SARS-COV-2 infection control measures in a Spanish tertiary hospital: A multimodal strategy

Introduction: There are different elements of a multimodal strategy to implement preventive measures and control the nosocomial transmission by SARS-CoV-2. Objectives: To describe multimodal strategies used with the frontline healthcare staff (HCS) to implement SARS-Cov-2 preventive measures in the hospital. Methods: Design: Descriptive study of preventive measures in Hospital del Mar, from August 2020 to February 2021. Inclusion Criteria: Medical and surgical departments;Exclusion Criteria: Outpatient visits department. Strategies implemented: Strategies were led by the nurses of Infection Control Program (ICP) with interested allies across the hospital. Education and Training: HCS were taught when and what type of Personal Protective Equipment (PPE) to use and how both donning and doffing them. Monitoring and feedback: Observations, one to one conversations, and supportive supervision helped the staff to improve performance. Reminders and communications: To promote protocols and standardize the desire actions at the right time, illustrated friendly reminders were posted on the door of rooms. Results: Education and training: The ICP and the occupational health department carried out training sessions for HCS leaders from each department and shift. There were 78 participants among nurses, auxiliary nurses, medical doctors, porters, and general service staff. More than half were nurses (53.8%), and the medical area staff had more participation than surgical, emergency, ICU, and midwifery area. Monitoring and feedback: From 696 observations across wards, in the beginning, the compliance of the appropriate use of PPE was 58.6% however in February increased to 81.3%. Reminders and communications: Each door of the rooms had a reminder about the use of preventive measures: hand hygiene when entering and leaving the room, use of gloves, gown, and facemask inside the room, use shields/goggles if necessary, and keep the door closed unless the patient has no respiratory symptoms. Conclusion: Multimodal strategies may be applicable to promote preventive measures in the pandemic context. Improvement in PPE compliance was observed after training, monitoring, and feedback.