Adherence to protective measures among healthcare workers in the UK: a cross-sectional study

Background: Healthcare workers (HCWs) are frontline responders to emergency infectious disease outbreaks such as COVID-19. To avoid the rapid spread of disease, adherence to protective measures is paramount. We investigated rates of correct use of personal protective equipment (PPE), hand hygiene and physical distancing in UK HCWs who had been to their workplace at the start of the COVID-19 pandemic and factors associated with adherence.
Methods: We used an online cross-sectional survey of 1035 UK healthcare professionals (data collected 12–16 June 2020). We excluded those who had not been to their workplace in the previous 6 weeks, leaving us with a sample size of 831. Respondents were asked about their use of PPE, hand hygiene and physical distancing in the workplace. Frequency of uptake was reported descriptively; adjusted logistic regressions were used to separately investigate factors associated with adherence to use of PPE, maintaining good hand hygiene and physical distancing from colleagues.
Results: Adherence to personal protective measures was suboptimal (PPE use: 80.0%, 95% CI 77.3 to 82.8; hand hygiene: 67.8%, 95% CI 64.6 to 71.0; coming into close contact with colleagues: 74.7%, 95% CI 71.7 to 77.7). Adherence to PPE use was associated with having received training about health and safety in the workplace for COVID-19, greater perceived social pressure to adopt the behaviour and availability of PPE. Non-adherence was associated with fatalism about COVID-19 and greater perceived difficulty of adopting protective measures. Workplace design using markings to facilitate distancing was associated with adherence to physical distancing.
Conclusions: Uptake of personal protective behaviours among UK HCWs at the start of the pandemic was variable. Factors associated with adherence provide insight into ways to support HCWs to adopt personal protective behaviours, such as ensuring that adequate PPE is available and designing workplaces to facilitate physical distancing.

背景：医护人员（Healthcare Workers, HCWs）是新冠疫情等突发传染病暴发时的一线应对人员。为遏制疾病快速传播，严格遵守防护措施至关重要。本研究针对新冠疫情初期仍前往工作场所的英国医护人员，调查其个人防护装备（Personal Protective Equipment, PPE）、手卫生及物理距离的正确使用率，并分析与防护依从性相关的影响因素。
方法：本研究采用线上横断面调查方法，共纳入1035名英国医护人员（数据采集时间为2020年6月12日至16日）。我们排除了此前6周内未前往工作场所的受访者，最终有效样本量为831。调研内容涵盖受访者在工作场所的PPE使用、手卫生及物理距离执行情况。本研究先以描述性统计方法报告行为依从频率；随后分别采用校正后的logistic回归模型，分析与PPE使用、良好手卫生执行及与同事保持物理距离相关的影响因素。
结果：医护人员对个人防护措施的依从性未达最优水平（PPE使用依从率：80.0%，95%置信区间（Confidence Interval, CI）77.3%~82.8%；手卫生依从率：67.8%，95%CI 64.6%~71.0%；与同事近距离接触比例：74.7%，95%CI 71.7%~77.7%）。PPE使用依从性与接受过新冠工作场所健康安全培训、感知到的行为采纳社会压力更大以及PPE可及性较高相关。防护依从性不足则与对新冠持宿命论态度以及感知到的防护措施执行难度更高相关。通过设置标识辅助保持物理距离的工作场所设计，与物理距离依从性显著相关。
结论：新冠疫情初期，英国医护人员的个人防护行为依从性存在较大差异。与防护依从性相关的影响因素，为支持医护人员落实个人防护行为提供了实践方向，例如确保PPE的充足供给，以及优化工作场所设计以辅助保持物理距离。