Examining the discourse regarding the delivery of occupational infection prevention and control training to healthcare workers: a scoping review of pandemic plans of 23 countries.

BACKGROUND: Over the years, countries reformed their pandemic plans but still healthcare systems were unprepared to handle the COVID-19 pandemic. Throughout the COVID-19 pandemic, healthcare workers (HCWs) raised issues around shortage of personal protective equipment (PPE), inadequate occupational infection prevention and control (IPC) training, lack of guidance regarding reuse/extended use of PPE and absence of HCWs. OBJECTIVE: The objective of this scoping review was to compare national and transnational pandemic plans and COVID-19 guidelines for the inclusion of recommendations regarding pandemic-specific occupational IPC training for HCWs, as well as strategies for managing the surge in PPE needs and staffing. INCLUSION CRITERIA: From each of the six WHO defined world regions, four countries with the highest burden of COVID-19 cases (as of mid-2020) were selected and attempted to locate the relevant pandemic plans and COVID-19 guidelines. METHODS: Searches were undertaken of 1: National Guidelines Clearinghouse, 2: websites of international public healthcare agencies such as WHO, the European Centre for Disease Prevention and Control (ECDC) and, 3: in-country health departments/Ministry of Health/Department of Public Health, between June 2020 and July 2021. The data were summarised under six themes drawn from publicly available pandemic plans and COVID-19 (IPC) guidelines of WHO, ECDC and 23 countries. RESULTS: The WHO, ECDC and 14 countries reported pandemic-specific IPC training; however, only four discussed training HCWs on correct PPE use; six countries listed strategies to manage the surge in demand of HCWs, while only five discussed managing the shortage of PPE. None of the COVID-19 guidelines recommended training HCWs for correct reuse or extended use of PPE and only one country's guideline outlined mandatory HCWs attendance and delivery of training in a regional language. CONCLUSION: Pandemic plans should be revised to include guiding principles regarding the delivery of pandemic specific IPC training. There is also a need to provide guidance on when countries should consider reuse and extended use of PPE. This discourse should also be reflected in disease-specific pandemic guidelines, like COVID-19 (IPC) guidelines. The aim of this review is to assist international health agencies in generating evidence-based guideline updates.

Current knowledge of COVID-19 and infection prevention and control strategies in healthcare settings: A global analysis

OBJECTIVE: In the current absence of a vaccine for COVID-19, public health responses aim to break the chain of infection by focusing on the mode of transmission. We reviewed the current evidence on the transmission dynamics and on pathogenic and clinical features of COVID-19 to critically identify any gaps in the current infection prevention and control (IPC) guidelines. METHODS: In this study, we reviewed global COVID-19 IPC guidelines by organizations such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC). Guidelines from 2 high-income countries (Australia and United Kingdom) and from 1 middle-income country (China) were also reviewed. We searched publications in English on 'PubMed' and Google Scholar. We extracted information related to COVID-19 transmission dynamics, clinical presentations, and exposures that may facilitate transmission. We then compared these findings with the recommended IPC measures. RESULTS: Nosocomial transmission of SARS-CoV-2 in healthcare settings occurs through droplets, aerosols, and the oral-fecal or fecal-droplet route. However, the IPC guidelines fail to cover all transmission modes, and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol-generating procedures. However, recommendations regarding the type of face mask varied, and the CDC recommends cloth masks when surgical masks are unavailable. CONCLUSION: IPC strategies should consider all the possible routes of transmission and should target all patient care activities involving risk of person-to-person transmission. This review may assist international health agencies in updating their guidelines.

Improving the impact of non-pharmaceutical interventions during COVID-19: examining the factors that influence engagement and the impact on individuals.

BACKGROUND: During an evolving outbreak or pandemic, non-pharmaceutical interventions (NPIs) including physical distancing, isolation, and mask use may flatten the peak in communities. However, these strategies rely on community understanding and motivation to engage to ensure appropriate compliance and impact. To support current activities for COVID-19, the objectives of this narrative review was to identify the key determinants impacting on engagement. METHODS: An integrative narrative literature review focused on NPIs. We aimed to identify published peer-reviewed articles that focused on the general community (excluding healthcare workers), NPIs (including school closure, quarantine, isolation, physical distancing and hygiene behaviours), and factors/characteristics (including social, physical, psychological, capacity, motivation, economic and demographic) that impact on engagement. RESULTS: The results revealed that there are a range of demographic, social and psychological factors underpinning engagement with quarantine, school closures, and personal protective behaviours. Aside from the factors impacting on acceptance and compliance, there are several key community concerns about their use that need to be addressed including the potential for economic consequences. CONCLUSION: It is important that we acknowledge that these strategies will have an impact on an individual and the community. By understanding the barriers, we can identify what strategies need to be adopted to motivate individuals and improve community compliance. Using a behavioural framework to plan interventions based on these key barriers, will also ensure countries implement appropriate and targeted responses.

Examining the current intelligence on COVID-19 and infection prevention and control strategies in health settings: A global analysis

OBJECTIVE: In the current absence of vaccine for COVID-19, public health response target breaking the chain of infection by focusing on the mode of transmission. This paper summarizes current evidence-base around the transmission dynamics, pathogenic, and clinical features of COVID-19, to critically identify if there are any gaps in the current IPC guidelines. METHODS: This study involved a review of global COVID-19 IPC guidelines such as WHO, the CDC, and European Centre for Disease Prevention and Control (ECDC). Guidelines from two high income countries (Australia and UK) and one middle income country (China) were also reviewed. We searched publications in English on 'Pubmed' and Google Scholars. We extracted information related to COVID-19 transmission dynamics, clinical presentations and exposures that may facilitate the transmission and compared and contrasted these findings with the recommended IPC measures. RESULTS: The review findings showed nosocomial transmission of SARS-CoV-2 in health settings through droplet, aerosol and by an oral-fecal or fecal-droplet route. However, the IPC guidelines fail to cover all transmission modes and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol generating procedures. However, recommendations around type of surgical masks varied. In addition, CDC recommends cloth masks when the surgical mask is totally unavailable. CONCLUSION: IPC strategies should consider all the possible routes of transmission and target all patient care activities where there may be person to person transmission risk. This review may assist international health agencies to update their guidelines.