The pre-analytical process management status and influencing factors of laboratory test before prescribing antimicrobial in developing country.

INTRODUCTION: The results of laboratory testing are crucial basis for clinicians to prescribe antimicrobial. Laboratory testing is a highly complex process, and increasing evidence suggests that errors and obstacles in the pre-analytical process (PP) will affect reasonable antimicrobial use. However, PP was an easily neglected link in hospital infection management and the current situation of it and the influencing factors of management are not clear. METHODS: A cross-sectional survey was conducted in the department of clinical, specimen collection, transportation, and inspection in 109 secondary and tertiary hospitals in Central China. The rate of antimicrobial susceptibility test request (AST) and related indexes of above departments were calculated to describe the situation. Management characteristics (frequency of training etc.) were described as proportions and fractional probit regression analysis was used to determine the influencing factors. RESULTS: The average rate of non restricted-use antimicrobial was 63%, the restricted-use was 86%, the special-use was 95%. The zero obstacle rate of specimen collection was 27.3%, of specimen transportation was 19.4% and of inspection feedback was 61.7%. There was a difference between the secondary and tertiary hospitals on non restricted-use (X2 = 22.968, P < 0.001); restricted-use (X2 = 29.466, P < 0.001); special-use (X2 = 27.317, P < 0.001). Taking non restricted-use as an example, training (OR = 0.312, 95%CI: 0.148,0.429), low-frequency appraisal (OR = 0.153, 95%CI: 0.082,0.224), guidance (OR = 0.32, 95%CI: 0.237,0.403) and information technology (OR = 0.104, 95%CI: 0.009,0.199) were positive factors. CONCLUSIONS: There were substantial differences in the rate of AST request in clinical department between secondary and tertiary hospitals. The zero obstacle rate in collection, transportation and inspection department were still low. In most departments, training and performance appraisal were positive factors, guidance and information technology were positive supporting factors.

Doctors vs. Nurses: Understanding the Great Divide in Vaccine Hesitancy among Healthcare Workers.

Healthcare workers such as doctors and nurses are expected to be trustworthy and creditable sources of vaccine-related information. Their opinions toward the COVID-19 vaccines may influence the vaccine uptake among the general population. However, vaccine hesitancy is still an important issue even among the healthcare workers. Therefore, it is critical to understand their opinions to help reduce the level of vaccine hesitancy. There have been studies examining healthcare workers' viewpoints on COVID-19 vaccines using questionnaires. Reportedly, a considerably higher proportion of vaccine hesitancy is observed among nurses, compared to doctors. We intend to verify and study this phenomenon at a much larger scale and in fine grain using social media data, which has been effectively and efficiently leveraged by researchers to address real-world issues during the COVID-19 pandemic. More specifically, we use a keyword search to identify healthcare workers and further classify them into doctors and nurses from the profile descriptions of the corresponding Twitter users. Moreover, we apply a transformer-based language model to remove irrelevant tweets. Sentiment analysis and topic modeling are employed to analyze and compare the sentiment and thematic differences in the tweets posted by doctors and nurses. We find that doctors are overall more positive toward the COVID-19 vaccines. The focuses of doctors and nurses when they discuss vaccines in a negative way are in general different. Doctors are more concerned with the effectiveness of the vaccines over newer variants while nurses pay more attention to the potential side effects on children. Therefore, we suggest that more customized strategies should be deployed when communicating with different groups of healthcare workers.

Communication openness and nosocomial infection reporting: the mediating role of team cohesion.

BACKGROUND: The states of IPC (Infection Prevention and Control) is serious under the COVID-19 pandemic. Nosocomial infection reporting is of great significance to transparent management of IPC in regard to the COVID-19 pandemic. We aimed to explore the relationship between communication openness and nosocomial infection reporting, explore the mediating effect of team cohesion in the two, and provide evidence-based organizational perspective for improving IPC management in the hospitals. METHOD: A questionnaire was used to collect data on communication openness, team cohesion and nosocomial infection reporting in 3512 medical staff from 239 hospitals in Hubei, China. Structural Equation Model (SEM) was conducted to examine the hypothetical model. RESULT: Communication openness was positively related to nosocomial infection reporting (ß = 0.540, p < 0.001), and was positively related to team cohesion (ß = 0.887, p < 0.001). Team cohesion was positively related to nosocomial infection reporting (ß = 0.328, p < 0.001). The partial mediating effect of team cohesion was significant (ß = 0.291, SE = 0.055, 95% CI = [ 0.178,0.392 ]), making up 35.02% of total effect. CONCLUSION: Communication openness was not only positively related to nosocomial infection reporting. Team cohesion can be regarded as a mediator between communication openness and nosocomial infection reporting. It implies that strengthening communication openness and team cohesion is the strategy to promote IPC management from the new organizational perspective.

China's Fight Against COVID-19: What We Have Done and What We Should Do Next?

Background Chinese government conducted unprecedented massive public health prevention interventions at the national level, which have effectively contained the spread of Coronavirus Disease 2019 (COVID-19) infections. Specifically, the outbreak in Wuhan has been effectively controlled. Meanwhile, the Chinese efforts to contain the virus have been widely recognized. Even the World Health Organization has praised the efforts of the Chinese government and advised other countries to learn from China's experience in the fight against COVID-19. However, the measures that have been conducted by China to effectively prevent the spread of COVID 19 in the country have not been rigorously analyzed. Therefore, this study aimed to explore the characteristics of China's control and prevention strategies, and identify the elements that changed the epidemiological curve of rapidly rising new confirmed cases of COVID-19. Methods Public health intervention measures and their effects on the spread of COVID-19 in terms of daily newly confirmed and cumulative cases were collected between January 20, 2020, and March 5. Notices of the Joint Prevention and Control Mechanism for COVID-19 of the State Council on Implementing Measures in Hubei were collected. Information obtained by relevant important documents and announcements was collected from the official website of the Chinese government. Additionally, from other media platforms, news, articles, and reviews were used to explain the intervention measure. Thus, using these data, we performed a retrospective description of the intervention strategies at three stages. Results The Chinese government adopted non-pharmacological interventions measures (NPIs) timely and efficiently. On February 20, the declining epidemic trend in China indicated that the three strictest disease prevention and control strategies issued by the Hubei Government had contributed to a smooth decline in the spread of the epidemic. Conclusions The NPIs taken by China play a decisive role to control the spread of novel coronavirus outbreaks. Further research and action are needed to ensure a sufficiently sensitive surveillance system and strong response mechanism, including the establishment of a highly accessible laboratory network, maintenance of awareness of both primary healthcare providers and the public, and regular training and exercise of local Centers for Disease Control and Prevention and general practitioners in the community-level.

Clinicians' Intention to Submit Microbiological Pathogenic Test Before Antibiotics Use and Its Influencing Factors: New Evidence from the Perspective of Hospital Management.

Purpose: Antimicrobial resistance (AR) is a global public health problem, improving clinicians' intention to submit microbiological pathogenic test (submission intention) can effectively increase the value for rational use antibiotics to curb AR. However, there are few studies on the factors influencing improvement of the submission intention, especially from the perspective of hospital management. This study will fill the gap and provide evidence that can continuously support improvement of antibiotics prescribing rationally. Patients and Methods: A cross-sectional survey of clinicians was conducted in all public hospitals in Hubei, China. Dependent variables were submission intention of non-restricted-use, restricted-use and special-use antibiotics which were measured submission, not sure submission, no submission. Independent variables were frequency of training and publicity on submission, and hospital with or without submission performance assessment, guideline, information decision system and laboratory items, including bacterial culture item, fungal culture item and so on. Clinicians' demographics were applied as control variables. Multinomial logistic regression was performed to model independent variables influencing submission intention. Results: For non-restricted-use antibiotics, guideline (OR = 0.263; 95% CI = [0.188, 0.369]) (OR = 0.526; 95% CI = [0.375, 0.738]) and bacterial culture item (OR = 0.141; 95% CI = [0.074, 0.268]) (OR = 0.520; 95% CI = [0.292, 0.927]) are key factors that positively affect clinicians' intention on submission and not sure submission; For restricted-use and special-use antibiotics, training frequency and bacterial culture item (OR = 0.155; 95% CI = [0.076, 0.315]) (OR = 0.092; 95% CI = [0.036, 0.232]) (OR = 0.106; 95% CI = [0.046, 0.248]) (OR = 0.027; 95% CI = [0.006, 0.117]) are key factors that positively affect clinicians' intention on submission and not sure submission. Conclusion: This study found that bacterial culture item, guideline, and training frequency are key factors that affect clinicians' intention on submission and not sure submission, but various factors exist different effects level on different types of antibiotics. Consequently, a focus should be placed on the construction and implementation of management factors, as well as reformation of antimicrobial stewardship in hospitals according to the types of antibiotics.

COVID-19 Containment: Comparisons and Suggestions for Global Response.

BACKGROUND: The 2019-nCoV (COVID-19) is spreading at an alarming rate worldwide. Therefore, it is currently one of the biggest global health challenges. This research review describes the differences in response to the coronavirus epidemic between countries across the world. In addition, an opinion that the experience of China in response against the epidemic would play an important role globally in the battle against the novel coronavirus has been discussed as well as the insufficient and delayed response by other countries. OBJECTIVES: To provide an overview of China's experience in the control and prevention of the COVID-19, and compare it to that of other countries. METHODS: Relevant literature for this review was obtained from the Chinese government website; the World Health Organization website; Johns Hopkins University website; the European Centre for Disease Prevention website; and the PubMed databases. In addition, related news channels were used to obtain information. RESULTS: China's experience in the fight against COVID-19 provides valuable insight into the handling of this epidemic, and suggests that promoting cooperation between countries is imperative for effective control and prevention measures against this global virus pandemic. CONCLUSIONS: China's experience suggests that the following measures were effective in the fight against COVID-19: "social isolation," "medical observation," "social distancing" or "limited contact with people," "self-protection," and combined modern public health intervention measures. These findings could help control outbreaks in other countries and regions across the world.

Coping With Diagnostic Uncertainty in Antibiotic Prescribing: A Latent Class Study of Primary Care Physicians in Hubei China.

Background: Misuse of antibiotics is prevalent worldwide and primary care is a major contributor. Although a clear diagnosis is fundamental for rational antibiotic use, primary care physicians often struggle with diagnostic uncertainty. However, we know little about how physicians cope with this situation and its association with antibiotic prescribing. Methods: A total of 583 primary care physicians were surveyed using the Dealing with Uncertainty Questionnaire. Their prescriptions (n = 949,181) over the year 2018 were retrieved retrospectively. Two categories of behavioral patterns of participants were identified based on latent class analyses (high vs. low openness and collaborativeness) in responding to diagnostic uncertainty. Multi-level logistic regression models were established to determine the associations between these behavioral patterns and antibiotic prescribing (overall and broad-spectrum antibiotics) for illness without an indication for antibiotics and those with a conditional indication for antibiotics, respectively, after adjustment for variations of patient (level one) and physician (level two) characteristics. Results: Most physicians reported open communications with their patients (80.96%), collected further information (85.08%), and referred patients to specialists (68.95%) in dealing with diagnostic uncertainly. More than half (56.95%) sought help from colleagues. Less than 20% acted on intuition or adopted a "wait and see" strategy. About 40% participants (n = 238) were classified into the group of low openness and collaborativeness in coping with diagnostic uncertainty. They were more likely to prescribe antibiotics for the recorded illness without an indication for antibiotics (AOR = 1.013 for all antibiotics, p = 0.024; AOR = 1.047 for broad-spectrum antibiotics, p < 0.001), as well as for the recorded illness with a conditional indication for antibiotics (AOR = 1.226 for all antibiotic, p < 0.001; AOR = 1.257 for broad-spectrum antibiotics, p < 0.001). Conclusion: Low tolerance with diagnostic uncertainty is evident in primary care. Inappropriate and over antibiotic prescribing is shaped by physicians' coping methods of diagnostic uncertainty. Physicians' openness and collaborativeness in responding to diagnostic uncertainty is associated with lower antibiotic prescribing in primary care. Interventions targeting on better management of diagnostic uncertainty may offer a promising approach in reducing antibiotic use in primary care.

Influence of Adult Attachment on COVID-19 Vaccination Intention: The Mediating Roles of Help-Seeking Style and Professional Help-Seeking Behavior.

Vaccination against COVID-19 is regarded as one of the most promising interventions to control the pandemic. This study aimed to examine whether adult attachment affects an individual's COVID-19 vaccination intention and whether this relationship is mediated by help-seeking style and professional help-seeking behavior. A total of 401 Chinese adults participated in this online cross-sectional survey. The questionnaires for adult attachment (Depend, Close, and Anxiety), help-seeking style (dependency, autonomy, and avoidance), professional help-seeking behavior, and COVID-19 vaccination intention were rated on five-point or seven-point Likert scales, with satisfactory reliability (Cronbach's α values were all >0.80). Structural equation modelling was used to construct path models based on the above elements. Higher scores in the Depend (Effect = 0.047, SE = 0.018, 95% CI = [0.019, 0.093]) and Close dimensions of attachment (Effect = 0.028, SE = 0.014, 95% CI = [0.007, 0.065]) predicted a stronger dependency-oriented help-seeking style, which thus predicted greater vaccination intention. Higher scores in the Close dimension (Effect = 0.007, SE = 0.004, 95% CI = [0.001, 0.018]) and lower scores in the Anxiety dimension of attachment (Effect = -0.003, SE = 0.002, 95% CI = [-0.008, -0.001]) predicted a stronger autonomy-oriented help-seeking style and further predicted more professional help-seeking behaviors, which promoted greater COVID-19 vaccination intention. The results of this study indicate that help-seeking moderates the relationship between adult attachment and COVID-19 vaccination intention. Guiding help-seeking behavior for individuals with different attachment styles may be an entry point for improving COVID-19 vaccination intention.

Influence of Parental Psychological Flexibility on Pediatric COVID-19 Vaccine Hesitancy: Mediating Role of Self-Efficacy and Coping Style.

Background: Pediatric COVID-19 vaccine hesitancy hinders the establishment of immune barrier in children. Psychological flexibility may be a key contributing factor to pediatric COVID-19 vaccine hesitancy, and self-efficacy and coping style play an important role in the relationship, but the underlying mechanisms remain unknown. Methods: A cross-sectional study was conducted on parents from June 2021 to July 2021. A total of 382 parents were recruited for an online-investigation. Serial mediation models were used to examine whether self-efficacy and coping style mediated in the psychological flexibility-pediatric COVID-19 vaccine hesitancy linkage. Result: Psychological flexibility was negatively related to pediatric COVID-19 vaccine hesitancy (r = -0.198, P < 0.001). Coping styles rather than self-efficacy played a mediating role independently (95% CI: -0.263 to -0.058). Serial mediation analyses indicated that self-efficacy and coping style co-play a serial mediating role in the association of psychological flexibility and pediatric COVID-19 vaccine hesitancy (95% CI: -0.037 to -0.001). Conclusion: The present study showed that high psychological flexibility, high self-efficacy, and positive coping style were conducive to the lower pediatric COVID-19 vaccine hesitancy.

Evaluation of environmental cleaning quality: an observational study at a tertiary hospital in Wuhan, China.

INTRODUCTION: The COVID-19 pandemic highlights the role of environmental cleaning in controlling infection transmission in hospitals. However, cleaning practice remains inadequate. An important component of effective cleaning is to obtain feedback on actual cleaning practice. This study aimed to evaluate the cleaning process quality from an implementation perspective. METHODOLOGY: An observational study was conducted in a tertiary public hospital in Wuhan, China and 92 cleaning processes of units housing patients with multidrug-resistant organism infections were recorded. The bed unit cleaning quality and floor cleaning quality were measured by six and five process indicators respectively. Descriptive statistics were used to describe the cleaning quality. RESULTS: For bed unit cleaning quality, the appropriate rates of cleaning sequence, adherence to cleaning unit principle, use of cloth, use of cloth bucket, separation of clean and contaminated tools, and disinfectant concentration were 35.9%, 71.7%, 89.7%, 11.5%, 65.4%, and 48.7%, respectively. For floor cleaning quality, the appropriate rates of adherence to cleaning unit principle, use of cloth, use of cloth bucket, separation of clean and contaminated tools, and disinfectant concentration were 13.4%, 50.0%, 35.5%, 11.0%, and 36.7%, respectively. CONCLUSIONS: The cleaning staff showed poor environmental cleaning quality, especially the floor cleaning quality. The findings can help reveal deficiencies in cleaning practices, raise awareness of these deficiencies, and inform targeted strategies to improve cleaning quality and hospital safety.

Healthcare workers' behaviors on infection prevention and control and their determinants during the COVID-19 pandemic: a cross-sectional study based on the theoretical domains framework in Wuhan, China.

BACKGROUND: Infection prevention and control (IPC) measures are crucial to combat the COVID-19 pandemic. This study aimed to explore the levels and determinants of HCWs' IPC behaviors based on the theoretical domains framework (TDF), which has been shown to be effective in guiding behavior change. METHODS: A cross-sectional survey was conducted in Wuhan, China in January 2020. Self-reported hand hygiene and droplet isolation behaviors (including the use of masks, gloves, goggles and gowns) were set as dependent variables. TDF domains and HCWs' characteristics were independent variables. Negative binomial regression analyses were performed to explore their relationships. RESULTS: HCWs reported good IPC behaviors, while the compliance with goggle and gown use was relatively low (below 85%). Environmental context and resources domain was significantly related to hand hygiene (ß = 0.018, p = 0.026), overall droplet isolation behaviors (ß = 0.056, p = 0.001), goggle (ß = 0.098, p = 0.001) and gown use (ß = 0.101. p < 0.001). Knowledge domain was significantly related to goggle (ß = 0.081, p = 0.005) and gown use (ß = 0.053, p = 0.013). Emotion domain was a predictor of overall droplet isolation behaviors (ß = 0.043, p = 0.016), goggle (ß = 0.074, p = 0.026) and gown use (ß = 0.106, p < 0.001). Social influences domain was a predictor of overall droplet isolation behaviors (ß = 0.031, p = 0.029) and gown use (ß = 0.039, p = 0.035). HCWs in high-risk departments had better behaviors of gown use (ß = 0.158, p = 0.032). HCWs who had encountered confirmed or suspected patients reported worse behaviors of goggle (ß = - 0.127, p = 0.050) and gown use (ß = - 0.153, p = 0.003). CONCLUSIONS: Adequate personal protective materials and human resources, education and training, as well as supervision and role model setting are necessary to improve IPC behaviors regarding the COVID-19 pandemic.

Rapid, Ultrasensitive, and Highly Specific Diagnosis of COVID-19 by CRISPR-Based Detection.

Coronavirus Disease 2019 (COVID-19), which is caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has rapidly spread leading to a global pandemic. Here, we combined multiple cross displacement amplification (MCDA) with CRISPR-Cas12a-based detection to develop a novel diagnostic test (MCCD) and applied for the diagnosis of COVID-19, called COVID-19 MCCD. The MCCD protocol conducts reverse transcription MCDA (RT-MCDA) reaction for RNA templates followed by CRISPR-Cas12a/CrRNA complex detection of predefined target sequences after which degradation of a single-strand DNA (ssDNA) molecule confirms detection of the target sequence. Two MCDA primer sets and two CrRNAs were designed targeting the opening reading frame 1a/b (ORF1ab) and nucleoprotein (N) of SARS-CoV-2. The optimal conditions include two RT-MCDA reactions at 63 °C for 35 min and a CRISPR-Cas12a/CrRNA detection reaction at 37 °C for 5 min. The COVID-19 MCCD assay can be visualized on a lateral flow biosensor (LFB) and completed within 1 h including RNA extraction (15 min), RT-MCDA reaction (35 min), CRISPR-Cas12a/CrRNA detection reaction (5 min), and reporting of result (within 2 min). The COVID-19 MCCD assay is very sensitive and detects the target gene with as low as seven copies per test and does not cross-react with non-SARS-CoV-2 templates. SARS-CoV-2 was detected in 37 of 37 COVID-19 patient samples, and nonpositive results were detected from 77 non-COVID-19 patients. Therefore, the COVID-19 MCCD assay is a useful tool for the reliable and quick diagnosis of SARS-CoV-2 infection.

Impact of burnout, secondary traumatic stress and compassion satisfaction on hand hygiene of healthcare workers during the COVID-19 pandemic.

AIM: To assess the prevalence of burnout, secondary traumatic stress, and compassion satisfaction and explore their impacts on self-reported hand hygiene among medical aid teams in the COVID-19 period in Wuhan, China. DESIGN: Cross-sectional study. METHOD: A total of 1,734 healthcare workers from 17 medical aid teams were surveyed. The survey included burnout, secondary traumatic stress and compassion satisfaction measured by the professional quality of life scale and self-reported hand hygiene. Data were collected between 5-7 March 2020. Multiple regression analyses were performed. RESULTS: Burnout and secondary trauma stress were at low and average levels, and compassion satisfaction was at average and high levels. Burnout was negatively associated with hand hygiene, while compassion satisfaction was positively associated. Hospital administrators should pay attention to burnout and compassion satisfaction to improve infection control behaviours. Management of healthcare workers in our study may be constructive in emerging infectious diseases.

Help-Seeking Behavior of Returning to Work in Healthcare Workers and its Influencing Factors During COVID-19 Subsiding.

OBJECTIVES: To explore the level and influencing factors of help-seeking behavior of returning to work in healthcare workers (HCWs). METHODS: A total of 861 HCWs were surveyed. A structured self-administered questionnaire was used to collect data. Multivariable logistic regression was performed to examine the influencing factors of help-seeking behavior. RESULTS: HCWs sought help with respect to COVID-19-diagnosized problem most. Help-seeking intention, problems encountered after return, test for return, work condition during COVID-19, relatives or friends diagnosed or suspected as COVID-19, and socio-demographic characteristics such as occupation, education, title, and marriage status are predictors of help-seeking behavior. CONCLUSIONS: Education and intervention should lay particular stress on HCWs featured rest at home before return, doctor, lower education and lower title to ensure the safety, accuracy, and quality of work after they return to work for a better occupational environment.

What influences the infection of COVID-19 in healthcare workers?

INTRODUCTION: The outbreak of COVID-19 has spread worldwide. The evidence about risk factors of healthcare workers who infected COVID-19 is limited. This study aims to describe characteristics and influencing factors of the COVID-19 infection in healthcare workers. METHODOLOGY: The study was performed among COVID-19 infected and uninfected healthcare workers in three hospitals in Wuhan. A total of 325 healthcare workers participated; among them 151 COVID-19-infected healthcare workers were included. Characteristics of infected healthcare workers, and influencing factors including exposure histories, the use of protective equipment in different risk conditions and areas, perceptions, emotions, satisfactions and educations were described and analyzed. RESULTS: Healthcare workers got infected clustered mostly in the physical examination center. When performing general operations on confirmed or suspected patients, the use of protective equipment including the effectiveness of masks (p < 0.001), gloves (p < 0.001); and the use of gloves (p < 0.001), suits (p < 0.001), gowns (p < 0.001), shoe covers (p < 0.001), and hats (p < 0.001) were protective factors. The use of protective equipment was a protective factor in most cases. Negative emotions and dissatisfaction to the hospital response were associated with the increased risk of infection. CONCLUSIONS: The use of protective equipment, emotions and satisfactions to hospital responses are key COVID-19-infected factors. The awareness, the supply and the use of protective equipment, the layout of departments and other environmental and management factors should be strictly equipped. In addition, hospitals should also pay attention to emotions and satisfaction of healthcare workers.

Air and surface contamination by SARS-CoV-2 virus in a tertiary hospital in Wuhan, China.

BACKGROUND: Few studies have explored air and surface contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare settings. METHODS: Air and surface samples were collected from the isolation wards and intensive care units designated for coronavirus disease 2019 (COVID-19) patients. Clinical data and the results of nasopharyngeal specimen and serum antibody testing were also collected for the patient sample. RESULTS: A total of 367 air and surface swab samples were collected from the patient care areas of 15 patients with mild COVID-19 and nine patients with severe/critical COVID-19. Only one air sample taken during the intubation procedure tested positive. High-touch surfaces were slightly more likely to be contaminated with SARS-CoV-2 RNA than low-touch surfaces. Contamination rates were slightly higher near severe/critical patients than near mild patients, although this difference was not statistically significant (p > 0.05). Surface contamination was still found near the patients with both positive IgG and IgM. CONCLUSIONS: Air and surface contamination with viral RNA was relatively low in these healthcare settings after the enhancement of infection prevention and control. Environmental contamination could still be found near seroconverted patients, suggesting the need to maintain constant vigilance in healthcare settings to reduce healthcare-associated infection during the COVID-19 pandemic.

Will healthcare workers improve infection prevention and control behaviors as COVID-19 risk emerges and increases, in China?

BACKGROUND: COVID-19 arise global attention since their first public reporting. Infection prevention and control (IPC) is critical to combat COVID-19, especially at the early stage of pandemic outbreak. This study aimed to measure level of healthcare workers' (HCW') self-reported IPC behaviors with the risk of COVID-19 emerges and increases. METHODS: A cross-sectional study was conducted in two tertiary hospitals. A structured self-administered questionnaire was delivered to HCWs in selected hospitals. The dependent variables were self-reported IPC behavior compliance; and independent variables were outbreak risk and three intent of infection risk (risk of contact with suspected patients, high-risk department, risk of affected area). Chi-square tests and multivariable negative binomial regression models were employed. RESULTS: A total of 1386 participants were surveyed. The risk of outbreak increased self-reported IPC behavior on each item (coefficient varied from 0.029 to 0.151). Considering different extent of risk, HCWs from high-risk department had better self-reported practice in most IPC behavior (coefficient ranged from 0.027 to 0.149). HCWs in risk-affected area had higher self-reported compliance in several IPC behavior (coefficient ranged from 0.028 to 0.113). However, HCWs contacting with suspected patients had lower self-reported compliance in several IPC behavior (coefficient varied from - 0.159 to - 0.087). CONCLUSIONS: With the risk of COVID-19 emerges, HCWs improve IPC behaviors comprehensively, which benefits for better combat COVID-19. With the risk (high-risk department and affected area) further increases, majority of IPC behaviors achieved improvement. Nevertheless, under the risk of contact with suspected patients, HCWs show worse IPC behaviors. Which may result from higher work load and insufficient supplies and resources among these HCWs. The preparedness system should be improved and medical assistance is urgently needed.

Compliance measurement and observed influencing factors of hand hygiene based on COVID-19 guidelines in China.

BACKGROUND: Higher requirement is put forward in the measurement of hand hygiene (HH) during a pandemic. This study aimed to describe HH compliance measurement and explore observed influencing factors with respect to coronavirus disease 2019 (COVID-19) guidelines in China. METHODS: Compliance was measured as the percentage of compliant opportunities based on criteria for 17 moments. The criteria for compliance included HH behavior, procedure, duration, hand drying method, and the overall that counts them all. The observed influencing factors included different departments and areas and protection motivation. Descriptive analysis and logistic regression were performed. RESULTS: The compliance of overall criteria, HH behavior, procedure, duration, and hand drying method were 79.44%, 96.71%, 95.74%, 88.93%, and 88.42%, respectively, which were significantly different from each other (P < .001). Meanwhile, the overall and hand drying method compliance in semi-contaminated areas (odds ratio [OR] = 1.829, P < .001; OR = 2.149, P = .001) and hygienic areas (OR = 1.689, P = .004; OR = 1.959, P = .015) were significantly higher than those in contaminated area. The compliance with HH behavior for the motivation of patient-protection (OR = 0.362, P < .001) was lower than that for the motivation of self-protection. CONCLUSIONS: HH compliance was firstly measured using different criteria for 17 moments according to COVID-19 guidelines in China. The measurement of HH compliance needs clearer definition and comprehensive practice. Contaminated areas and motivation of patient-protection contribute to lower compliance, which may be addressed by allocating more human resources and increasing supervision and education.