Health workers and COVID19 Perceptions of local infection

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Health workers and COVID-19 Perceptions of local infection prevention and control measures HEALTH EMERGENCIES

Health workers and COVID-19 Perceptions of local infection prevention and control measures HEALTH EMERGENCIES programme

Barriers and facilitators to adherence with IPC Factors influencing health worker adherence to IPC

Barriers and facilitators to adherence with IPC Factors influencing health worker adherence to IPC guidance: - Clarity and ease of understanding of guidance - Fatigue associated with additional IPC strategies - Support from management - Communication and expectations regarding training - Practicalities of the environment – space - PPE availability and quality - Belief in value - Fear of infection to self or family - Workplace culture and social norms https: //www. cochranelibrary. com/cdsr/doi/10. 1002/14651858. CD 013582/ful l HEALTH EMERGENCIES programme

Healthcare worker views of IPC procedures Rationale: Training and guidelines necessary but insufficient for

Healthcare worker views of IPC procedures Rationale: Training and guidelines necessary but insufficient for adherence to IPC measures. Aim: To capture healthcare worker perceptions of local IPC measures – influences on behaviour that affect motivation and ability to follow guidelines –knowledge, skills, beliefs about capabilities, social roles, emotion, beliefs about consequences, physical and social environment, trust. Implementing groups: Preparations/ ethics: Malawi, Uganda, Cameroon, USA (New Orleans); Data collection: Canada, India (Vellore, Bangalore), Ghana, Senegal, Nigeria, Palestine; Analysis/ reporting: Europe, Canada, Brazil (Sao Paulo) Protocol at: https: //www. who. int/publications/m/item/perceptions-ofhealthcare-workers-regarding-local-infection-prevention-and-controlprocedures-for-covid-19 -research-protocol HEALTH EMERGENCIES programme

India: Vellore – Single center in South India: tertiary referral hospital with >2500 beds

India: Vellore – Single center in South India: tertiary referral hospital with >2500 beds & ~10 000 staff – 17 June 2020 – 4 July 2020, 369 completed surveys, convenience sampling – Online via Whats. App or tablets (interview, using PPE, >1 m distance), also intranet for access on wards – Sample: 54. 7% female, 30% nurses, 15% registrars, 14% faculty, 10% housekeeping; 25% caring responsibilities for people >60 yrs; 48% cared for patient with COVID-19 Key findings: (all % relate to “Agree” or “Strongly Agree” responses) – >70% received specific and standard IPC training – 78% confident in ability to don & doff PPE, 82% confident in following guidelines – PPE availability: >70% can easily access PPE in line with standard IPC precautions – Fear of infection to self 56%, to family 71%; 73% accept this risk as part of their job, 49% feel it is within their control – Median score indicated agreement (6 on 7 -point scale) with statements regarding trust in health facility – WHO well-being score median 60 IQR 36 -80 Next steps: analyses ongoing, including subgroup analyses Vellore, Tamil Nadu covidindia. org (Data from: commons. wikimedia. org/wiki/Data: COVID-19_cases_in_Tamil_Nadu. tab) HEALTH Dr Sneha R (junior lead), Dr Malathi Murugesan, Dr Bhagteshwar Singh, Prof Priscilla Rupali (senior lead); Implementation via EMERGENCIES programme BIGlobal group’s (NIHR Global Health Research Group on Brain Infections; director = Prof Tom Solomon, University of Liverpool )

Brazil: State of Sao Paulo – – – State of Sao Paulo (42 million

Brazil: State of Sao Paulo – – – State of Sao Paulo (42 million pop), 28 April – 13 June 2249 valid answers; Sampling: convenience Online via State Health Dept, professional associations, Whats. App Free text qualitative responses together with survey response Sample: 81% female; 30% nurses, 29% assistant nurses, 17% doctors; 52% dependent children; 60% directly cared for patient COVID-19 Key findings - 67% thought full body suits recommended – media? - 73% received sufficient COVID-19 specific training, 78% confident in don and doff PPE, 95% confidence in following guidelines - 45% agree IPC recommendations adds strain, but not unnecessary strain (78%) - 84% agree clear policies and protocols in place, strong social norms - Fear of infection to self 86%, to family 92%; fear of taking care of patients 50%, 36% try to avoid patient contact - Mixed views about whether getting infected in within their control (41% yes) - 73% trust in health facility, 42% trust in regional government, 27% trust in national government Qualitative highlights: (526 valid responses) - Confidence in COVID-19 knowledge influenced by professional issues, IPC measures, politics, social and cultural factors - Strong religious components - Emphasised lack of appreciation (mainly nurses), fear, PPE misinformation, lack of alignment between 3 levels of government, and population not behaving as they should Next steps: Report to State Health Dept highlighting need to improve communication between health authorities, institutions, and HW training, especially in PPE; showing appreciation of HW (includes wages) HEALTH EMERGENCIES programme

Canada - - Nationwide survey, March 16 and May 18, 2020 426 responses Online

Canada - - Nationwide survey, March 16 and May 18, 2020 426 responses Online data collection via large listservs, Slack channels, including the Canadian Association of Critical Care Nurses and the Canadian Association of Emergency Physicians Sample: 82% female; 74% bedside nurses, 17% physicians; 32% dependent children; 66% directly cared for patient with suspected or confirmed COVID-19 Key messages - 67% received sufficient COVID-19 specific training, 86% confident in don and doff PPE to prevent transmission - Strong social norm regarding the importance of and expectations around IPC, with strong internal perception of IPC as part of their job role - 74% agree IPC recommendations adds strain, but not unnecessary strain (77%) - 66% agree clear policies and procedures in place - Fear of infection to self 82%, to family 83%; fear of taking care of patients 45%, 23% try to avoid patient contact - 59% believed they had control over to whether they become infected or not - Healthcare workers currently practicing in settings caring for COVID-19 patients felt more confident in their IPC skills - Bedside nurses had higher trust, stronger beliefs in the use of PPE and in the hospital / medical system environment to protect them - Those with experience in previous outbreaks had higher levels of fear, but more confidence in IPC skills and felt more supported What PPE did you use when you cared for a suspected/confirmed COVID-19 case? N, % Hand hygiene 280 (99. 29) Disposable gloves 276 (97. 87) Face masks 273 (96. 81) Disposable gowns 245 (86. 88) Face shields 242 (85. 82) Isolating patients with confirmed infection 226 (80. 14) Eye protection 180 (63. 83) Avoiding patient contact 67 (23. 76) Full body suits 2 (0. 71) HEALTH EMERGENCIES Team: Sarah L Silverberg, Lisa M Puchalski-Ritchie, Nina Gobat, Srinivas Murthy programme Funding: CIHR Coronavirus Rapid Research Funding Opportunity (OV 2170359)

Europe: 40 countries - 2305 responses (R 1: n=190; R 2: n=2115) Online data

Europe: 40 countries - 2305 responses (R 1: n=190; R 2: n=2115) Online data collection via two sampling rounds: R 1: probability based; R 2: convenience Sample round 1: 43% female; 8% bedside nurses, 89% doctors; 27% caring responsibilities for older adults; 68% directly cared for patient COVID-19 Sample round 2: 68% female; 40% bedside nurses, 43% doctors; 27% caring responsibilities for older adults; 75% directly cared for patient COVID-19 www. recovereurope. eu RECo. VER is funded by the EC under H 2020 call SC 1 -PHECORONAVIRUS-2020 Key findings - 72% (round 1), 68% (round 2) of frontline HCWs received sufficient COVID-19 specific training, - 85% (round 1), 81% (round 2) confident in don and doff PPE - 88% (round 1), 85% (round 2) agree IPC recommendations add significant strain to their workload - 73% (round 1) 80% (round 2) agree clear policies and protocols are in place, strong social norms re: role expectation and peer influences - Fear of infection to self 80% (round 1), 68% (round 2); to family 90% (round 1), 79% (round 2); fear of taking care of COVID-19 patients 34% round 1, 36% round 2; - Less acceptance that risk of getting infected with COVID-19 is part of their job in round 2 compared to round 1 (69% versus 85%) - Mixed views about whether getting infected in within their control (feeling outside of their control: 33% round 1, 38% round 2) - 71% round 1, 73% round 2 report institutional trust - PPE availability: most often reported to be in limited or in no supply: N 95 masks, fluidresistant gowns and eye protection. Study team: Denise van Hout (UMC Utrecht), Paul Hutchinson (Tulane), Sarah Tonkin-Crine (Uni Oxford), Marta Wanat (Uni Oxford), Sibyl Antheriens (Antwerp Uni), Herman Goossens, (Antwerp Uni), Nina Gobat (Uni Oxford), HEALTH WHO well-being 5: - Median score Round 1: 54 (IQR 36 -68) points; Round 2: 56 (IQR 44 -72) points EMERGENCIES programme

Operational social science research HEALTH EMERGENCIES programme

Operational social science research HEALTH EMERGENCIES programme

Next steps • Bring this perspective to guideline development • Rapid evidence reviews on

Next steps • Bring this perspective to guideline development • Rapid evidence reviews on social and behaviorual aspects • Ongoing attention to emerging research questions, gaps and tools to support (e. g. question banks) • Promote integration of social and behavioural perspectives QUESTIONS? HEALTH EMERGENCIES programme