Infection Prevention Behaviors Research Articles

What Are the Infection Prevention Behaviors of Kidney Transplant Recipients and the Factors Related to These?

The infection prevention behaviours of kidney transplant recipients have been investigated, but the factors affecting these have not. Therefore, the present study aimed to examine the infection prevention behaviours of kidney transplant recipients and the factors related to these. The sample of this descriptive, cross-sectional study included 148 kidney transplant recipients being followed in a kidney transplant outpatient clinic. Data were collected with a sociodemographic and clinical characteristics form, the Adherence to Measures against Infections Questionnaire and the Self-Control and Self-Management Scale between November 2022 and May 2023. The mean age of the patients was 50.29 ± 13.11 years. The rate of self-reported hand hygiene was 51%. Age caused a significant difference in receiving a vaccine against pneumonia and wearing a mask. The rate of self-reported behaviour of rinsing vegetables was higher among the married patients compared to single patients. Self-management created a significant difference in receiving a vaccine against influenza and pneumonia, eating salad in a café or restaurant and wearing a mask outside home and consuming raw food, delicatessen products and street food (p < 0.05). This study revealed that the kidney transplant recipients displayed incomplete infection prevention behaviours including hand hygiene. Infection prevention behaviours differed in terms of age and self-control and self-management. Education and interventions are needed to improve the infection prevention behaviours of kidney transplant recipients. This study illustrates the characteristics of, and relationship between, sociodemographic factors and self-management of infection prevention behaviours in kidney transplant recipients. Strengthening the reporting of cross-sectional studies (STROBE) was followed. The study demonstrates that there is a need for interventions that will improve both the self-management levels and infection protection behaviours of patients. Studies conducted in this direction will lead to a decrease in the infection rates of patients.

Barriers to Effective Infection Prevention in the Neonatal Intensive Care Unit: A Qualitative Study.

Infection prevention (IP) behaviors such as hand hygiene (HH) and mobile device disinfection are important to reduce the risk of infection transmission from both family members and hospital staff to critically ill neonates. To inform the design of educational interventions to improve both patient family and staff IP behaviors, we engaged separate groups of nurses and family members to understand perceptions about the spread of infection and barriers to implementing effective IP strategies. This was a qualitative study using focus groups to gather data from neonatal nurses and patient family members. Data were triangulated with hospital-wide survey data and analyzed using inductive content analysis. Twelve nurses and 4 patient family members participated. Themes related to communication about IP between staff and family members emerged: stakeholders expressed discomfort with the timing and nature of just-in-time HH education. These communication challenges contributed to stress levels within the neonatal intensive care unit. This finding was reflected in the hospital-wide survey. Steps should be taken to improve communication about IP behaviors between patient family members and frontline staff. Reducing nurse burden of providing just-in-time HH reminders to patient family members through increased IP education may decrease stress and facilitate IP behaviors. This has the potential to decrease infection spread and improve patient outcomes. The development of interventions targeting stakeholder communication is therefore warranted, but additional research is needed to understand the timing and process for delivery of the educational material.

Individual Characteristics Associated with Fears and Prevention Behaviors Related to Respiratory Infectious Disease among South Korean Adults Using Complex Sample Design.

This study aimed to identify the relationships among individual characteristics, COVID-19-related fears, and infection-prevention behaviors using data from 228,932 adults (weighted to 43,583,798.71) aged 19 and older who participated in the 2021 Community Health Survey conducted by the Korea Disease Control and Prevention Agency. The complex sample design analysis using SPSS 20.0 revealed the following. Women had statistically significantly higher COVID-19-related fears and a higher level of preventive behaviors compared to men. During the COVID-19 pandemic, the level of physical activity among men was higher than that of women. Compared to the period before COVID-19, the frequency of smoking and drinking decreased for both men and women, with the reduction being more pronounced in men than in women. The high-exercise group had a lower level of COVID-19-related fears. Self-perceived health status was inversely and significantly related to COVID-19-related fears. The low-exercise group had a lower score for self-perceived health status than the high-exercise group. This study demonstrated that maintaining sufficient physical activity positively influences self-perceived health and reduces anxieties related to COVID-19 infection and fatalities. The results highlight the importance of physical activity and the need to identify strategies that effectively maintain regular exercise while adhering to infection-prevention measures during pandemics.

State of infection prevention knowledge among healthcare professionals in Japan: a questionnaire survey analysis using text mining

Healthcare-associated infections (HAIs) are an important issue that needs to be continuously addressed in healthcare institutions, and healthcare professionals (HCPs) are expected to strengthen educational programmes on infection prevention. Although the incidence of HAIs in Japan has been decreasing, the actual state of knowledge on infection prevention among HCPs remains unclear. To clarify the actual infection prevention knowledge of HCPs in Japan. The study participants were 1158 HCPs working in healthcare institutions with frequent contact with patients (283 doctors, 591 nurses, 115 physical therapists, 97 radiologists, and 72 medical technologists). HCPs described the infection prevention behaviours they consciously adhered to via an online self-administered questionnaire. Data were analysed by text mining. Categories were extracted from the responses to reveal HCPs' infection prevention knowledge. More than half of the participants (64.9%) were aged > 40 years, and 48.1% had over 20 years of clinical experience. The majority of the participants were nurses (51.0%), 43.9% had a bachelor's degree, and 56.6% were female. Seven categories regarding infection prevention knowledge were extracted: "performing hand hygiene and gargling," "wearing personal protective equipment," "strengthening one's immunity," "protecting oneself and patients from infection," "distinguishing clean and unclean zones," "actions to prevent transmission to others in daily life activities," and "maintaining distance from others." These results suggest that most HCPs working in healthcare settings in Japan prioritize and adhere to standard precautionary measures, and that the low incidence of HAIs may be influenced by perceptions of the knowledge of "handwashing and gargling" among HCPs.

사회생태학적 모형에 기반한 육군훈련소 병사들의 호흡기감염병 예방행위 영향 요인

사회생태학적 모형에 기반한 육군훈련소 병사들의 호흡기감염병 예방행위 영향 요인

Examining the Relationship between Infection Control Practices and ESBL Bacterial Carriage in Healthcare Workers

The Enterobacteriaceae family widely produces Extended Spectrum Beta-Lactamase (ESBL), and infection by ESBL-producing bacteria can significantly increase morbidity, complicate therapeutic difficulties, escalating healthcare costs, and increase mortality rates. Transmission of these bacteria within the hospital environment may lead to the prevalence of ESBL-producing bacterial carriers among healthcare workers. Health workers' infection prevention and control (IPC) behavior plays a role in transmitting these pathogenic bacteria. This study aimed to determine the relationship between IPC behavior and the incidence of ESBL-producing bacterial carriers in health workers at Banjarnegara Islamic Hospital. This research used an observational analytic approach with a cross-sectional method. The sampling technique involved purposive sampling, resulting in a total sample of 61 people. Data were obtained by completing an IPC behavior questionnaire and collecting rectal swab samples cultured on CHROM ESBL Agar media. Statistical analysis was done using the Mann-Whitney test. The research identified a prevalence of 13.1% (8/61) ESBL-producing bacterial carriers among health workers at Banjarnegara Islamic Hospital. However, based on statistical analysis, the p-value was 0.664, leading to the rejection of the hypothesis (accepted if p-value &lt;0.05). In conclusion, there is no significant relationship between IPC behavior and the incidence of ESBL-producing bacterial carriers in health workers at Banjarnegara Islamic Hospital.

Vaccination Status, Vaccine Awareness and Attitudes, and Infection Control Behaviors of Japanese College Students: A Comparison of 2021 and 2023.

Background: Now that the spread of COVID-19 has been controlled, it is important to investigate changes in young people's perceptions of the vaccine and their behavior toward infection. The objectives of this study were as follows: (1) to investigate the association between Omicron strain vaccination rates among college students, their perceptions of the vaccine, and past adverse reactions to the vaccine; (2) to compare 2021 (when COVID-19 was spreading) and 2023 (when COVID-19 was strained) to identify changes in attitudes toward vaccination and motivations for vaccination and changes in infection prevention behavior. Methods: This cross-sectional survey was conducted via e-mail from 5 January to 30 January 2023. All students at Hiroshima University were sent an e-mail, which provided them access to the survey form and requested their cooperation. The questionnaire consisted of 33 items related to attributes, vaccination status, adverse reactions after vaccination, motivation for vaccination, perception of the vaccine, presence of coronavirus infection, sequelae, and infection prevention measures. Results: A total of 1083 students responded to the survey. Over 50% of the students were vaccinated with the Omicron booster. Regarding trust in vaccines, the majority of both male and female respondents said they had some trust in vaccines, although this was less than that observed in the 2021 survey. As for infection control measures, only 2% of males and 0.3% of females answered that they did not take any infection control measures. The most common response was "wear a mask", as in the 2021 survey, with 476 men (96.6%) and 575 women (99.5%). Conclusions: The survey showed a high Omicron-responsive vaccination rate of more than 50%. In addition, more than 99% of the students were found to be taking measures to prevent infection, such as wearing masks.

Bayesian probability revision and infection prevention behavior in Japan: A quantitative analysis of the first wave of COVID-19

The relationship between cognitive biases and infection prevention behavior remains unexplored in the existing literature. This study uses data from a questionnaire survey conducted in Japan on the first wave of Coronavirus Disease 2019 (COVID-19) from February to May 2020 to empirically investigate the impact of Bayesian probability inference, the influence of cognitive biases of PCR test results on infection prevention behavior, and the discrepancy between infection prevention intentions and behaviors. We used a bivariate ordinal probit model when considering the correlation between behaviors. The results showed that the higher probability responses, implying pessimistic biases, were more likely to indicate that declaring a state of emergency was necessary and effective, and were more health-oriented in ensuring infection prevention behavior even at the expense of the economy. However, the study found that although they wanted to reduce the frequency of their outings and the number of people they met, they did not reduce them in terms of actual behavior change. It also found that those with pessimistic biases had a higher WTP for the vaccine.

Investigating the causal effects of COVID-19 vaccination on the adoption of protective behaviors in Japan: Insights from a fuzzy regression discontinuity design.

During the COVID-19 pandemic, concerns emerged that vaccinated individuals might engage less in infection-preventive behaviors, potentially contributing to virus transmission. This study evaluates the causal effects of COVID-19 vaccination on such behaviors within Japan, highlighting the significance of understanding behavioral dynamics in public health strategies. Utilizing Japan's age-based vaccination priority for those born before April 1, 1957, this research employs a regression discontinuity design (RDD) to assess the vaccination's impact. Data from the fourth round of a longitudinal online survey, conducted from July 20 to 27, 2021, served as the basis for analyzing 14 infection-protective behaviors, including mask usage, handwashing, and avoiding crowds. A total of 12067 participants completed the survey. The analyzed sample size varied by outcome variable, ranging from 1499 to 5233. The analysis revealed no significant differences in the 14 behaviors examined among fully vaccinated, partially vaccinated, and unvaccinated individuals. This consistency across groups suggests that vaccination status did not significantly alter engagement in protective behaviors during the observation period. Empirical findings highlight the complexity of behavioral responses following vaccination, indicating that such responses may be influenced by various factors, rather than by vaccination status alone. Additionally, this result underscores the importance of crafting public health policies that account for the intricate interplay between vaccination and behavior. This study contributes to the broader discourse on managing responses to the pandemic and tailoring interventions to sustain or enhance protective health behaviors amid vaccination rollouts.

Factors Influencing the Intention of COVID-19 Infection Preventive Behaviors Among Hemodialysis Patients in Korea: A Cross-sectional Study

Objectives: This study aimed to identify the factors influencing the intention of COVID-19 infection preventive behaviors among patients undergoing hemodialysis by applying the theory of planned behavior. Methods: The study included 209 patients with chronic renal failure undergoing hemodialysis at five hospitals in Gangwon-do, Korea. Data were collected from December 28, 2021 to January 15, 2022. The analysis involved percentage, mean and standard deviation, independent t-test, ANOVA, Pearson’s correlation coefficient, and hierarchical multiple regression using SPSS 22.0. Results: Significant correlations were observed between attitude toward COVID-19 preventive behavior, subjective norms regarding COVID-19 preventive behavior, perceived behavior control of COVID-19 preventive behavior, restricted dietary control, COVID-19 knowledge, self-efficacy in COVID-19 preventive behavior, and intention of COVID-19 infection preventive behavior. Hierarchical multiple regression analysis revealed that subjective norms regarding COVID-19 preventive behavior (β = 0.49, p &lt; 0.001) and perceived behavior control of COVID-19 preventive behavior (β = 0.26, p &lt; 0.001) significantly influenced the intention of COVID-19 infection preventive behavior among hemodialysis patients. The model accounted for 54.8% of the variance (F = 43.02, p &lt; 0.001). Conclusions: Identifying relevant factors associated with COVID-19 preventive behaviors among vulnerable hemodialysis patients is crucial for providing adequate care by healthcare professionals. Proactive measures are necessary to prevent and manage the infection in this patient population.

Understanding covid-19 prevention behaviours: Implications for social and health marketers for the prevention of future pandemics

From the integrative perspectives of the health belief model and social influence theories, the study sought to identify factors social and health marketers should focus on to elicit voluntary change in behavior toward the performance of COVID-19 infection prevention behaviors such as frequent handwashing with soap, social distancing, and avoidance of handshaking using mixed method approach. The quantitative data from 605 respondents through structured questionnaires were analyzed using PLS-SEM. The qualitative data through five focus group discussions were also analyzed using thematic analysis. The result shows that religiosity and trust in traditional medicine are the major factors contributing to the lack of severity and susceptibility to the coronavirus. The result further shows informational and normative social influencers as significant mediators between the constructs of the HBM and the performance of the COVID-19 protocols, suggesting that these influencers play a significant role in achieving the performance of the recommended behaviors.

임상간호사의 COVID-19 감염예방행위에 미치는 영향요인

임상간호사의 COVID-19 감염예방행위에 미치는 영향요인

Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic

BackgroundFood insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people.MethodsIn partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences.ResultsAmong 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n = 588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders.ConclusionsHigh rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in American Indian and Alaska Native communities.

Association of COVID-19 preventive behavior and job-related stress with the sleep quality of healthcare workers one year into the COVID-19 outbreak: a Japanese cross-sectional survey

BackgroundThis study aimed to evaluate the association of COVID-19 preventive behavior and job-related stress with sleep quality among healthcare workers (HCWs). We conducted a cross-sectional survey using a questionnaire at the National Center of Neurology and Psychiatry, Tokyo, Japan.MethodsA total of 586 participants who completed the questionnaire were eligible for the study. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. We examined the level of engagement between poor sleep and COVID-19-related infection preventive behaviors, such as avoiding closed spaces, crowded places, and close contact (three Cs), a distance of at least one meter from others, wearing a face mask regularly, washing hands regularly, and working remotely, as well as job-related stress in the work environment, exposure to patients, potential risk of infection, fear of infecting others, need for social confinement, and financial instability. We conducted a hierarchical logistic regression analysis to examine the relationship between poor sleep and COVID-19 preventive behavior, job-related stress, and other covariates, including age, sex, and the Kessler Psychological Distress Scale (K6), which was used to measure non-specific psychological distress.ResultsPoor sleep was observed in 223 (38.1%) participants. Adherence to COVID-19 preventive measures was relatively high: 84.1% of participants answered “always” for wearing a face mask regularly and 83.4% for washing hands regularly. In the multivariate logistic regression analysis, stress in the work environment (odds ratio [OR] = 2.09, 95% confidence interval [CI], 1.37–3.20; p < 0.001), financial instability (OR = 1.73, 95% CI, 1.12–2.67; p < 0.05), and low adherence to working remotely (OR = 1.65, 95% CI, 1.06–2.57; p < 0.05) were independently and significantly associated with poor sleep after controlling for the covariates.ConclusionsOne year into the COVID-19 pandemic, the poor sleep rates of HCWs remained high. These results emphasize the need to protect HCWs from work environment stress and financial concerns.

Adding COVID to cancer: does cancer status influence COVID-19 infection preventive behaviors?

A better understanding of how to promote disease mitigation and prevention behaviors among vulnerable populations, such as cancer survivors, is needed. This study aimed to determine patterns of and factors associated with COVID-19-related preventive behaviors among cancer survivors and assess whether the COVID-19 preventive behaviors of cancer survivors differ from the general population. In June 2020, an online survey of adults (N = 897) assessed predictors of COVID-19-related preventive behaviors, including socio-demographics, COVID-19 beliefs and perceptions (Health Belief Model [HBM] variables), and cancer statuses (cancer survivors currently in treatment, cancer survivors not currently in treatment, and individuals with no history of cancer). An average score of respondent engagement in eight preventive behaviors was calculated. Differences in HBM variables and preventive behaviors by cancer status were assessed using ANCOVAs. Hierarchical multiple regression analyzed associations among socio-demographics, HBM constructs, cancer statuses, and engagement in COVID-19 preventive behaviors. Participants reported engaging in 3.5 (SD = 0.6) preventive behaviors. Cancer survivors not in treatment engaged in preventive behaviors significantly less than the comparison group. In the final adjusted model, after adding COVID-19 beliefs and perceptions, cancer status was no longer significant. All HBM constructs except perceived susceptibility were significant predictors of preventive behaviors. COVID-19 beliefs and perceptions were more robust predictors preventive behaviors than cancer status. Nonetheless, public health organizations and practitioners should communicate the risk and severity of infection among cancer survivors and emphasize the need to engage in protective behaviors for COVID-19 and other infectious diseases with this vulnerable population.

Factors Influencing Nurses’ Infection-preventive Behaviors for Emerging Infectious Diseases: A Cross-sectional Study

Purpose: This study investigated the effects of knowledge, risk perception, and nursing professionalism on nurses’ infection-preventive behaviors for emerging infectious diseases (EIDs).Methods: This cross-sectional study’s participants were 204 nurses with at least 3 months of experience caring for patients with EIDs at four government-designated medical institutions in Korea, which were the first to handle cases of EIDs.Results: The average score for infection-preventive behaviors concerning EIDs was 4.54±0.45 points out of 5.00, and the score for the early response stage for EIDs was the lowest. The factors influencing nurses’ infection preventive behaviors for EIDs were personal protective equipment education, knowledge, and risk perception. Nursing professionalism was identified as a new influencing factor.Conclusion: To improve nurses’ infection prevention behaviors for EIDs, specific and practical training in protective equipment must be conducted. Increasing nurses’ professional knowledge, strengthening risk perception, and implementing strategic programs to strengthen nursing professionalism are required. Nurses should be instructed and given clear rules on properly utilizing personal protection equipment. Nursing managers and nurses can improve their professionalism by creating a positive organizational culture.

Behavioural determinants shaping infection prevention and control behaviour among healthcare workers in Dutch general practices: a qualitative study reflecting on pre-, during and post-COVID-19 pandemic

BackgroundSince the Coronavirus Disease 2019 (COVID-19) pandemic, awareness of infection prevention and control (IPC) has increased in primary care settings. This study aimed to examine behavioural determinants shaping IPC behaviour pre-, during, and post-pandemic among healthcare workers (HCWs) in general practices, to inform optimised IPC in primary care.MethodsFor this qualitative study, semi-structured in-depth interviews were conducted during two study periods: (1) pre-COVID-19 pandemic: July 2019-February 2020, with 14 general practitioners (GPs) and medical assistants, and (2) during the COVID-19 pandemic: July 2022-February 2023, with 22 GPs and medical assistants. The design was informed by behaviour change theories. Data were analysed using thematic analysis.ResultsMain themes were: (1) risk perception and IPC awareness, (2) attitudes towards IPC and professional responsibility, (3) decision-making process and risk considerations for IPC adherence, (4) social norm and social influence in GP practice team, and (5) environmental context and resource availability in GP practice. During the pandemic, risk perception and awareness of the importance of IPC increased compared to the pre-pandemic period. A consistent belief emerged that IPC is part of professional responsibility, while needing to be balanced with other aspects of patient care. Decision-making is dependent on the individual GP and mainly influenced by risk assessments and sustainability considerations. The social context in the practice team can reinforce IPC behaviours. GP practice building and layout, and limited IPC resource and material availability were reported as main barriers.ConclusionsThe theory-informed insights of this study can be used for targeted interventions to optimise IPC behaviour in general practices. Adopting multifaceted strategies to target the various determinants is recommended to sustain IPC, by implementing continuous education using tailored communication, integrating IPC in work routines and organisational workflows, refining existing IPC protocols by incorporating decision-making tools for HCWs, fostering a culture of IPC through knowledge-sharing and teamwork, and addressing GP practice physical environment and IPC resource barriers.

Exploratory study to characterise the individual types of health literacy and beliefs and their associations with infection prevention behaviours amid the COVID-19 pandemic in Japan: a longitudinal study.

During a global infectious disease pandemic such as the coronavirus disease 2019 (COVID-19), individuals' infection prevention/risk-taking behaviours are likely to differ depending on their health literacy and beliefs regarding the disease. To effectively promote infection prevention behaviours, it is necessary to enable information dissemination and risk communication that consider individuals' health literacy and beliefs. In this study, we exploratorily characterised segments based on individual health literacy and beliefs regarding COVID-19 among the Japanese during the early stage of the COVID-19 pandemic, and investigated whether infection prevention/risk-taking behaviours and fear of COVID-19 differed among these segments. In this study, we conducted two web-based longitudinal surveys in Japan (PHASE 1, 1-30 November 2020, 6,000 participants; PHASE 2, 1-31 December 2020, 3,800 participants). We characterised segments of the target population using cluster analysis on health literacy and beliefs regarding COVID-19 obtained in PHASE 1. We further investigated the associations between the clusters and infection prevention/risk-taking behaviours and fear of COVID-19, obtained from PHASE 2. Five clusters were identified: 'Calm/hoax denial', 'Hoax affinity/threat denial', 'Minority/indifference', 'Over vigilance', and 'Optimism'. There were significant differences in infection prevention/risk-taking behaviours and fear of COVID-19 among the five clusters. The belief in susceptibility to infection, rather than affinity for hoaxes and conspiracy theories, was coherently associated with infection prevention/risk-taking behaviours and fear of infection across clusters. This study provides foundational knowledge for creating segment-specific public messages and developing interactive risk communication to encourage infection prevention behaviours.

Comparing factors related to perceived control and preventive behaviors from COVID-19 between Japanese and American nursing students: A cross-sectional study.

Higher levels of perceived control are important to maintain health. The difference in factors related to perceived control and preventive behaviors during the COVID-19 pandemic between Japanese and American nursing students remains unknown. This study aimed to compare factors related to perceived control and infection preventive behaviors between the two countries. This cross-sectional study included nursing students attending four universities in Japan and one in the United States. Using Google Forms, the participants answered a survey comprising sociodemographic data, the Perceived Control and Self-Efficacy Scale, the Perceived Health Competence Scale, and a preventive behavior questionnaire. The data were collected from November 2020 to May 2021. Linear and logistic regressions were used to analyze the factors related to perceived control and preventive behaviors, respectively. Data from 878 students were analyzed. University/campus emerged as a strong predictor for perceived control and preventive behaviors in both countries, with a positive correlation between perceived control and preventive behaviors. Older age, less frequent alcohol consumption, higher perceived health competence, less frequent work in Japan; and chronic conditions in the United States were associated with frequent preventive behaviors. Younger age was correlated with higher perceived control in Japan, while religion and increased workload were potential factors for American students. Individual factors were pivotal in Japan, whereas interpersonal factors were more likely related to perceived control in the United States. Additionally, in both countries, policy or organizational factors significantly influenced students' preventive behaviors.

Improving compliance with personal protective equipment among anaesthetists through behaviour-changing interventions during the coronavirus disease 2019(COVID-19) pandemic.

Since 2020, the coronavirus disease 2019 (COVID-19) pandemic has seen many changes in our daily infection prevention behaviours so as to reduce healthcare-associated transmission of COVID-19 in patients and healthcare workers. In the early phases of the COVID-19 pandemic of 2020, there was much emphasis on compliant personal protective equipment utilization in the operating theatres (OTs) for COVID-19-positive patients. However, during this period, there was a lack of international validated protocols on the appropriate handling and subsequent storage of personal protective equipment in the context of aerosol-generating procedures in OTs for asymptomatic antigen rapid test (ART)-negative patients. Given the potential for transmission even with a negative ART due to the incubation period, our team developed a checklist of eye protection (e.g. goggles/face shield) and N95 mask handling and storage in non-isolation OTs for these patients. We sought to improve the compliance of best practices from 20% to 80% amongst junior anaesthetists in Singapore General Hospital so as to prevent infection transmission and cross-contamination in the OT through education and behaviour-changing interventions. This quality improvement project took place over 19 weeks from June to October 2020 by our team of anaesthetists and nurse clinicians in the non-isolation OT setting. To analyse the problem, we performed a root cause analysis to understand attitudes and beliefs driving their behaviour. The top 80% of cited root causes for non-compliance then guided prioritization of resources for subsequent behaviour-changing interventions. Using the comprehensive infection control checklist, we conducted several plan-do-study-act cycles while implementing this new checklist amongst junior anaesthetists. A total of 227 assessments of junior anaesthetists were made in the care of asymptomatic ART-negative patients. Compliance with correctly handling goggles post-intubation started out as 33.3% in Week 1, which improved to 78.5% by Week 19. Compliance with goggle storage and face shield disposal started out at 13.6% in Week 1 and increased to 78.6% by Week 19. We attributed this improvement to education and behaviour-changing interventions. This quality improvement project focusing on improving compliance with personal protective equipment utilization during the COVID-19 pandemic in the management of asymptomatic ART-negative patients in non-isolation OTs demonstrated the importance of interventions of education, persuasion, modelling, and training in effecting and sustaining organizational behaviour change in physicians and other healthcare personnel.