Compliance with hand hygiene practices and its appropriateness among healthcare workers during COVID-19 pandemic in public health facilities of Tamil Nadu, India.

Background: Compliance with appropriate hand hygiene practises is the most efficient and cost-effective intervention that can be implemented in the healthcare setting. Given its importance, we tried to capture the compliance with hand hygiene practises and their appropriateness among healthcare workers during the COVID-19 pandemic in public health facilities in Tamil Nadu. Methods: This cross-sectional study involved doctors, nurses, and allied healthcare professionals from various departments in 18 public healthcare facilities spanning six districts in Tamil Nadu. A random-intercept model was employed for the multivariable logistic regression analysis to evaluate the factors influencing hand hygiene compliance and its adequacy. The effect size was presented as an adjusted odds ratio (aOR) accompanied by a 95% confidence interval (CI). Results: In total, 2733 hand hygiene observations were made. Only during 19.4% (95%CI: 17.9%-20.9%) of these observations, hand washing was done. Only during 37.9% (95%CI: 33.9%-42.1%) of these observations, hand washing was done appropriately by following all the essential steps of hand hygiene. Nurses (aOR = 2.49; 95%CI: 1.90-3.26), healthcare workers in General Surgery (aOR = 2.18; 95%CI: 1.53-3.10) and Obstetrics & Gynaecology departments (aOR = 1.75; 95%CI: 1.26-2.43), working in inpatient departments (aOR = 2.64; 95%CI: 1.38-5.04) had significantly higher compliance to hand hygiene practices. Nurses (aOR = 2.58; 95%CI: 1.33-5.01) and General Medicine department healthcare workers (aOR = 1.98; 95%CI: 1.09-3.61) had significantly higher compliance to appropriate hand hygiene practices. Conclusion: Our study shows that only during one-fifth of the observations did healthcare workers do hand washing, and less than 10% did it appropriately by following all the essential steps of hand hygiene.

Impact of health insurance coverage on health care utilization during COVID-19 pandemic: A propensity score matched survey analysis in a target region in India.

BACKGROUND: Health insurance is considered as a mechanism to accelerate the progress towards universal health coverage and ensure financial risk protection for households throughout the country. There is a growing body of evidence reporting that the health insurance coverage can significantly improve the access and utilization of healthcare services. Hence, we attempted to determine the impact of health insurance on the utilization of healthcare services during COVID-19 pandemic. METHODS: A community-based cross-sectional study was conducted in rural Tamil Nadu. The primary data collection was conducted during November 2021. We employed a multi-stage stratified random sampling technique. Propensity score matching analysis was performed using radius matching method at 0.05 calliper to estimate the following parameters: average treatment effect (ATE), average treatment effect on treated (ATT), and average treatment effect on untreated (ATU). RESULTS: In total, 2390 participants were included. Almost two-third belonged to 18-45 years with almost equal distribution of males and females. Only 13.6% were covered by health insurance. Healthcare utilization was significantly higher among participants with health insurance (55.2%) compared to participants without coverage (42.5%). The ATT values in intervention and control group were 0.55 and 0.46 (p < 0.001). Similarly, the ATU values in intervention and control group were 0.42 and 0.51. The ATE value was 0.08. CONCLUSION: Our study shows that the health insurance coverage had significant impact on utilization of healthcare services during COVID-19 pandemic. Further longitudinal research exploring the effect of different forms of health insurance for improving access and utilization of healthcare services can be undertaken.