Factors influencing the protective behavior of individuals during COVID-19: a transnational survey

To slow the spread of infectious disease, it is crucial to understand the engagement of protective behavior among individuals. The purpose of this study was to systematically examine individuals' protective behaviors and the associated factors across countries during COVID-19. This causal-comparative study used a self-developed online survey to assess individuals' level of engagement with six protective behaviors. Analysis of variance and McNemar's test were employed for data analysis. Three hundred and eighty-four responses were analyzed. The majority of participants lived in three areas: Taiwan, Japan, and North America. Overall, the participants reported a high level of engagement in protective behaviors. However, engagement levels varied according to several demographic variables. Hand hygiene and cleaning/ventilation are two independent behaviors that differ from almost all other protective behaviors. There is a need to target the population at risk, which demonstrates low compliance. Different strategies are needed to promote specific protective behaviors.

Utilizing the SEIPS model to guide hand hygiene interventions at a tertiary hospital in Ethiopia

We aimed to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to increase effectiveness and sustainability of the World Health Organization's (WHOs) hand hygiene (HH) guidelines within healthcare systems. Our cross-sectional, mixed-methods study took place at Jimma University Medical Center (JUMC), a tertiary care hospital in Jimma, Ethiopia, between November 2018 and August 2020 and consisted of three phases: baseline assessment, intervention, and follow-up assessment. We conducted questionnaires addressing HH knowledge and attitudes, interviews to identify HH barriers and facilitators within the SEIPS framework, and observations at the WHO's 5 moments of HH amongst healthcare workers (HCWs) at JUMC. We then implemented HH interventions based on WHO guidelines and results from our baseline assessment. Follow-up HH observations were conducted months later during the Covid-19 pandemic. 250 HCWs completed questionnaires with an average knowledge score of 61.4% and attitude scores indicating agreement that HH promotes patient safety. Interview participants cited multiple barriers to HH including shortages and location of HH materials, inadequate training, minimal Infection Prevention Control team presence, and high workload. We found an overall baseline HH compliance rate of 9.4% and a follow-up compliance rate of 72.1%. Drastically higher follow-up compared to baseline compliance rates were likely impacted by our HH interventions and Covid-19. HCWs showed motivation for patient safety despite low HH knowledge. Utilizing the SEIPS model helped identify institution-specific barriers that informed targeted interventions beyond WHO guidelines aimed at increasing effectiveness and sustainability of HH efforts.

[Evolution of adherence to hand hygiene in health care professionals in a third level hospital in relation to the SARS-CoV-2 pandemic]

OBJECTIVE

Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital Universitario Insular de Gran Canaria with respect to previous years.

METHODS

Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated.

RESULTS

Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05).

CONCLUSIONS

In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.

Differences in risk perception, knowledge and protective behaviour regarding COVID-19 by education level among women and men in Germany. Results from the COVID-19 Snapshot Monitoring (COSMO) study

The main strategy for combatting SARS-CoV-2 infections in 2020 consisted of behavioural regulations including contact reduction, maintaining distance, hand hygiene, and mask wearing. COVID-19-related risk perception and knowledge may influence protective behaviour, and education could be an important determinant. The current study investigated differences by education level in risk perception, knowledge and protective behaviour regarding COVID-19 in Germany, exploring the development of the pandemic over time. The COVID-19 Snapshot Monitoring study is a repeated cross-sectional online survey conducted during the pandemic in Germany from 3 March 2020 (waves 1-28: 27,957 participants aged 18-74). Differences in risk perception, knowledge and protective behaviour according to education level (high versus low) were analysed using linear and logistic regression. Time trends were accounted for by interaction terms for education level and calendar week. Regarding protective behaviour, interaction terms were tested for all risk perception and knowledge variables with education level. The strongest associations with education level were evident for perceived and factual knowledge regarding COVID-19. Moreover, associations were found between low education level and higher perceived severity, and between low education level and lower perceived probability. Highly educated men were more worried about COVID-19 than those with low levels of education. No educational differences were observed for perceived susceptibility or fear. Higher compliance with hand washing was found in highly educated women, and higher compliance with maintaining distance was found in highly educated men. Regarding maintaining distance, the impact of perceived severity differed between education groups. In men, significant moderation effects of education level on the association between factual knowledge and all three protective behaviours were found. During the pandemic, risk perception and protective behaviour varied greatly over time. Overall, differences by education level were relatively small. For risk communication, reaching all population groups irrespective of education level is critical.

[Evolution of hand hygiene adherence of health professionals of specialized care.]

OBJECTIVE

Hand hygiene (HH) is essential for the prevention of health care-associated infections (HAIs). Compliance rates documented in Spain and internationally are low, although improvement is possible using some strategies and training. The aim of this study was to know the evolution of the adherence to the 5 moments for hand hygiene of the health professionals of the Hospital Universitario Fundación Alcorcón and to propose measures to implement it.

METHODS

A direct observation study about the compliance of the 5 moments for HH in this hospital for seven years was carried out. Different professional groups received training, using the traditional method and simulation learning. The data was summarized using percentages and absolute frequencies. They were analyzed using SPSS version 21 for Windows.

RESULTS

Adherence increased from 37% in 2011 to 57.8% in 2019. Compliance in the 5 moments was higher after patient contact than before it. Nurses were one of the groups with the highest compliance.

CONCLUSIONS

Even though they have improved, compliance rates need to be maintained and to increase especially in moments as crucial as before an aseptic procedure. Training and the implementation of strategies are key.

A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.

[How to increase the health staff adherence to the hands hygiene protocol?]

OBJECTIVE

Nosocomial infection is a frequent adverse event in health care. Hand hygiene (HH) reduces cross-transmission, but staff adherence is not always adequate. The objectives of this work were evaluating the effectiveness of the HH technique applied in the workplace and monitoring the adherence of the healthcare staff of a Hospital of Medium-Long Stay to the HH protocol.

METHODS

Two cross sectional studies were carried out (2010-2012), to determine the prevalence of colonization of the hands of the staff by pathogenic microorganisms, a cross-sectional study (2015), to evaluate their knowledge of the HH technique and two cross-sectional studies (2015-2016), to evaluate the compliance of the protocol in the healthcare practice. The WHO Self-Assessment Framework was applied annually. The hydroalcoholic solution consumption was monitored as a process indicator.

RESULTS

The prevalence of colonization of the staff hands went from 28.3% to 21.2%. Compliance with hand hygiene went from 39.5% to 72% and the results of the WHO Self-Assessment Framework went from an intermediate level with 287.5 points to an advanced level with 432.5 points. The consumption of hydroalcoholic solution went from 3.9 to 19.3 liters/1000 stays.

CONCLUSIONS

Staff adherence to the HH protocol has increased, having significantly improved the compliance with the recommendations, the hydroalcoholic solution consumption and the HH level assigned to the hospital. The most effective measures to improve the results have been the development of specific improvement plans, having been decisive, the involvement of managers and the use of direct observation as a regular method of work.

Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis

BACKGROUND

Multi-modal interventions are effective in increasing hand hygiene (HH) compliance among healthcare workers, but it is not known whether such interventions are cost-effective outside high-income countries.

AIM

To evaluate the cost-effectiveness of multi-modal hospital interventions to improve HH compliance in a middle-income country.

METHODS

Using a conservative approach, a model was developed to determine whether reductions in meticillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs) alone would make HH interventions cost-effective in intensive care units (ICUs). Transmission dynamic and decision analytic models were combined to determine the expected impact of HH interventions on MRSA-BSI incidence and evaluate their cost-effectiveness. A series of sensitivity analyses and hypothetical scenarios making different assumptions about transmissibility were explored to generalize the findings.

FINDINGS

Interventions increasing HH compliance from a 10% baseline to ≥20% are likely to be cost-effective solely through reduced MRSA-BSI. Increasing compliance from 10% to 40% was estimated to cost US$2515 per 10,000 bed-days with 3.8 quality-adjusted life-years (QALYs) gained in a paediatric ICU (PICU) and US$1743 per 10,000 bed-days with 3.7 QALYs gained in an adult ICU. If baseline compliance is not >20%, the intervention is always cost-effective even with only a 10% compliance improvement.

CONCLUSION

Effective multi-modal HH interventions are likely to be cost-effective due to preventing MRSA-BSI alone in ICU settings in middle-income countries where baseline compliance is typically low. Where compliance is higher, the cost-effectiveness of interventions to improve it further will depend on the impact on hospital-acquired infections other than MRSA-BSI.

Global hand hygiene improvement progress: two surveys using the WHO Hand Hygiene Self-Assessment Framework

The World Health Organization (WHO) conducted two global surveys in 2011 and 2015 using the Hand Hygiene Self-Assessment Framework. In 2011, 2119 health facilities from 69 countries participated, and in 2015, 807 health facilities from 91 countries participated. In total, 86 facilities submitted results for both surveys; their overall score increased significantly (P<0.001) from 335.1 [standard deviation (SD) 7.5] to 374.4 (SD 90.5). In terms of WHO regions, the scores for the Eastern Mediterranean, Europe and Western Pacific regions all improved significantly (P<0.01). This represents a snapshot of the current position of global hand hygiene improvement efforts, outlining facility progress and highlighting the value of such an assessment tool.

Sustainable hand hygiene efforts; a review of a successful campaign

AIM

The aim of this paper is to provide a review of the hand hygiene literature and to give an example of the use of this literature to create a multimodal sustainable hand hygiene program.

BACKGROUND

The literature describes six key ingredients to consider when designing a hand hygiene program. These ingredients include leadership engagement, environmental assessment, education, a tight feedback loop, communication and routine revitalization. Programs tend to be more successful when several of these ingredients are utilized.

PROGRAM IMPLEMENTATION

The multimodal program created and implemented at one academic medical center is described. This program is an example of using the six key ingredients found in the literature with an interesting marketing and revitalization strategy.

CONCLUSION

The literature offers strategies that have led to successful programs in the past. The multimodal use of these strategies was demonstrated in the creation of a successful hand hygiene program at one academic medical center.

[The simple measure of handwashing to prevent the risk from biological agents: what has changed since the theories of Semmelweis]

In this manuscript, we consider the importance of hand hygiene as the chief measure of prevention and protection in the occupational context. In particular, we remember the physician who lived in the middle of the 19th century, Ignazio Semmelweis, genius but not understood creator of the theory for infection control, based on hand hygiene. Subsequent studies have clearly demonstrated the validity of Semmelweis' research, through scientific publications and the establishment of international guidelines, such as by the World Health Organization (WHO). It is important to remember the initial work and then, sharpen this tool, resulting in the adoption of simple, but effective behavioural practices, that should be spread by several means and tools of information, education and communication, addressed at all involved, for the reduction of exposure to the occupational biological risk.