Effectiveness of inspectors' team in increasing compliance with personal protective equipment use and reducing COVID19 infection spread among healthcare workers

Effectiveness of inspector mechanism for the emergency infection prevention and control in the SARS-CoV-2 epidemic period: a self-control real-word study

BACKGROUND

To ensure emergency infection prevention and control (IPC) can be fully supervised and monitored in coronavirus disease (COVID-19) epidemic period, a three-level inspector mechanism called "Internal self-check, Departmental cross-check, and Verification of outstanding key and difficult issues" was established in southwest China. The present study aimed to explore the effectiveness of inspector mechanism for the emergency IPC.

METHODS

A self-control real-world study was conducted during COVID-19 epidemic period from 2020 to 2022. An innovative designed mobile phone application was used to realize paperless information transmission and data management. Data were compared between inspection levels using SPSS 19.0 software.

RESULTS

A total of 2,800,132 supervision records were collected, including 149,137 comprehensive epidemic IPC projects, 1,410,093 personal protective equipment (PPE) use, 1,223,595 wearing and removing process of PPE and 17,307 ultraviolet light-detectable fluorescent (UV/F) surface marker. During the study period, the inspectors and subjects explored many optimized IPC measures. The compliance rate of check items has exceeded 98%, and internal self-check has a statistically significant higher rate than departmental cross-check (99.95% versus 98.74%, χ2 = 26111.479, P < 0.001). Compare with the failure rate in internal self check, the failure rate of PPE usage and wearing/removing process was statistically higher in departmental cross-check (χ2 = 1957.987, P < 0.001, χ2 = 465.610, P < 0.001, respectively). The overall clearance rate of UV/F surface markers is 87.88%, but there is no statistically significant difference over the three years of the present study (F = 2.902, P = 0.071).

CONCLUSIONS

Inspector mechanism for the emergency IPC completed an incredible inspection workload and offered creative assistance to combat the COVID-19 outbreak. These methods and accumulated experiences should be helpful for us to strengthen IPC for future epidemic.

What is needed to sustain improvements in hospital practices post-COVID-19? a qualitative study of interprofessional dissonance in hospital infection prevention and control

Background

Hospital infection prevention and control (IPC) depends on consistent practice to achieve its purpose. Standard precautions are embedded in modern healthcare policies, but not uniformly observed by all clinicians. Well-documented differences in attitudes to IPC, between doctors and nurses, contribute to suboptimal IPC practices and persistence of preventable healthcare-associated infections. The COVID-19 pandemic has seriously affected healthcare professionals’ work-practices, lives and health and increased awareness and observance of IPC. Successful transition of health services to a ‘post-COVID-19’ future, will depend on sustainable integration of lessons learnt into routine practice.

Methods

The aim of this pre-COVID-19 qualitative study was to investigate factors influencing doctors’ IPC attitudes and practices, whether they differ from those of nurses and, if so, how this affects interprofessional relationships. We hypothesised that better understanding would guide new strategies to achieve more effective IPC. We interviewed 26 senior clinicians (16 doctors and 10 nurses) from a range of specialties, at a large Australian tertiary hospital. Interview transcripts were reviewed iteratively, and themes identified inductively, using reflexive thematic analysis.

Results

Participants from both professions painted clichéd portraits of ‘typical’ doctors and nurses and recounted unflattering anecdotes of their IPC behaviours. Doctors were described as self-directed and often unaware or disdainful of IPC rules; while nurses were portrayed as slavishly following rules, ostensibly to protect patients, irrespective of risk or evidence. Many participants believed that doctors object to being reminded of IPC requirements by nurses, despite many senior doctors having limited knowledge of correct IPC practice. Overall, participants’ comments suggested that the ‘doctor-nurse game’—described in the 1960s, to exemplify the complex power disparity between professions—is still in play, despite changes in both professions, in the interim.

Conclusions

The results suggest that interprofessional differences and inconsistencies constrain IPC practice improvement. IPC inconsistencies and failures can be catastrophic, but the common threat of COVID-19 has promoted focus and unity. Appropriate implementation of IPC policies should be context-specific and respect the needs and expertise of all stakeholders. We propose an ethical framework to guide interprofessional collaboration in establishing a path towards sustained improvements in IPC and bio-preparedness.