28 Paediatric Emergency Department Staff Perceptions of Infection Control Measures against Severe Acute Respiratory Syndrome

Abstract

Severe Acute Respiratory Syndrome (SARS) is a respiratory illness recognized on several continents. Our city is one of the first major centres affected by SARS prompting the government to mandate rigorous infection control measures. Health care workers' perceptions of the effectiveness and practice of infection control measures during an evolving outbreak are previously unreported. The purpose of this study was to determine Paediatric Emergency Department (PED) staff perceptions of the effectiveness and practice of infection control measures against Severe Acute Respiratory Syndrome. All medical staff of the PED in a tertiary medical centre completed a written questionnaire over 7 days near the onset of the SARS outbreak. At the time of study, the effectiveness of infection control measures against this new pathogen was unknown. Level of concern regarding SARS and perceptions of the effectiveness and use of infection control measures were assessed on a 5-point scale. Statistical analysis was performed with SPSS using Chi-square and ANOVA tests with significance at p<0.05. Response rate was 97% (116/120). Using isolation rooms (mean score 4.6/5), wearing a mask when examining patients (4.5/5) and handwashing (4.5/5) were considered most effective. Staff physicians reported more handwashing than nurses and trainees (4.9/5 vs 4.5/5 and 4.5/5, p<0.05) while other measures were reported equally. Those who considered SARS a high public health threat reported higher compliance with handwashing (4.8/5 vs 4.4/5), wearing a mask at all times in the PED (3.9/5 vs 3.2/5), and gloves (3.6/5 vs 2.9/5) (p<0.05), but not eye protection (3.4/5 vs 3.0/5), gown use (4.9/5 vs 4.7/5), or wearing a mask when examining patients (5.0/5 vs 4.8/5) (p=NS). Staff who considered combined infection control measures effective in protecting patients and health care workers did not report increased compliance (p=NS). PED staff perceived some infection control measures to be more effective than others in protecting against the spread of SARS, and perceptions differed among staff physicians, nurses, and trainees. Eye protection was perceived as only moderately effective in protecting against the spread of SARS and reported compliance was relatively poor among PED staff. Concern of SARS as a public health threat rather than perceived effectiveness of infection control measures appears to have a greater impact on compliance.