Effect of Public Empathy with Infection-Control Guidelines on Infection-Prevention Attitudes and Behaviors: Based on the Case of COVID-19

Since the outbreak of the novel coronavirus disease (COVID-19), the government has provided infection-control guidelines to prevent the spread of the virus. The authors of this study examined the structure (causal relationship) of factors that influence public behavior toward COVID-19 and verified the effect of public empathy with infection-control guidelines in each structure. Data were collected using a self-administered questionnaire survey from 211 Korean adults. The results showed that (1) the perceived susceptibility and severity of economic damage had a positive effect on infection-prevention attitudes and infection-prevention attitudes had a positive effect on infection-prevention behaviors; (2) the perceived severity of economic damage had a positive effect on infection-prevention attitudes; and (3) public empathy with infection-control guidelines positively moderated the effect of the perceived severity of economic damage on infection-prevention behaviors and that of perceived susceptibility on infection-prevention attitudes. Accordingly, the authors of this study present the following three suggestions to prevent the spread of an infectious disease: engage in risk communication focused on a potential virus infection and cooperation, make multifaceted efforts to increase public empathy with infection-control guidelines, and implement measures to alleviate or reduce economic damage to the public in a viral pandemic.

COVID-19 Infection among the Health Care Staff at Frontier Medical and Dental College and Hospital

Background: First case of pandemic COVID-19 was diagnosed in December 2019 in China from where it spread throughout the world. In Pakistan, first case was diagnosed in February 2020 which resulted in a complete and several smart national lockdowns. National Command and Operation Center (NCOC) and Ministry of Health published guidelines for patient’s treatments during pandemic which includes: 1) providing only emergency Treatments 2) Patient’s pre-admittance Questioning, 3) Increasing intervals between appointment, 4) prevent crowding in waiting rooms, 5) Wearing masks at all times. 6) Wearing PPE. Methods: Data from all clinical departments of Frontier Medical and Dental College and Hospital Abbottabad was collected between March and December 2020 which included Number of; 1) Patients treated 2) Medical Staff 3) patients with positive COVID-19 reports 4) healthcare workers suffering from COVID-19. And 6) Post treatment Virus Infected patients. Results: 291 health care staff including 135 medical and dental doctors, 4 dental hygienists, 82 paramedics and 70 Administrative staff worked during the study period and 3280 procedures were performed. Out of these, thirty-eight (38) staff members treated 190 verified COVID-19 patients. During the study period 6 dentists (2.06%) and 9 (3.09%) medical doctors, 2 (0.7%) assistants and 3 (1.03%) admin staff were tested positive for the virus. Conclusion: Present study highlights the importance of education and stickiness to the infection control guidelines thus minimizing the risk of transmission of corona virus among the Healthcare professionals in hospitals. Keywords: COVID-19; Infection control, PPE, NCOC

Factors Associated with Intention to Comply with Infection Control Guidelines in Physicians and Nurses: An Analysis Based on the Theory of Planned Behavior

Purpose: This study aimed to identify factors affecting physicians and nurses’ intention to comply with healthcare-associated infection control guidelines, based on the theory of planned behavior.Methods: This study was a cross-sectional, descriptive survey. Data were collected using self-report questionnaires from 169 doctors and nurses at a tertiary hospital. Pearson correlation analysis and multiple regression analysis were used to analyze the factors influencing intention to comply with healthcare-associated infection control guidelines.Results: The mean score of intention to comply with infection control guidelines was 17.17±2.60 points (possible range 3-21 points). The intention to comply with infection control guidelines was positively associated with subjective norms and perceived behavioral control over compliance with healthcare-associated infection control guidelines. In the multiple regression analysis, perceived behavioral control was the only significant predictor of intention to comply with healthcare-associated infection control guidelines.Conclusion: In order to encourage doctors and nurses to comply with infection control guidelines, it is necessary to provide resources, enhance the work environment, and utilize strategies to increase perceived behavioral control over compliance with infection control guidelines.

Dentist Related Factors Associated with Implementation of COVID-19 Protective Measures: A National Survey

Little is known about the extent to which dentists have implemented COVID-19 infection control guidelines and the factors influencing this process in daily practice. This national online survey assessed the implementation of enhanced infection control guidelines in daily practice, and explored dentist related factors influencing their application, more specifically dentist infection status and their perceived risk of cross-infection in the dental setting. The survey was validated, pretested and carried out in 2020. A total of 1436 dentists participated, of whom 9.1% presumably had COVID-19 infection experience. At least 75% of dentists complied with the core part of the recommended protective measures protocol. For each patient treated during the pandemic, an additional cost of 10–30 EUR (86.7%) and an extra time of 10–30 min (70.7%) was estimated. A stepwise binary logistic regression analysis revealed that dentists assumed to have experienced COVID-19 reported a higher self-perceived risk of virus acquisition (β = 2.090; p = 0.011), lower concern of getting infected (β = 0.576; p = 0.027), and lower confidence in being able to prevent disease transmission in the dental setting (β = 0.535; p = 0.022). Some parts of the protective measures were more difficult to apply than others; however, there was no indication of increased disease acquisition in the dental setting.

QUALITY IMPROVEMENT INITIATIVE IN CSSD AT A MATERNITY CARE HOSPITAL USING THE PDCA CYCLE TO SUPPORT KAIZEN (CONTINUOUS IMPROVEMENT)

Background: The Central Sterile Supply Department (CSSD) is a service unit of the hospital responsible for providing guaranteed sterile equipment/ instruments to all the departments of hospital for immediate use in patients care. Method: During a 4-month period, in CSSD which caters two number of operation theatres and a 6 bedded Intensive care unit, a central laboratory and a blood bank a study was done, we used PDCA approach to PLAN i.e., identify and analyze the problem, within CSSD and to “DO” i.e., implement changes in CSSD from the inputs given by all the stakeholders involved viz. CSSD technicians, staff, nursing ofcers and the consultants. Subsequently PDCA approach was used to identify and analyze the problem, viable solutions were incorporated. Results : To identify the problem process mapping and interactive sessions with the staff and it was identied that the main problem was inadequate quality in the CSSD services. Our analysis also extracted that the Standard operating procedures were documented related to CSDD were found to be inadequate with regard to the machine maintenance, staff training. The “Do” stage is where we checked for possible solutions or changes. By carrying out a detailed process mapping of the CSSD work ow, an action was taken based on what was learned in the study and to incorporate what we have learned from the test into wider changes, to plan new improvements and start the cycle. Conclusions : The interesting application of PDCA cycle to improve Kaizen and the results achieved reinforces the usefulness of the Kaizen tools to improve business excellence. Using the same facilities, it was possible for efcient space utilization, better improvement in Knowledge of the manpower, identied few gaps in the material procurement and developed standard operating procedures to be followed which are on par to the national and international infection control guidelines which resulted in better working conditions and efcient output from the central sterile supply department.

Towards capturing a database of respiratory exhalations from flow visualisations

One of the most common modes of infection transmission is through pathogen laden droplets expelled during natural human respiratory exhalations such as speaking, coughing, and sneezing. Infection control guidelines for the prevention of respiratory infection make assumptions about two key parameters: the safe distance between an infected and healthy individual and the size of large and small droplets (Bahl et al., 2020). Studies in the past have utilised flow visualisation techniques to understand the dynamics of respiratory flows but most of them provide only qualitative data on respiratory droplets and do not provide sufficient detail to estimate accurate flow velocities (Bourouiba et al., 2014; Vansciver et al., 2011; Scharfman et al., 2016). One of the reasons this remains a demanding application is the vast range of droplet sizes that are expelled at various velocities. Here, we present an experimental framework using particle tracking to understand the flow dynamics of the expelled droplets. Three different illumination techniques were used to capture high-speed frames of different exhalations (see figure 1). The high density of droplets in case of sneezing lead to overlap of droplet trajectories with volume illumination approach, which was resolved using tailored optics to illuminate only a slice of sneeze flow. Thereafter, the image processing techniques required for precise PTV were refined to examine droplet dynamics of various exhalations (see figure 2). The techniques were applied to multiple cases of respiratory exhalations to understand subject to subject variability. The results for sneezing revealed a mean droplet velocity of 2 m/s to 5.4 m/s across different subjects. Additionally, less than 1% of droplets were expelled at velocities greater than 10 m/s and almost 80% of were expelled at velocities less than 5 m/s. These values were substantially lower than the values usually assumed in studies modelling or replicating sneezes (Xie et al., 2007; Atkinson and Wein, 2008). The results also revealed a high variation in the droplet dynamics, even among the sneezes from the same subject. Flow direction, spread angle, and head movement were also quantified, and the results reveal substantial variation between the subjects. In the case of coughing, maximum droplet velocities observed were in the range of 10−15 m/s however, these high velocities were detected only during the initial 0.05 s. This work addresses the critical gaps in the understanding of the respiratory transmission of infection by providing valuable data on the droplet dynamics of various exhalations, on which the experimental data was very limited in the existing literature. Furthermore, this data will aid in numerical modelling of respiratory flows, particularly for sneezes, as studies to date rely only on airflow data of the exhalations.

Evidence based management guidelines in dentistry during COVID-19 pandemic – a review of the literature

The present COVID-19 pandemic presents a high risk of transmission. Several infection control procedures have been employed to alleviate the further spread of this disease. The dental practice could be a potential risk factor for the transmission of this virus, which has a potential for aerosol generation. For a successful dental practice, effective infection control guidelines have to be established using relevant scientific research. In this perspective, the present article focused on current systematic reviews with evidence based effective treatment protocols during this pandemic.

Longitudinal study of a SARS-CoV-2 infection in an immunocompromised patient with X-linked agammaglobulinemia

We describe the case of a 23-year-old immunocompromised male patient with clinically diagnosed X-linked agammaglobulinemia who was admitted to the hospital on the 14th April 2020 due to coronavirus disease of 2019 (COVID-19). Despite COVID-19 test negativizations, the patient was hospitalized most of the time and finally admitted to the intensive care unit where he died from multiorgan failure and shock. Over 149 days, 26 respiratory samples were collected, subjected to viral genome sequencing, and all assigned to the same lineage, supporting a single viral infection event. The accumulation of mutations throughout the course of the infection was accelerated and suggested the presence of compartmentalized viral subpopulations that evolved independently in the upper and lower respiratory airways. These results support that long-term viral shedding in immunocompromised patients is one possible mechanism for the emergence of variants of concern and provide evidence towards the infection control guidelines in these patients.