Patient adherence with infection control measures on a novel 'COVID-19 triage' psychiatric in-patient ward.

Ryan Williams,John Tweed,Mariana Pinto Da Costa,Josephine Agyeman,Laura Rebolledo,Osman Khalid

doi:10.1192/bjo.2021.968

Ryan Williams, John Tweed + Show 4 more

Open Access

https://doi.org/10.1192/bjo.2021.968

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Abstract

Intra-hospital transmission of coronavirus disease 2019 (COVID-19) is a major concern. Psychiatric in-patient units pose unique challenges for the prevention of transmission. 'COVID-triage' wards with strict infection control procedures have been implemented to prevent the spread of infection, but little is known about the extent to which psychiatric in-patients adhere to these procedures. To examine patient adherence with infection control measures on a novel 'COVID-triage' psychiatric in-patient ward in London, England. This was an observational study of adherence with infection control measures. The proportion of patients who were adherent with infection control measures was calculated. The association of adherence with demographic and clinical factors was examined. The majority of patients (n = 138/176, 78.4%) were not adherent with infection control measures. However, adherence did improve when patients who were non-adherent were given direct instructions by staff during clinical contact. Patients with diagnoses of psychotic disorders, personality disorders and substance use disorders were less likely to be adherent than those without these diagnoses. Psychiatric in-patients show poor adherence with infection control measures. Proactive engagement by staff is key to improving patients' adherence. Urgent efforts are needed to identify and implement other effective methods of improving adherence in acute settings.

Highlights

Intra-hospital transmission of coronavirus disease 2019 (COVID19) is a major concern
The ‘coronavirus disease 2019’ (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major global public health threat, responsible for over 3.7 million deaths worldwide as of 10 June 2021.1
After adjustment for covariates, patients with a recorded primary diagnosis of any non-psychotic disorder were significantly more likely to be adherent with infection control measures compared with those with diagnoses of psychotic disorders (odds ratio (OR) = 3.13, 95% CI 1.25–7.83, P = 0.015)

Summary

Introduction

Intra-hospital transmission of coronavirus disease 2019 (COVID19) is a major concern. The environment in many of these facilities may limit effective infection control – patients are generally confined to close-proximity living spaces where they share common dining, bathroom and recreational areas.[4] Whereas patients in general hospitals spend the majority of time in separated bays, the nature of mental illness and models of care mean that psychiatric in-patients participate in group activities that increase patient-to-patient contact.[5]. Many psychiatric patients have poor physical health,[6,7,8] with a large proportion fulfilling criteria for ‘clinical vulnerability’ to COVID-19 because of comorbidities.[9] Disparities in mortality have been well-characterised for a range of causes for patients with severe mental illness.[10] Of specific relevance, patients with psychotic disorders who contract influenza or pneumonia have been found to have higher mortality rates.[11]

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