Changes in infection control practice for coronavirus disease 2019 (COVID-19) between 2020 and 2021: A nationwide questionnaire survey in Japan

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has influenced current infection control practices in the healthcare setting.We surveyed 74 hospitals in Japan regarding changes in their infection control practices or policies between 2020 and the present.We found that the current hospital infection control practices for COVID-19 are adequate. (Received 7 June 2021; accepted 14 June 2021) Since its inception in early 2020, the coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges to infection control practices in various regions around the world. COVID-19 among healthcare workers (HCWs) and hospitalized patients has led to substantial increases inmorbidity andmortality. Meanwhile, several new guidelines on infection control practices focusing on severe acute respiratory coronavirus virus 2 (SARSCoV-2) have been hurriedly issued by professional societies.1,2 Despite the importance of preventive measures against nosocomial transmission of SARS-CoV-2, the optimal SARS-CoV-2 infection control practices for acute-care hospitals are still moot. Some unresolved infection control–related issues remain, including what the indications for testing are, when patients should be quarantined, what constitutes appropriate personal protective equipment (PPE), when isolation precaution should be discontinued, what precautions should be taken in high flow nasal cannula (HFNC) use, and how infection control practices vary by institutions. We investigated the current infection control practices at the participating institutions and compare the most current infection control practices (February–April 2021) with those of February– April 2020. Methods The current study was based on responses to a survey regarding infection control practices against SARS-CoV-2 which was sent to Japanese tertiary-care hospitals. The survey asked about hospital characteristics (eg, location, type of hospital, cumulative number of hospitalized patients with COVID-19 at each institution), individual-level practice (eg, PPE use, and actual infection control practices against SARS-CoV-2), and hospital-level practice [eg, precautions in HFNC use, and noninvasive positive pressure ventilation (NPPV) use] during February–April 2020 and February– April 2021. A draft of the questionnaire was developed by the primary investigators (H.H. and A.T.) based on the current infection control guidelines as well as our own clinical experience of COVID-19 infection control practice.1,2 This survey was reviewed by the other primary investigators (K.O. and H.S.) for finalization. The questionnaire was then distributed to participants (either infection control nurses, physicians or other infection control personnel) at hospitals caring for COVID-19 patients with a snowball sampling. The survey was conducted using Google forms fromApril 19, 2021, through May 16, 2021.3 The institutional review board at Tokyo Metropolitan Tama Medical Center approved the project. Results During the study period, 74 hospitals responded to the survey. Table 1 shows the details of each institution. Approximately 65% of the participating institutions were in the Kanto region, which includes the Tokyo metropolitan area, the epicenter of the COVID-19 pandemic in Japan. Many hospitals (48 of 74, 64.9%) dispatched physicians from various subspecialties, including surgery, to care for patients with COVID-19. Hospital infection control measures relied heavily on local Japanese and US guidelines. For PPE use, the N95 mask only or in combination with a surgical mask with an integrated eye shield was commonly used in Author for correspondence: Hitoshi Honda, MD, Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 1838524, Japan. E-mail: [email protected] Cite this article:Honda H, Takamatsu A, Saito H, and Okamoto K. (2021). Changes in infection control practice for coronavirus disease 2019 (COVID-19) between 2020 and 2021: A nationwide questionnaire survey in Japan. Antimicrobial Stewardship & Healthcare Epidemiology, https://doi.org/10.1017/ash.2021.177 © The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America. All rights reserved. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Antimicrobial Stewardship & Healthcare Epidemiology (2021), 1, e12, 1–5 doi:10.1017/ash.2021.177