Assessment of adequacy of respiratory infection prevention in hospitals of Inner Mongolia, China: a cross-sectional study using unannounced standardized patients

ABSTRACT

Introduction

Recent respiratory infectious disease (RID) outbreaks of influenza and the novel coronavirus have resulted in global pandemics. RIDs can trigger nosocomial infections if not adequately prevented.

Objective

The objective of this study was to rate the adequacy of healthcare workers (HCWs) and hospital settings on RID prevention using unannounced standardized patients (USP) in clinical settings of hospital gateways.

Methods

Trained USPs visited 5 clinical settings: information desks, registration desks, two outpatient departments and the emergency departments in 10 hospitals across 3 cities of Inner Mongolia, China. USPs observed the hospital air ventilation and distance from the nearest hand-washing facilities to each clinical setting, then mimicked symptoms of either tuberculosis or influenza before observing the HCW’s behavior. A total of 480 clinical-setting assessments were made by 19 USPs.

Results

The overall adequacy of triage services was 86.7% and for prevention of the spread of airborne droplets was 83.5%. Almost all hospitals offered adequate air ventilation. Compared to the information desk, adequacy of triage and preventing the spread of airborne droplets by physicians in the three clinical departments was less likely to be adequate. Triage services for USPs simulating symptoms of influenza were 2.6 times more likely to be adequate than for those simulating symptoms of tuberculosis but there was no significant difference in the prevention of the spread of airborne droplets.

Conclusions

There is a need to improve respiratory infectious disease procedures in our study hospitals, especially in outpatient and emergency departments.

KEYWORDS:

• Respiratory infectious diseases prevention
• triage
• protection from airborne droplets
• air ventilation
• unannounced standardized patients

Acknowledgments

This study is a part of the first author’s thesis in partial fulfillment of the requirements for a Ph.D. at the Prince of Songkla University. The study was supported by China Medical Board under “A second collaborative program to improve the health research capacity of western medical universities in China and Prince of Songkla University.” The authors are grateful to the Inner Mongolia People’s Hospital and Research Institute for Health Policy, Inner Mongolia Medical University.

Reviewer disclosure’s

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The study was supported by China Medical Board under ‘A second collaborative program to improve the health researchcapacity of western medical universities in China and Prince of Songkla University.’