Publication date: Jan 22, 2024
Since 2020, the 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 (PPE) utilization in the operating theatres (OT) 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 PPE in the context of Aerosol Generating Procedures (AGPs) 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. googles/face shield) and N95 mask handling and storage in non-isolation OTs for these patients. We sought to improve compliance of best practices from 20% to 80% amongst junior anaesthetists in Singapore General Hospital (SGH) 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 clinician 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 (PDSA) 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 to correctly handling goggles post-intubation started out as 33. 3% in week 1, which improved to 78. 5% by week 19. Compliance to 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 to PPE utilization during the COVID-19 pandemic in the management of asymptomatic ART-negative patients in non-isolation operating theatres demonstrated the importance of interventions of education, persuasion, modelling and training in effecting and sustaining organizational behaviour change in physicians and other healthcare personnel.
Behaviour changing interventions|