Podcast: Factors that influence whether healthcare workers follow infection prevention and control guidelines for respiratory infectious diseases

COVID-19 has spread quickly, and Cochrane is producing a series of rapid reviews of relevant evidence to help decision makers. One of these looks at the views of healthcare workers on infection prevention and control guidelines, and we asked lead author, Catherine Houghton from the National University of Ireland in Galway to describe the key findings, published in April 2020.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. COVID-19 has spread quickly, and Cochrane is producing a series of rapid reviews of relevant evidence to help decision makers. One of these looks at the views of healthcare workers on infection prevention and control guidelines, and we asked lead author, Catherine Houghton from the National University of Ireland in Galway to describe the key findings, published in April 2020.

Catherine: At times like this, we are more acutely aware than ever of the tremendous role of our healthcare workers; and infection prevention and control guidelines, or IPC guidelines, are vital to protect them, their patients and, indeed, their families and friends. The guidelines cover strategies such as the use of personal protective equipment, or PPE, including masks, face shields, gloves and gowns; separating patients with respiratory infections from others; and stricter cleaning routines. 
We used an approach called qualitative evidence synthesis to look at what helps or hinders healthcare workers when using these guidelines to work with respiratory infectious diseases. This allows us to bring together the findings of individual studies in a way that captures “real world” views and experiences across a number of settings. 
We found 36 relevant studies and sampled 20 for analysis. Ten were from Asia, four from Africa, four from central and North America, and two from Australia. The studies explored the views and experiences of nurses, doctors, allied health professionals and other healthcare workers when dealing with respiratory diseases such as SARS, MERS, tuberculosis, and influenzas. Most of the participants worked in hospitals but some worked in primary and community care settings.
We found several important factors that influenced healthcare workers’ adherence with IPC guidelines. From an organisational perspective, staff found it confusing when guidelines were too long and ambiguous or if they differed from national and international guidance. Guidelines had often changed frequently and this need to be communicated in a way that busy staff can access easily. Healthcare workers described how their responses to IPC guidelines were influenced by the level of support from their management team, and needed management to consider, for example, the extra workload and burden of working with PPE. On top of this, a lack of PPE, or PPE that was of poor quality, was a serious concern for healthcare workers; and they highlighted the need to adjust supplies as infection outbreaks continued, meaning that forward planning was crucial. 
Healthcare workers pointed to a need for training about the infection itself and about how to use PPE. This training was important for all staff, including cleaners, porters, and kitchen staff, in order to help adherence to the guidelines. Ultimately, a workplace culture that values adherence can influence whether healthcare workers followed the IPC guidelines.
The environment also posed problems in terms of adherence. Sufficient space to isolate patients was seen as vital, including the need for isolation and waiting rooms, and shower facilities for staff. Other important practical needs included minimising overcrowding, fast tracking infected patients, restricting visitors, and providing easy access to handwashing facilities.
For the individual worker, believing in the value and effectiveness of IPC guidelines helped adherence. Healthcare workers felt motivated to follow the guidance because of fear of infecting themselves and their families, or because they felt responsible for their patients. Some worried about wearing PPE such as masks, if this made patients feel frightened or stigmatised.
Finally, to help people access our key messages, we’ve created an evidence summary that poses questions for managers and organisations to consider when implementing IPC guidelines. This will allow them put in place the supports to help healthcare workers adhere to the guidelines for respiratory infectious diseases and minimise the risk to themselves and others.

Monaz: Thanks Catherine. If you would like to read the full version of the rapid review, its available free online. If you go to Cochrane library dot com and search "healthcare workers and IPC guideline", you’ll find it and a link to the evidence summary.

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