ABSTRACT
Background and objectives: Malaysia first announced Movement Control Order (MCO) in March 2020 following escalation of COVID-19 outbreak and declaration of pandemic, leading to nationwide partial lockdown. Fear of virus spread and MCO directives were presumed to markedly affect trends in visits to the emergency department (ED). This study aims to observe the trend in ED utilization among hybrid hospitals in Malaysia following the MCO period. Methods: This retrospective, observational, cross-sectional study involved COVID-19 hybrid hospitals under Ministry of Health Malaysia. Hybrid hospitals are institutions that manage both confirmed and non-COVID-19 patients and were included in the study. Full COVID-19 and screening hospitals were excluded. Data were taken from January to October 2020 and compared with 2019 data of same months. Primary outcome is monthly trend of total ED utilization by adult and pediatric population, and secondary outcome observes the trend of ED attendance according to triage categories. Changes in attendance were calculated in percentage. Descriptive analysis was reported in median and interquartile range. Mann-Whitney U test was used to compare the difference between two medians in each month. Results: A total of 25 hospitals were included in the study. Total attendance to ED has dropped significantly nationwide from March 2020 onward after MCO was initiated. Reduction in total attendance between March and October 2020 ranges between 36.4% and 63.4% with significant difference compared to 2019. Higher percentage of reduction was seen in the pediatric population between 56.2% and 76.1% compared to the adult population which ranged between 32.5% and 60.9%. These differences were significant from April to October 2020 (p<0.05). Comparing the triage categories, no significant difference was seen in utilization of critical zone despite reduction in number of cases. Attendance to semi-critical zones showed significant differences in April to June 2020 with reduction of 47% (p<0.001), 33% (p=0.029), and 29.5% (p=0.021), respectively. Non-critical zone saw significant difference in its utilization from April to October 2020 compared to preceding year Conclusions: This study showed Malaysian perspective of COVID-19 effects on ED utilization during the first outbreak wave. Despite general reduction in total attendance, ED still receives substantial number of critical patients with high-acuity presentations.
ABSTRACT
Background and objectives: Healthcare workers (HCWs) in emergency departments (EDs) are at higher risk of COVID-19 infection due to the unknown status of patients presenting to ED. Strict adherence to personal protective equipment (PPE) is absolute. This study aimed to evaluate the knowledge of and compliance to use of PPE among ED personnel during COVID-19 outbreak. Methods: This is a cross-sectional, web-based questionnaire study conducted in two COVID-19 hospitals and two screening hospitals in Malaysia. A study questionnaire consisted of demographic characteristics, knowledge, and compliance to COVID-19, and PPE was developed and distributed among HCWs in ED. Participation in this study was voluntary and anonymous. Knowledge score, PPE selection, and proportion of compliane to PPE were analyzed using descriptive analysis. Categorical variables were reported as percentages, while continuous variables as mean with standard deviation (SD) or median with interquartile range (IQR). The association between knowledge score and demographic variables was tested using correlation tests, and regression analysis was performed to determine significant predictors for knowledge and compliance. Results: Of the total 233 respondents, 60.5% were females and 58.8% were doctors. In all, 68.2% had attended training, with 77.3% having attended training less than 6 h in total. In all, 48.9% of respondents were from COVID-19 hospitals and 51.1% from screening hospitals. Mean knowledge score was 14.6 of 19. Choice of PPE between COVID-19 and screening hospitals was comparable in respiratory and non-respiratory zone with variation seen in triage area. In total, 85% perceived training as adequate, but compliance to some PPE was observed only in 46.4%. HCWs in COVID-19 hospitals were 52% significantly less compliant to PPE than those in screening hospitals (odds ratio (OR), 0.48;95% confidence interval (CI), 0.26-0.90, p=0.023). Factors associated with compliance to some PPEs include age, designation, years in service, total hours of training, and type of hospitals. Conclusion: Rate of compliance to PPE in ED remains substandard despite being confident with PPE knowledge, donning and doffing technique, as well as adequacy of training received. Poor compliance to PPE is a major concern as it may adversely affect the frontline healthcare system. Further evaluation of underlying issues is worth exploring.