Concerns, perceived impact and preparedness in an avian influenza pandemic--a comparative study between healthcare workers in primary and tertiary care.

INTRODUCTION: With the potential threat of an avian influenza (AI) pandemic, healthcare workers (HCWs) are expected to play important roles, and they encounter significant stress levels from an expected increase in workload. We compared the concerns, perceived impact and preparedness for an AI pandemic between HCWs working in public primary care clinics and a tertiary healthcare setting. MATERIALS AND METHODS: An anonymous, self-administered questionnaire was given to 2459 HCWs working at 18 public polyclinics (PCs) and a tertiary hospital (TH) in Singapore from March to June 2006. The questionnaire assessed work-related and non-work-related concerns, perceived impact on personal life and work as well as workplace preparedness. RESULTS: We obtained responses from 986 PC and 873 TH HCWs (response rate: 74.6% and 76.7%). The majority in both groups were concerned about the high AI risk from their occupation (82.7%) and falling ill with AI (75.9%). 71.9% accepted the risk but 25.5% felt that they should not be looking after AI patients with 15.0% consider resigning. HCWs also felt that people would avoid them (63.5%) and their families (54.1%) during a pandemic. The majority expected an increased workload and to feel more stressed at work. For preparedness, 74.2% felt personally prepared and 83.7% felt that their workplaces were prepared for an outbreak. TH HCWs were more likely to be involved in infection-control activities but the perception of infection-control preparedness in both groups was high (>80.0%). CONCLUSIONS: HCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic. Their main concerns were risks of falling ill from exposure and the possibility of social ostracism of themselves and their families. Preparedness levels appeared high in the majority of HCWs. However, concerns of HCWs could affect their overall effectiveness in a pandemic and should be addressed by incorporating strategies to manage them in pandemic planning.

Concerns and preparedness for an avian influenza pandemic: a comparison between community hospital and tertiary hospital healthcare workers.

Little is known about differences in levels of concerns or preparedness for an avian influenza (AI) pandemic among healthcare workers (HCWs) in different types of hospitals. We compared these concerns and preparedness between 326 HCWs of two community hospitals (CHs) and 908 HCWs from a tertiary hospital (TH) using a self-administered questionnaire between March-June 2006. Response rates were 84.2% and 80.0% from the CHs and TH. Most HCWs (71.6%) felt prepared for an AI outbreak and had significant concerns. They perceive an AI pandemic having adverse impacts on their personal life and work, such as people avoiding them (57.1%). A greater percentage of TH compared to CH HCWs expressed concerns such as feeling their jobs put them at great AI exposure (78.3% vs 67.5%, p=0.012). TH HCWs were more likely to report participating in readiness preparation activities, such as training for infection control (90.0% vs 82.2%, p=0.014) and feel that they (74.1% vs 64.7%, p=0.045) and their hospital (86.8% vs 71.8%, p=0.000) were prepared for an outbreak. Healthcare institutions need to include personal, psychological and family concerns on the agenda and increase participation in readiness preparation activities among HCWs to help prepare for such future crises.

On-site influenza vaccination arrangements improved influenza vaccination rate of employees of a tertiary hospital in Singapore.

BACKGROUND: On-site vaccination arrangements were introduced in 2005 to improve influenza vaccination rate among employees of a 1500-bed tertiary hospital in Singapore. METHODS: On-site arrangements include mobile teams to 3 distant departments and same-service area vaccination for employees at 4 service areas. RESULTS: Influenza vaccination rate in 2005 was 66.4% (versus 56.8% in 2004, odds ratio 1.50, 95% confidence interval 1.39-1.62). Employees who attended on-site arrangements had higher influenza vaccination rate (97.0%). CONCLUSION: On-site vaccination arrangements improved influenza vaccination rate among hospital employees.

Predictors of vancomycin-resistant enterococcus (VRE) carriage in the first major VRE outbreak in Singapore.

INTRODUCTION: Until recently, vancomycin-resistant enterococcus (VRE) infection or colonisation was a rare occurrence in Singapore. The first major VRE outbreak involving a 1500-bed tertiary care institution in March 2005 presented major challenges in infection control and came at high costs. This study evaluates the predictors of VRE carriage based on patients' clinical and demographic profiles. MATERIALS AND METHODS: Study patients were selected from the hospital inpatient census population during the VRE outbreak (aged 16 years or more). Clinical information from 84 cases and 377 controls were analysed. RESULTS: Significant predictors of VRE carriage included: age>65 years Odds ratio (OR), 1.98; 95% CI (confidence interval), 1.14 to 3.43); female gender (OR, 2.15; 95% CI, 1.27 to 3.65); history of diabetes mellitus (OR, 1.94; 95% CI, 1.14 to 3.30), and staying in a crowded communal ward (OR, 2.75; 95% CI, 1.60 to 4.74). Each additional day of recent hospital stay also posed increased risk (OR, 1.03; 95% CI, 1.01 to 1.04). CONCLUSION: Elderly diabetic females with prolonged hospitalisation in crowded communal wards formed the profile that significantly predicted VRE carriage in this major hospital-wide outbreak of VRE in Singapore. It is imperative that active VRE surveillance and appropriate infection control measures be maintained in these wards to prevent future VRE outbreaks.

Screening for myopia and refractive errors using LogMAR visual acuity by optometrists and a simplified visual acuity chart by nurses.

PURPOSE: To compare the sensitivity and specificity of a widespread method of screening for refractive errors in Singapore schoolchildren using a simplified acuity screening chart with a more rigorous method using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. A secondary aim is to estimate the best cutoff values for the detection of refractive errors using these two methods. METHODS: This is a population-based study, involving 1779 schoolchildren from three schools in Singapore. Logarithm of the minimum angle of resolution (logMAR) visual acuity was recorded using a modified Bailey-Lovie chart by trained optometrists, and visual acuity measurement was also undertaken using a simplified 7-line visual acuity screening chart by school health nurses. The main outcome measures were the receiver-operating characteristics (ROC's) of logMAR and the simplified screening visual acuity to detect myopia or any refractive errors. The difference between measurements, simplified screening visual acuity--logMAR visual acuity, was calculated. RESULTS: The optimal threshold using the simplified screening visual acuity chart for the detection of myopia or any refractive error was 6/12 or worse. Using logMAR visual acuity, the most efficient threshold for the detection of myopia was 0.26, but this was 0.18 for the detection of any refractive error. The area under the ROC curves was significantly greater in the case of the logMAR visual acuity measurement compared with the simplified screening visual acuity measurement for the detection of myopia or any refractive errors. The 95% limits of agreement for the two methods (simplified screening--logMAR acuity) was -0.219 to +0.339. CONCLUSIONS: Bearing in mind that the visual acuity measurements were performed by two different groups of professionals, visual acuity screening using the ETDRS method appears to be more accurate than the simplified charts for the detection of myopia or any refractive errors in children.