.

CONCLUSION

The compliance of HCWs in a psychiatric inpatient ward to ICPs during the COVID-19 pandemic ranged from poor to suboptimal. This result was alarming. Revisions of current ICP guidelines and policies that specifically target barriers in psychiatric settings will be necessary.

RETRACTED: Safety climate, quality of care, adherence to and compliance with standard precautions among nurses: Structural equation modeling

AIMS

The aim was to investigate the interrelationships of nurses' safety climate, quality of care, and adherence to and compliance with standard precautions (SPs).

BACKGROUND

Investigations about nurses' safety climate and quality care and their association with adherence to and compliance with SPs remain remarkably scant across literature, specifically among developing countries like the Philippines.

DESIGN

Cross-sectional design and structural equation modeling (SEM) approach while complying with STROBE guidelines.

METHODS

Participant nurses were recruited using convenience sampling (n = 870). Four validated self-report instruments were used to collect data from February to August 2022. Spearman rho, SEM, mediation, and path analyses were employed for data analysis.

RESULTS

The emerging model showed acceptable model fit parameters. The safety climate positively influenced the quality of care and adherence to and compliance with SPs. Quality of care directly affected adherence to SPs, while adherence to SPs directly affected compliance with SPs. The quality of care mediated the relationship between safety climate and adherence to SPs. Whereas adherence to SPs mediated the relationships between safety climate and compliance with SPs and the quality of care and compliance with SPs.

CONCLUSIONS

Nurses' safety climate directly affected the quality of care and SPs adherence and compliance. The quality of care mediated the impact of safety climate on SPs adherence. Finally, SPs adherence demonstrated a mediating effect among quality of care, safety climate, and SPs compliance.

IMPLICATIONS FOR NURSING POLICY AND PRACTICE

Nursing policymakers and administrators can use the findings to design strategic policies and sustainable in-service educational courses fostering and maintaining nurses' safety climate, quality of care, and SPs adherence and compliance.

Nurses' safety climate, quality of care, and standard precautions adherence and compliance: A cross-sectional study

INTRODUCTION

Investigations about the interrelationships of nurses' safety climate, quality of care, and standard precautions (SP) adherence and compliance remain particularly scarce in the literature. Thus, we tested a model of the associations between nurses' safety climate, quality of care, and the factors influencing adherence and compliance with SPs utilizing the structural equation modeling (SEM) approach.

DESIGN

Cross-sectional design complying with STROBE guidelines.

METHODS

Using convenience sampling, nurses (n = 730) from the Philippines were recruited. Data were collected between April and September 2022 using four validated self-report measures. Spearman Rho, mediation and path analyses, and SEM were employed for data analysis.

RESULTS

Acceptable model fit indices were shown by the emerging model. The safety climate is positively associated with quality of care and factors influencing adherence to and compliance with SPs. Quality of care directly affected factors influencing adherence to SPs. The factors influencing adherence to SPs directly affected SP compliance. Quality of care mediated between safety climate and the factors influencing adherence to SPs. Factors influencing adherence to SPs mediated between safety climate, quality of care, and SP compliance.

CONCLUSIONS

The study's variables are not distinct but overlapping nursing concepts that must be examined collectively. Nurse administrators can utilize the emerging model to formulate strategies and regulations for evaluating and enhancing nurses' safety climate, quality of care, and SP adherence and compliance.

CLINICAL RELEVANCE

Our findings may impact policymaking, organizational, and individual levels to improve nurses' clinical practice.

PATIENT OR PUBLIC CONTRIBUTION

This study had no patient contribution or public funding.

Health and safety of health workers in the Suame Municipality of Ghana - Lessons learnt from the COVID-19 outbreak in infection prevention and control for future pandemics

Objectives

Effective adherence to infection prevention and control practices is needed to reduce the rate of healthcare-acquired infections among healthcare workers. Policies to control healthcare-acquired infections among healthcare workers can be designed and implemented using information on adherence to infection prevention and control practices adherence and its determinants. This study, therefore, sought to assess the adherence to infection prevention and control practices among healthcare workers during the 2019 Coronavirus disease pandemic.

Methods

A multicentre cross-sectional study was conducted among 323 randomly selected healthcare workers in four health facilities in the Suame Municipality, Ghana. Data on participants' socio-demographics, knowledge of infection prevention and control practices and adherence to infection prevention and control practices were collected using a pre-tested structured questionnaire. Multivariate logistic regression analysis was used to examine the effect of demographic characteristics and knowledge of infection prevention and control on adherence to infection prevention and control practices among study participants.

Results

Over three-quarters (75.9%) of the study participants had adequate knowledge of infection prevention and control practices with a significant knowledge gap in the colour coding of bin liners for waste segregation (35.6%). The proportion of study participants who reported good adherence to infection prevention and control practices was 86.7%. Healthcare workers who were 33 years and above (Adjusted odds ratio (AOR): 0.27; 95% Confidence interval (CI): 0.08-0.92) and absence of an infection prevention and control committee at the facility AOR: 0.25; 95% CI: 0.08-0.73) had reduced odds of good adherence to infection prevention and control practices. Nursing staff (AOR: 9.49, 95% CI: 2.51-35.87) and having adequate knowledge of infection prevention and control practices (AOR: 2.66; 95% CI: 1.19-5.97) were associated with increased odds of good adherence to infection prevention and control practices.

Conclusion

Adherence to infection prevention and control practices was high among this sample of Ghanaian healthcare workers. Interventions and strategies to improve adherence should include the setting up of infection prevention and control committees, education and strict observance of colour coding of bin liners for waste segregation and intensification of training of healthcare workers in infection prevention and control practices.

Importance of Hospital Infection Control

The increasing demand for healthcare-acquired infection (HAI) control practices and services has intensified the need to evaluate care quality. The World Health Organization (WHO) introduced an infection prevention and control (IPC) framework to mitigate the impact of HAIs, crucial for ensuring patient safety in hospitals. HAIs acquired after hospitalization pose significant challenges due to factors such as compromised immunity, invasive medical procedures, and antibiotic-resistant pathogens, which have dire consequences, including higher mortality rates and increased healthcare costs. Healthcare workers (HCWs) are critical in implementing IPC measures. Infection control programs that include strategies such as hand hygiene, personal protective equipment (PPE), environmental cleaning, and surveillance have become standard. However, challenges such as resistance to change, resource limitations, patient turnover, and variability in patient conditions persist. Strategies to maintain hospital infection control involve rigorous compliance monitoring, staff education, advanced technologies such as artificial intelligence (AI), machine learning (ML), telemedicine, and innovative sanitation methods. The future of hospital infection control may involve increased integration of environmental monitoring, antimicrobial stewardship, and patient participation while leveraging collaboration among healthcare facilities. The review highlights the criticality of hospital infection control and suggests trends and opportunities to strengthen prevention efforts and patient safety.

Evaluation of the impact of COVID-19 pandemic on hospital-acquired infections in a tertiary hospital in Malaysia

BACKGROUND

Infection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan Ahmed Shah Hospital.

METHOD

This is a retrospective cohort study that compared the rate of HAIs from April to October 2019 (pre COVID period) and April to October 2020 (during COVID period). Data was collected through the review of patients' electronic medical records.

RESULTS

There were a total of 578 patients included in the selected wards during the pre- and during the pandemic. Thirty-nine episodes (12.1%) of HAIs were report in the pre COVID period and 29 (11.3%) during COVID-19. In both periods, hospital-acquired pneumonia (HAP) was the most frequent HAI among the patients. There was a rise in catheter-associated bloodstream infections (CLABSI) (0.8%) and ventilator associated pneumonia (VAP) (1.1%) during the COVID-19 period. The most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA) (28.2%) and Enterococcus faecalis (17.9%) in the Pre COVID-19 period, and Pseudomonas aeruginosa (27.6%) and Stenotrophomonas maltophilia (6.9%) during COVID-19.

CONCLUSION

Our research concluded that the rates of HAIs during the COVID-19 pandemic were not significantly impacted by the improved in-hospital infection prevention efforts to control the pandemic. There is need for further efforts to promote adherence to preventive practices.

Psychosocial determinants associated with healthcare workers' self-reported compliance with infection prevention and control during the COVID-19 pandemic: a cross-sectional study in Dutch residential care facilities for people with intellectual and developmental disabilities

BACKGROUND

Healthcare workers' (HCWs) compliance with infection prevention and control (IPC) is crucial to reduce the infection transmission risk. However, HCWs' compliance with IPC in residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDDs) is known to be suboptimal. Therefore, this study examined sociodemographic and psychosocial determinants associated with IPC non-compliance in this setting, to inform IPC policy and promotion programmes for adequate IPC behaviour.

METHODS

An online questionnaire was administered to 285 HCWs from 16 RCFs between March 2021 and March 2022. Determinants associated with IPC non-compliance were assessed using logistic regression analyses.

RESULTS

Being a woman (OR: 3.57; 1.73-7.37), and being a non-medical professional were associated with increased odds of non-compliance (social workers, OR: 2.83; 1.65-4.85; behavioural specialists, OR: 6.09; 1.98-18.72). Perceived inadequate education/training (aOR: 1.62; 1.15-2.27) and perceived time constraints/competing priorities (aOR: 1.43; 1.03-1.98) were also associated with increased odds of non-compliance, independent of sociodemographic variables. In contrast, the belief that the supervisor complies with IPC (descriptive norm supervisor) was associated with decreased odds of non-compliance (aOR: 0.60; 0.41-0.88).

CONCLUSIONS

To improve IPC in disability care settings, the implementation of tailored and structural IPC education and training programmes (e.g., on-the-job training) is recommended to increase HCWs' capabilities and bridge the IPC compliance gap between medical and non-medical professionals. In addition, role models, particularly supervisors, are crucial for promoting IPC behaviour. Facilities should create a culture of IPC compliance by norm setting, acting on, and modelling IPC behaviours at all levels of the organisation (management, medical, and non-medical staff).

Self-reported compliance with infection prevention and control of healthcare workers in Dutch residential care facilities for people with intellectual and developmental disabilities during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Compliance of healthcare workers (HCWs) with infection prevention and control (IPC) is crucial to resident safety. Nevertheless, HCWs' compliance with IPC has not been previously studied in a disability care setting.

OBJECTIVE

To assess levels of self-reported compliance with IPC among HCWs in residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDDs), and to assess whether IPC compliance varies among different professional groups.

METHODS

A total of 285 HCWs from 16 Dutch RCFs completed an online questionnaire assessing 16 IPC procedures, following national guidelines. Data were analysed using descriptive statistics and chi-square tests to assess potential differences in compliance between professional groups.

RESULTS

Overall, HCWs complied on average with 68.7% of IPC. Only 30.1% of HCWs had sufficient compliance (defined as compliance with ≥80% of IPC practices). Compliance varied considerably between individual IPC procedures, in which compliance with wearing short-sleeved clothes (30.9%) and using disposable protective clothing (32.7%) were the lowest. Compliance with jewellery and hair regulations was suboptimal (45.6% and 55.4%, respectively). Non-medical professionals complied with IPC less frequently (social workers, 24.2%; behavioural specialists, 12.9%) than medical professionals (47.4%) (p < 0.001).

CONCLUSIONS

The majority of HCWs had suboptimal compliance with IPC. As IPC compliance differs between professionals, recommendations are to 1) implement tailored education and training programmes, and 2) pursue a facility-wide minimum required IPC compliance. Implementing and communicating a minimum set of IPC procedures - including hand hygiene, personal hygiene, and clothing requirements - applying to all professionals is important to minimise the infection transmission risk in RCFs for people with IDDs.

Infection prevention and control for COVID-19 response in the Rohingya refugee camps in Bangladesh: an intra-action review

BACKGROUND

Infection Prevention and Control (IPC) is critical in controlling the COVID-19 pandemic and is one of the pillars of the WHO COVID-19 Strategic Preparedness and Response Plan 2020. We conducted an Intra-Action Review (IAR) of IPC response efforts to the COVID-19 pandemic in Cox's Bazar, Bangladesh, to identify best practices, challenges, and recommendations for improvement of the current and future responses.

METHODS

We conducted two meetings with 54 participants purposively selected from different organizations and agencies involved in the frontline implementation of IPC in Cox's Bazar district, Bangladesh. We used the IPC trigger questions from the WHO country COVID-19 IAR: trigger question database to guide the discussions. Meeting notes and transcripts were then analyzed manually using content analysis, and results were presented in text and quotes.

RESULTS

Best practices included: assessments, a response plan, a working group, trainings, early case identification and isolation, hand hygiene in Health Facilities (HFs), monitoring and feedback, general masking in HFs, supportive supervision, design, infrastructure and environmental controls in Severe Acute Respiratory Infection Isolation and Treatment Centers (SARI ITCs) and HFs and waste management. Challenges included: frequent breakdown of incinerators, limited PPE supply, inconsistent adherence to IPC, lack of availability of uniforms for health workers, in particular cultural and gender appropriate uniforms and Personal Protective Equipment (PPE). Recommendations from the IAR were: (1) to promote the institutionalization of IPC, programs in HFs (2) establishment of IPC monitoring mechanisms in all HCFs, (3) strengthening IPC education and training in health care facilities, and (4) strengthen public health and social measures in communities.

CONCLUSION

Establishing IPC programmes that include monitoring and continuous training are critical in promoting consistent and adaptive IPC practices. Response to a pandemic crisis combined with concurrent emergencies, such as protracted displacement of populations with many diverse actors, can only be successful with highly coordinated planning, leadership, resource mobilization, and close supervision.

Evaluation of the Effectiveness and Perceived Benefits of Interventional Structured Infection Prevention and Control Training Module Introduced in the Undergraduate Medical Curricula

INTRODUCTION

Assessing and improving infection prevention and control (IPC) knowledge and practicing skills among medical students who are the future medical practitioners is crucial for reducing the burden of healthcare-associated infections (HAIs). In this study, we assessed the IPC knowledge of undergraduate clinical-year medical students before and after interventional IPC modular training and evaluated the effectiveness and students' perception on structured modular IPC training presented to them.

METHODS

This cross-sectional interventional study was conducted on single medical cohort comprising of 145 final-year undergraduate medical students of the academic year 2022-23 at COMHS. Pre-test, post-test, and feedback questionnaire were used as the assessing tools. The data were collected, entered into Excel sheet, and analyzed using SPSS software version 22. McNemar and Paired-T tests were carried out, and a p value<0.05 was considered significant. Feedback of the questionnaire was analyzed using 3 Point Likert Scale as agree, neutral, and disagree.

RESULTS

Overall, mean IPC knowledge scores after training (37.65±1.37) was significantly higher as compared to before training (25.13±4.51). Prior knowledge scores on certain aspects of IPC such as duration of hand washing, steps of hand washing, sequence of donning and doffing of PPE, use of N95 mask, and appropriate sharp and needle precautions, and biomedical waste management were varied from 13.6% to 65.6%. However, overall participants' knowledge (p value <0.001) on these aspects increased significantly after the training. The majority of the participants (>90%) perceived IPC training as an excellent tool to improve IPC knowledge and practicing skills.

CONCLUSION

IPC training had a significant impact in gaining adequate IPC knowledge and practicing skills among our participants. Therefore, it is recommended that IPC training should be implemented in the undergraduate medical curriculum with greater emphasis on practicing skills.

Nursing staff compliance and adherence to standard precautions during the COVID-19 pandemic: A cross-sectional study

This study investigated the compliance and adherence of nursing staff (nurses, nursing assistants, and midwives) to standard precautions (SPs). A cross-sectional design while adhering to STROBE guidelines was used for this study. Nursing staff from a government tertiary hospital (n = 515) were recruited and completed the Compliance with Standard Precautions Scale (CSPS) and Factors Influencing Adherence to Standard Precautions Scale (FIASPS). Analysis of variance, Pearson's correlation, and linear regression analysis were used to analyze the data. The overall average compliance with the SPs of the nursing staff was suboptimal, and the disposal of sharps domain had the lowest compliance. Nurses were more compliant with sharps disposal, and nursing assistants with waste disposal. Contextual cues were the most influential factor influencing participants' adherence to SPs. All CSPS domains were significantly correlated with the Contextual cues factor of the FIASPS. Finally, service years and educational attainment were significant predictors of SPs adherence. The findings underscore the organization's critical responsibility for actively enforcing policies using monitoring systems and contextual cues in the workplace to ensure staff compliance and adherence with SPs.

Concerns, perceived impact, practices, preventive measures, and stress among healthcare workers during COVID-19 pandemic in Malaysia

Introduction

Healthcare workers (HCWs) have been continually exposed to patients with COVID-19 and are at higher risk of contracting the disease. Their psychological health is important for overall wellbeing and productivity, which could lead to a reduction in human errors during the pandemic crisis. This study aimed to measure the level of concerns, work practices, adequacy of preventive measures among HCWs, and the impacts on their life and work, including mental health status during the second wave of the COVID-19 pandemic in Malaysia.

Methods

An online questionnaire was distributed randomly to 1,050 HCWs from the Ministry of Health facilities in the Klang Valley who were involved directly in managing or screening COVID-19 cases from May to August 2020. The questionnaire was divided into five domains, which were concerns, impact on life and work, practice, perceived adequacy of preventive measures, and Revised Impact of Event Scale (IES-R). Logistic regression was used to identify sociodemographic predictors of the five domains.

Results

A total of 907 respondents (86.4%) participated in this survey. Approximately half of the respondents had a low concern (50.5%), most of them had a good practice (85.1%), with 67.5% perceiving there were adequate preventive measures, and they perceived the outbreak had a low impact (92%) on their life and work. From the IES-R domain, 18.6% of respondents potentially suffered from post-traumatic stress disorder (PTSD).

Conclusion

During the second wave of the COVID-19 outbreak in Malaysia, HCWs practiced high levels of precautions and preventive measures because they were aware of the risk of infection as an occupational hazard. With the adequate implementation of policy and control measures, the psychological wellbeing of the majority HCWs remained well and adequately supported.

Exploring factors influencing the compliance of patients and family carers with infection prevention and control recommendations across Bangladesh, Indonesia, and South Korea

Background

Poor compliance with infection prevention and control (IPC) measures has been a longstanding issue globally. To date, healthcare workers (HCWs) have been the primary target for policy and strategy revisions. Recent studies exploring the contributing factors to the spread of COVID-19 across countries in Asia have suggested that the scope of focus should be extended to family carers who provide patient care activities. This study aimed to explore factors affecting patients' and their family carers' IPC compliance in hospitals in Bangladesh, Indonesia, and South Korea.

Method

A qualitative study incorporating 57 semi-structured interviews was conducted in five tertiary-level hospitals across the three focus countries between July 2019 and February 2020. Interviews were undertaken with: (1) patients, family carers and private carers; and (2) healthcare workers, including nurses, doctors, and hospital managers. Drawing upon the principles of grounded theory, data were inductively analyzed using thematic analysis.

Results

A total of three main themes and eight subthemes are identified. Key themes focused on the assumptions made by healthcare workers regarding the family/private carers' level of understanding about IPC and training received; uncertainty and miscommunication regarding the roles of family/private carers; variations in carer knowledge toward IPC and healthcare-associated infections, and the impact of cultural values and social norms.

Conclusion

This exploratory study offers novel findings regarding the factors influencing IPC compliance among patients and their family/private carers across various cultural settings, irrespective of resource availability. The role of cultural values and social norms and their impact on IPC compliance must be acknowledged when updating or revising IPC policies and guidelines.