背景:COVID-19大流行促使人们在一般实践中重新评估感染预防和控制(IPC),强调需要全面实施IPC。这项研究旨在评估医护人员(HCWs)在COVID-19大流行之前和期间在一般实践中关于IPC的经验和观点,及其对大流行后IPC实施的影响。
方法:这项定性研究涉及半结构化,在两个时间段进行深度访谈:(1)在COVID-19大流行之前(2019年7月至2020年2月),涉及14名全科医生(GP)和医疗助理;(2)在COVID-19大流行期间(2022年7月至2023年2月),包括22名全科医生和医疗助理。数据分析包括涉及多个系统级别的主题分析。
结果:研究结果表明,与大流行前相比,大流行期间向全面的IPC实施和组织转变。自从Omicron变种以来,一些一般做法维持了一套广泛的IPC措施,而其他人则发布了大多数措施。HCWs对大流行后IPC实施的未来期望各不相同:由于希望恢复大流行前的标准,一些人预计实施会减少,而其他人则预计在季节性呼吸道流行期间,IPC将在结构上扩大。主要的背景挑战包括患者合作,人员短缺(由于感染),IPC材料/设备短缺,以及经常变化和模棱两可的指导方针。吸取的关键教训是加强准备(例如,个人防护设备供应),以及对护理组织的新观点(例如,数字护理)。HCWs报告的主要建议是加强初级保健内部的区域合作,在初级保健之间,公共卫生,和二级保健。
结论:HCWs的经验,观点和建议为加强对未来流行病和大流行的准备提供了见解,并在一般实践中维持IPC。对于IPC改进策略,建议采用基于系统的综合方法,包括跨多个级别的行动,并与多个利益相关者互动。
BACKGROUND: The COVID-19 pandemic has prompted a re-evaluation of infection prevention and control (IPC) in general practices, highlighting the need for comprehensive IPC implementation. This study aimed to evaluate healthcare workers\' (HCWs) experiences and perspectives regarding IPC in general practices before and during the COVID-19 pandemic, and its implications for post-pandemic IPC implementation.
METHODS: This qualitative study involved semi-structured, in-depth interviews during two time periods: (1) prior to the COVID-19 pandemic (July 2019-February 2020), involving 14 general practitioners (GPs) and medical assistants; and (2) during the COVID-19 pandemic (July 2022-February 2023), including 22 GPs and medical assistants. Data analysis included thematic analysis that addressed multiple system levels.
RESULTS: Findings indicated a shift towards comprehensive IPC implementation and organisation during the pandemic compared to the pre-pandemic period. Since the Omicron variant, some general practices maintained a broad set of IPC measures, while others released most measures. HCWs\' future expectations on post-pandemic IPC implementation varied: some anticipated reduced implementation due to the desire to return to the pre-pandemic standard, while others expected IPC to be structurally scaled up during seasonal respiratory epidemics. Main contextual challenges included patient cooperation, staff shortages (due to infection), shortages of IPC materials/equipment, and frequently changing and ambiguous guidelines. Key lessons learned were enhanced preparedness (e.g., personal protective equipment supply), and a new perspective on care organisation (e.g., digital care). Main recommendations reported by HCWs were to strengthen regional collaboration within primary care, and between primary care, public health, and secondary care.
CONCLUSIONS: HCWs\' experiences, perspectives and recommendations provide insights to enhance preparedness for future epidemics and pandemics, and sustain IPC in general practices. For IPC improvement strategies, adopting an integrated system-based approach that encompasses actions across multiple levels and engages multiple stakeholders is recommended.