Assessment of the Effectiveness of Identity-Based Public Health Announcements in Increasing the Likelihood of Complying With COVID-19 Guidelines: Randomized Controlled Cross-sectional Web-Based Study.

BACKGROUND: Public health campaigns aimed at curbing the spread of COVID-19 are important in reducing disease transmission, but traditional information-based campaigns have received unexpectedly extreme backlash. OBJECTIVE: This study aimed to investigate whether customizing of public service announcements (PSAs) providing health guidelines to match individuals' identities increases their compliance. METHODS: We conducted a within- and between-subjects, randomized controlled cross-sectional, web-based study in July 2020. Participants viewed two PSAs: one advocating wearing a mask in public settings and one advocating staying at home. The control PSA only provided information, and the treatment PSAs were designed to appeal to the identities held by individuals; that is, either a Christian identity or an economically motivated identity. Participants were asked about their identity and then provided a control PSA and treatment PSA matching their identity, in random order. The PSAs were of approximately 100 words. RESULTS: We recruited 300 social media users from Amazon Mechanical Turk in accordance with usual protocols to ensure data quality. In total, 8 failed the data quality checks, and the remaining 292 were included in the analysis. In the identity-based PSA, the source of the PSA was changed, and a phrase of approximately 12 words relevant to the individual's identity was inserted. A PSA tailored for Christians, when matched with a Christian identity, increased the likelihood of compliance by 12 percentage points. A PSA that focused on economic values, when shown to individuals who identified as economically motivated, increased the likelihood of compliance by 6 points. CONCLUSIONS: Using social media to deliver COVID-19 public health announcements customized to individuals' identities is a promising measure to increase compliance with public health guidelines. TRIAL REGISTRATION: ISRCTN Registry 22331899; https://www.isrctn.com/ISRCTN22331899.

The Associations Between Access to Recreational Facilities and Adherence to the American Heart Association's Physical Activity Guidelines in US Adults.

Physical activity decreases the risk of long-term health consequences including cardiac diseases. According to the American Health Association (AHA), adults should perform at least 75 min of vigorous physical activity (PA) or 150 min of moderate PA per week to impact long-term health. Results of previous studies are varied and have yet to integrate perceived access to facilities with AHA PA guidelines. We investigated whether access to free or low-cost recreational facilities was associated with meeting the AHA PA guidelines. Methodology: This cross-sectional study utilized data extracted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) database collected in 2017 (n = 1,750). The main exposure variable was access to free or low-cost recreational facilities. The main outcome variable was meeting the AHA guidelines of 150 min moderate PA or 75 min vigorous PA per week. Covariates included age, sex, level of education, overall health, BMI, ethnicity, hours of work per week, income, and time living at current address. Unadjusted and adjusted logistic regression analysis were used to calculate measures of odds ratio (OR) and corresponding 95% confidence interval (CI). Results: Of the 1,750 included participants, 61.7% (n = 1,079) reported to have access to recreational facilities. Of those with access to facilities, 69.9% met AHA PA guidelines while 30.4% did not. After adjusting for covariates, participants who reported access to recreational facilities were 42% more likely to meet AHA PA guidelines compared with participants who did not (adjusted OR 1.42; 95% CI 1.14-1.76). Secondary results suggest that healthier individuals were more likely to have met AHA PA guidelines. Conclusions: Having access to free or low-cost recreational facilities such as parks, walking trails, bike paths and courts was associated with meeting the AHA PA guidelines. Increasing prevalence and awareness of neighborhood recreational facilities could assist in access to these facilities and increase the ability of individuals to meet AHA PA guidelines. Future research should determine which types of recreational facilities impact physical activity strongest and discover methods of increasing their awareness.

Cross-infection and infection control in dental clinics in Nablus and Tulkarm districts.

BACKGROUND: Infection control had many developments in the COVID 19 (Coronavirus Disease 2019) pandemic, despite this, there were many complications in different health care facilities as well as dentists' clinics due to the lack of infection control knowledge and compliance failure. This study aimed to assess the level of knowledge and compliance with the infection control measures in the dental clinics in the Nablus and Tulkarm districts. RESULTS: The results showed that the total positive response regard all infection control domains were (70.0 %). Whereas the participants gave the highest positive response for personnel protective equipment i.e. gloving was (96.10 %). They gave the instruments related to controls the lowest responses, i.e. instruments sterilization was (59.40 %). The analyzed data showed significant statistical differences in the compliance with infection control measures between Nablus and Tulkarm districts "p < 0.05" in the interest of dentists from Tulkarm. CONCLUSIONS: In conclusion, the findings of this study showed that there is moderate compliance to infection control protocol in Nablus and Tulkarm dental clinics. Thus, there is a need to strengthen adherence to infection control measures. METHOD: A universal sampling was used to assess the infection control program at the dental clinics in Nablus and Tulkarm Districts. The study sample involved 265 dentists. Data was collected using a questionnaire which has been sent via email between July and August 2020. Descriptive statistics, Chi-square test, One-way ANOVA and Post-Hock tests have been used. Statistical significance was set at ″P <0.05″. Cronbach's alpha has been conducted to ensure the reliability and validity of the questionnaire.

Perform hand hygiene and the doors will open - the effectiveness of new system implementation on paediatric intensive care unit visitors' handwashing compliance.

Hand hygiene (HH) performance on entering intensive care units (ICUs) is commonly accepted but often inadequately performed. We developed a simple, inexpensive module that connects touchless dispensers of alcohol sanitiser (TDAS) to the automatic doors of a paediatric ICU, and assessed the impact of this intervention on HH compliance of hospital staff and visitors. A prospective observational study was conducted over a 3-week period prior to the intervention, followed by a 4-week period post intervention. HH performance was monitored by a research assistant whose office location enabled direct and video-assisted observation of the ICU entrance. A total of 609 entries to the ICU was recorded. Overall HH performance was 46.9% (92/196) before and 98.5% (406/413) after the intervention. Our findings suggest that HH performance on entering an ICU can be improved via a mechanism that makes operation of an automatic door dependent on use of a TDAS system, and thus contribute to infection control.

Adherence to guidance for prioritizing higher risk groups for breast cancer screening during the COVID-19 pandemic in the Ontario Breast Screening Program: a descriptive study.

BACKGROUND: Breast cancer screening in Ontario, Canada, was deferred during the first wave of the COVID-19 pandemic, and a prioritization framework to resume services according to breast cancer risk was developed. The purpose of this study was to assess the impact of the pandemic within the Ontario Breast Screening Program (OBSP) by comparing total volumes of screening mammographic examinations and volumes of screening mammographic examinations with abnormal results before and during the pandemic, and to assess backlogs on the basis of adherence to the prioritization framework. METHODS: A descriptive study was conducted among women aged 50 to 74 years at average risk and women aged 30 to 69 years at high risk, who participated in the OBSP. Percentage change was calculated by comparing observed monthly volumes of mammographic examinations from March 2020 to March 2021 with 2019 volumes and proportions by risk group. We plotted estimates of backlog volumes of mammographic examinations by risk group, comparing pandemic with prepandemic screening practices. Volumes of mammographic examinations with abnormal results were plotted by risk group. RESULTS: Volumes of mammographic examinations in the OBSP showed the largest declines in April and May 2020 (> 99% decrease) and returned to prepandemic levels as of March 2021, with an accumulated backlog of 340 876 examinations. As of March 2021, prioritization had reduced the backlog volumes of screens for participants at high risk for breast cancer by 96.5% (186 v. 5469 expected) and annual rescreens for participants at average risk for breast cancer by 13.5% (62 432 v. 72 202 expected); there was a minimal decline for initial screens. Conversely, the backlog increased by 7.6% for biennial rescreens (221 674 v. 206 079 expected). More than half (59.4%) of mammographic examinations with abnormal results were for participants in the higher risk groups. INTERPRETATION: Prioritizing screening for those at higher risk for breast cancer may increase diagnostic yield and redirect resources to minimize potential long-term harms caused by the pandemic. This further supports the clinical utility of risk-stratified cancer screening.

COVID-19 vaccine uptake and hesitancy opinions from frontline health care and social care workers: Survey data from 37 countries.

BACKGROUND AND AIMS: Vaccine hesitancy is an ongoing major challenge. We aimed to assess the uptake and hesitancy of the COVID-19 vaccination. METHODS: A short online survey was posted between April 12 to July 31, 2021 targeted at health and social care workers (HCWs) across the globe. RESULTS: 275 from 37 countries responded. Most were hospital or primary care physicians or nurses, 59% women, aged 18-60 years, and 21% had chronic conditions with most prevalent being diabetes, hypertension, and asthma. We found that most HCWs (93%) had taken or willing to receive the COVID-19 vaccine. While 7% were vaccine hesitant (mainly women aged 30-39 years), respondents main concerns was the safety or potential side effects. Vaccine willing respondents raised concerns of unequal access to the COVID-19 vaccination in some countries, and highlighted that the only solution to overcoming COVID-19 infections was the vaccine booster doses given annually and free mass vaccination. CONCLUSIONS: This study found that the majority of the frontline HCWs are willing to receive the COVID-19 vaccine. Further promotion of the COVID-19 vaccine would reassure and persuade HCWs to become vaccinated.

Adherence to hand hygiene at five moments and specific protection in a tertiary care hospital during the COVID-19 pandemic.

INTRODUCTION: During the COVID-19 pandemic, adherence to hygiene measures is an objective aimed at reducing morbidity and mortality. OBJECTIVE: To evaluate adherence to hand hygiene and protection measures during the COVID-19 pandemic in a tertiary care hospital. METHODS: Cross-sectional study on health personnel handwashing at the five moments recommended by the World Health Organization, as well as on the use of specific personal protective equipment. RESULTS: One hundred and seventeen hand hygiene opportunities were observed in health personnel. Hand washing was observed in 40 (34 %) and omission in 76 (65 %). Adherence to the use of face shield was observed in five (4 %), and lack of adherence in 112 (96%). Adherence to the use of face mask was observed in 65 nursing professionals (87 %), with appropriate use of the mask in 56 of them (60 %) and use of face shield in one (1 %). CONCLUSION: Health personnel showed low proportions of adherence to hand hygiene and use of equipment for specific protection during the COVID-19 pandemic.

INTRODUCCIÓN: Ante la pandemia de COVID-19, el apego a las medidas de higiene es un objetivo para disminuir la morbimortalidad. OBJETIVO: Evaluar el apego a la higiene de manos y medidas de protección durante la pandemia de COVID-19 en un hospital de tercer nivel. MÉTODOS: Estudio transversal acerca del lavado de manos del personal de salud en los cinco tiempos recomendados por la Organización Mundial de la Salud, así como sobre el uso del equipo de protección personal específico. RESULTADOS: Fueron observadas 117 oportunidades de higiene de manos en personal de salud: 40 (34 %) respecto al lavado de manos y 76 (65 %) respecto a su omisión; sobre el apego al uso de careta en cinco (4 %) y sobre la falta de apego en 112 (96 %). Se identificó apego al uso de mascarilla en 65 profesionales de enfermería (87 %), uso adecuado de mascarilla en 56 de ellos (60 %) y uso de careta en uno (1 %). CONCLUSIÓN: El personal mostró baja proporción de apego a la higiene de manos y al uso de equipo para la protección específica durante la pandemia de COVID-19.

Extent of compliance with COVID-19 prevention and control guidelines among supermarkets in Kampala Capital City and Mukono Municipality, Uganda.

BACKGROUND: Despite the development and enforcement of preventive guidelines by governments, COVID-19 continues to spread across nations, causing unprecedented economic losses and mortality. Public places remain hotspots for COVID-19 transmission due to large numbers of people present; however preventive measures are poorly enforced. Supermarkets are among the high-risk establishments due to the high interactions involved, which makes compliance with the COVID-19 preventive guidelines of paramount importance. However, until now, there has been limited evidence on compliance with the set COVID-19 prevention guidelines. Therefore, this study aimed to measure compliance with the COVID-19 prevention guidelines among supermarkets in Kampala Capital City and Mukono Municipality Uganda. METHODS: A cross-sectional study was conducted among selected supermarkets in Kampala Capital City and Mukono Municipality in September 2020. A total of 229 supermarkets (195 in Kampala City and 34 in Mukono Municipality) were randomly selected for the study. Data were collected through structured observations on the status of compliance with COVID-19 prevention guidelines, and entered using the KoboCollect software, which was preinstalled on mobile devices (smart phones and tablets). Descriptive statistics were generated to measure compliance to the set COVID-19 Ministry of Health prevention guidelines using Stata 14 software. RESULTS: Only 16.6% (38/229) of the supermarkets complied with the COVID-19 prevention and control guidelines. In line with the specific measures, almost all supermarkets 95.2% (218/229) had hand washing facilities placed at strategic points such as the entrance, and 59.8% (137/229) of the supermarkets surveyed regularly disinfected commonly touched surfaces. Only 40.6% and 30.6% of the supermarkets enforced mandatory hand washing and use of face masks respectively for all customers accessing the premises. Slightly more than half, 52.4% (120/229) of the supermarkets had someone or a team in charge of enforcing compliance to COVID-19 measures and more than half, 55.5% (127/229) of the supermarkets had not provided their staff with job-specific training/mentorship on infection prevention and control for COVID-19. Less than a third, 26.2% (60/229) of the supermarkets had an infrared temperature gun for screening every customer, and only 5.7% (13/229) of the supermarkets captured details of clients accessing the supermarket as a measure to ease follow-up. CONCLUSION: This study revealed low compliance with COVID-19 guidelines, which required mandatory preventive measures such as face masking, regular disinfection, social distancing, and hand hygiene. This study suggests the need for health authorities to strengthen enforcement of these guidelines, and to sensitise the supermarket managers on COVID-19 in order to increase the uptake of the different measures.

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.

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.

Breastfeeding inequities in South Africa: Can enforcement of the WHO Code help address them? - A systematic scoping review.

INTRODUCTION: Suboptimal breastfeeding rates in South Africa have been attributed to the relatively easy access that women and families have had to infant formula, in part as a result of programs to prevent maternal-to-child transmission (MTCT) of HIV. This policy may have had an undesirable spill-over effect on HIV-negative women as well. Thus, the aims of this scoping review were to: (a) describe EBF practices in South Africa, (b) determine how EBF has been affected by the WHO HIV infant feeding policies followed since 2006, and (c) assess if the renewed interest in The Code has had any impact on breastfeeding practices in South Africa. METHODS: We applied the Joanna Briggs Institute guidelines for scoping reviews and reported our work in compliance with the PRISMA Extension (PRISMA-ScR). Twelve databases and platforms were searched. We included all study designs (no language restrictions) from South Africa published between 2006 and 2020. Eligible participants were women in South Africa who delivered a healthy live newborn who was between birth and 24 months of age at the time of study, and with known infant feeding practices. RESULTS: A total of 5431 citations were retrieved. Duplicates were removed in EndNote and by Covidence. Of the 1588 unique records processed in Covidence, 179 records met the criteria for full-text screening and 83 were included in the review. It was common for HIV-positive women who initiated breastfeeding to stop doing so prior to 6 months after birth (1-3 months). EBF rates rapidly declined after birth. School and work commitments were also reasons for discontinuation of EBF. HIV-positive women expressed fear of HIV MTCT transmission as a reason for not breastfeeding. CONCLUSION: The Review found that while enforcing the most recent WHO HIV infant feeding guidelines and the WHO Code may be necessary to improve breastfeeding outcomes in South Africa, they may not be sufficient because there are additional barriers that impact breastfeeding outcomes. Mixed-methods research, including in-depth interviews with key informants representing different government sectors and civil society is needed to prioritize actions and strategies to improve breastfeeding outcomes in South Africa.

Hand Hygiene, an Update.

Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.

SARS-CoV-2 screening of asymptomatic health care workers: experience of a General hospital.

Health care workers (HCWs) are at major risk to be infected by SARS-CoV-2 and transmit the virus to the patients. Furthermore, travels are a major factor in the diffusion of the virus. We report our experience regarding the screening of asymptomatic HCWs returning from holidays, following the issue of a national guideline on 08/20/2020. The organization of the occupational health department and the clinical laboratory was adapted in order to start the screening on August, 24, 2020. All HCWs tested for SARS-CoV-2 the week before and 4 weeks after the implementation of the screening were included. The mean number of tests was analyzed per working day and working week. Overall, 502 (31.4%) HCWs were tested for SARS-CoV-2 during the study period. The mean number of HCWs tested per working day was 27.1. HCWs accounted for 36.9% (n = 167) and 11.2% (n = 84) of the tests performed in the 1st and the 4th week following the implementation of the guidelines. The number of tests performed each week in HCWs increased by at least 20-fold after the implementation of the guidelines. No asymptomatic HCW was tested positive. Screening of asymptomatic HCWs was poorly effective in the context of low circulation of the virus. We suggest giving priority to infection prevention and control measures and screening of symptomatic subjects and asymptomatic contacts.

Emergency department impaired adherence to personal protective equipment donning and doffing protocols during the COVID-19 pandemic.

OBJECTIVES: Coronavirus Disease 2019 (COVID-19) is a highly infectious viral pandemic that has claimed the lives of millions. Personal protective equipment (PPE) may reduce the risk of transmission for health care workers (HCWs), especially in the emergency setting. This study aimed to compare the adherence to PPE donning and doffing protocols in the Emergency Department (ED) vs designated COVID-19 wards and score adherence according to the steps in our protocol. DESIGN: Prior to managing COVID-19 patients, mandatory PPE training was undertaken for all HCWs. HCWs were observed donning or doffing COVID-19 restricted areas. SETTING: Donning and doffing was observed in COVID-19 designated Emergency department and compared to COVID-19 positive wards. PARTICIPANTS: All HCWs working in the aforementioned wards during the time of observation. RESULTS: We observed 107 donning and doffing procedures (30 were observed in the ED). 50% HCWs observed donned PPE correctly and 37% doffed correctly. The ED had a significantly lower mean donning score (ED: 78%, Internal: 95% ICU: 96%, p < 0.001); and a significantly lower mean doffing score (ED: 72%, Internal: 85% ICU: 91%, p = 0.02). CONCLUSIONS: As hypothesized, HCWs assigned to the designated ED wing made more protocol deviations compared with HCWs positive COVID-19 wards. Time management, acuity, lack of personnel, stress and known COVID-19 status may explain the lesser adherence to donning and doffing protocols. Further studies to assess the correlation between protocol deviations in use of PPE and morbidity as well as improvement implementations are required. Resources should be invested to ensure PPE is properly used.

Increased Adherence to Infection Control Practices Among Medical Laboratory Technicians During the COVID-19 Pandemic: A Self-Reported Survey Study.

Background: The adherence of medical laboratory technicians (MLT) to infection control guidelines is essential for reducing the risk of exposure to infectious agents. This study explored the adherence of MLT towards infection control practices during the COVID-19 pandemic. Method: The study population consisted of MLT (n = 444) who worked in private and government health sectors in Jordan. A self-reported survey was used to collect data from participants. Findings: More than 87% of the participants reported adherence to hand-washing guidelines and using personal protective equipment (PPE) when interacting with patients (74.5%), and handling clinical samples (70.0%). Besides, 88.1%, 48.2%, and 7.7% reported wearing of lab coats, face masks, and goggles, at all times, respectively. The majority reported increased adherence to infection control practices during the COVID-19 pandemic. This includes increased PPE use at the workplace (94.2%), increased frequency of disinfection of laboratory surfaces (92.4%) and laboratory equipment (86.7%), and increased frequency of handwashing/use of antiseptics (94.6%). Having a graduate degree was significantly associated with increased adherence of participants to the daily use of goggles/eye protection (p = 0.002), and the use of PPE while handling clinical samples (p = 0.011). Having work experience of >10 years was associated with increased adherence to the use of PPE while handling clinical samples (p = 0.001). Conclusion: MLT reported very good adherence with most assessed infection control practices. In addition, they reported increased conformity with infection control guidelines during the COVID-19 pandemic.

Risk factors, symptom reporting, healthcare-seeking behaviour and adherence to public health guidance: protocol for Virus Watch, a prospective community cohort study.

INTRODUCTION: The coronavirus (COVID-19) pandemic has caused significant global mortality and impacted lives around the world. Virus Watch aims to provide evidence on which public health approaches are most likely to be effective in reducing transmission and impact of the virus, and will investigate community incidence, symptom profiles and transmission of COVID-19 in relation to population movement and behaviours. METHODS AND ANALYSIS: Virus Watch is a household community cohort study of acute respiratory infections in England and Wales and will run from June 2020 to August 2021. The study aims to recruit 50 000 people, including 12 500 from minority ethnic backgrounds, for an online survey cohort and monthly antibody testing using home fingerprick test kits. Nested within this larger study will be a subcohort of 10 000 individuals, including 3000 people from minority ethnic backgrounds. This cohort of 10 000 people will have full blood serology taken between October 2020 and January 2021 and repeat serology between May 2021 and August 2021. Participants will also post self-administered nasal swabs for PCR assays of SARS-CoV-2 and will follow one of three different PCR testing schedules based on symptoms. ETHICS AND DISSEMINATION: This study has been approved by the Hampstead National Health Service (NHS) Health Research Authority Ethics Committee (ethics approval number 20/HRA/2320). We are monitoring participant queries and using these to refine methodology where necessary, and are providing summaries and policy briefings of our preliminary findings to inform public health action by working through our partnerships with our study advisory group, Public Health England, NHS and government scientific advisory panels.

Hand hygiene compliance of healthcare workers before and during the COVID-19 pandemic: A long-term follow-up study.

BACKGROUND: Information about the long-term effects of hand hygiene (HH) interventions is needed. We aimed to investigate the change in HH compliance (HHC) of healthcare workers (HCWs) once a data-driven feedback intervention was stopped, and to assess if the COVID-19 pandemic influenced the HH behavior. METHODS: We conducted an observational, extension trial in a surgical department between January 2019-December 2020. Doctors (n = 19) and nurses (n = 53) were included and their HHC was measured using an electronic HH monitoring system (EHHMS). We compared the changes in HHC during 3 phases: (1) Intervention (data presentation meetings), (2) Prepandemic follow-up and (3) Follow-up during COVID-19. RESULTS: The HHC during phase 1 (intervention), phase 2 (prepandemic follow-up) and phase 3 (follow-up during COVID-19) was 58%, 46%, and 34%, respectively. Comparison analyses revealed that the HHC was significantly lower in the prepandemic follow-up period (46% vs 58%, P < .0001) and in the follow-up period during COVID-19 (34% vs 58%, P < .0001) compared with the intervention period (phase 1). CONCLUSIONS: Despite the COVID-19 pandemic, the HHC of the HCWs significantly decreased over time once the data presentation meetings from management stopped. This study demonstrates that HCWs fall back into old HH routines once improvement initiatives are stopped.

A network modelling approach to assess non-pharmaceutical disease controls in a worker population: An application to SARS-CoV-2.

As part of a concerted pandemic response to protect public health, businesses can enact non-pharmaceutical controls to minimise exposure to pathogens in workplaces and premises open to the public. Amendments to working practices can lead to the amount, duration and/or proximity of interactions being changed, ultimately altering the dynamics of disease spread. These modifications could be specific to the type of business being operated. We use a data-driven approach to parameterise an individual-based network model for transmission of SARS-CoV-2 amongst the working population, stratified into work sectors. The network is comprised of layered contacts to consider the risk of spread in multiple encounter settings (workplaces, households, social and other). We analyse several interventions targeted towards working practices: mandating a fraction of the population to work from home; using temporally asynchronous work patterns; and introducing measures to create 'COVID-secure' workplaces. We also assess the general role of adherence to (or effectiveness of) isolation and test and trace measures and demonstrate the impact of all these interventions across a variety of relevant metrics. The progress of the epidemic can be significantly hindered by instructing a significant proportion of the workforce to work from home. Furthermore, if required to be present at the workplace, asynchronous work patterns can help to reduce infections when compared with scenarios where all workers work on the same days, particularly for longer working weeks. When assessing COVID-secure workplace measures, we found that smaller work teams and a greater reduction in transmission risk reduced the probability of large, prolonged outbreaks. Finally, following isolation guidance and engaging with contact tracing without other measures is an effective tool to curb transmission, but is highly sensitive to adherence levels. In the absence of sufficient adherence to non-pharmaceutical interventions, our results indicate a high likelihood of SARS-CoV-2 spreading widely throughout a worker population. Given the heterogeneity of demographic attributes across worker roles, in addition to the individual nature of controls such as contact tracing, we demonstrate the utility of a network model approach to investigate workplace-targeted intervention strategies and the role of test, trace and isolation in tackling disease spread.

Assessment of adherence to public health measures and their impact on the COVID-19 outbreak in Benin Republic, West Africa.

INTRODUCTION: following the global COVID-19 outbreak, the government of Benin implemented preventive measures to stall viral transmission. We sought to evaluate adherence of the Beninese people to these preventive measures, in order to identify predictors of poor adherence and adapt the national response to COVID-19. METHODS: two consecutive online surveys were conducted between May and August 2020. Four hundred and sixty two and 507 adult participants aged 18 years and above responded to the first and second survey respectively, with >70% being males. RESULTS: more than 98% of respondents reported wearing face masks. A five-point adherence score was constituted by scoring observance to key preventive measures (mask use, physical distancing, hand hygiene, coughing hygiene and avoiding to touch one´s face). We observed that the mean adherence scores were fairly stable over time, respectively 4.08 and 4.03 during the first and second survey (p=0.439). Increasing age (aOR=1.043, 95% CI: 1.026 - 1.061; p<0.001) and obtaining COVID-19 information from official sources (aOR=1.628, 95% CI: 1.275 - 2.081; p<0.001) were significantly associated with higher adherence scores in a multivariable model. CONCLUSION: these findings suggest that a wide dissemination of adequate information about COVID-19 would increase adherence, and that targeted efforts should be directed towards increasing the compliance to preventive measures among the younger age groups.