Self-Reported Use of Personal Protective Equipment among Chinese Critical Care Clinicians during 2009 H1N1 Influenza Pandemic

<div><h3>Background</h3><p>Critically ill patients with 2009 H1N1 influenza are often treated in intensive care units (ICUs), representing significant risk of nosocomial transmission to critical care clinicians and other patients. Despite a large body of literature and guidelines recommending infection control practices, numerous barriers have been identified in ICUs, leading to poor compliance to the use of personal protective equipment (PPE). The use of PPE among critical care clinicians has not been extensively evaluated, especially during the pandemic influenza. This study examined the knowledge, attitudes, and self-reported behaviors, and barriers to compliance with the use of PPE among ICU healthcare workers (HCWs) during the pandemic influenza.</p> <h3>Methodology/Principal Findings</h3><p>A survey instrument consisting of 36 questions was developed and mailed to all HCWs in 21 ICUs in 17 provinces in China. A total of 733 physicians, nurses, and other professionals were surveyed, and 650 (88.7%) were included in the analysis. Fifty-six percent of respondents reported having received training program of pandemic influenza before they cared for H1N1 patients, while 77% reported to have adequate knowledge of self and patient protection. Only 18% of respondents were able to correctly identify all components of PPE, and 55% reported high compliance (>80%) with PPE use during patient care. In multivariate analysis, vaccination for 2009 H1N1 influenza, positive attitudes towards PPE use, organizational factors such as availability of PPE in ICU, and patient information of influenza precautions, as well as reprimand for noncompliance by the supervisors were associated with high compliance, whereas negative attitudes towards PPE use and violation of PPE use were independent predictors of low compliance.</p> <h3>Conclusion/Significance</h3><p>Knowledge and self-reported compliance to recommended PPE use among Chinese critical care clinicians is suboptimal. The perceived barriers should be addressed in order to close the significant gap between perception and knowledge or behavior.</p> </div

Use of PPE during 2009 influenza pandemic: knowledge, attitudes, and behaviors.

<p>HCW, healthcare worker; ICU, intensive care unit; PPE, personal protective equipment.</p>*<p>p<0.05, **p<0.01, ***p<0.001, physicians versus nurses.</p

Characteristics of respondents.

*<p>p<0.05, **p<0.01, ***p<0.001, physicians versus nurses.</p

Epidemiology and Outcome of Severe Sepsis and Septic Shock in Intensive Care Units in Mainland China

<div><p>Introduction</p><p>Information about sepsis in mainland China remains scarce and incomplete. The purpose of this study was to describe the epidemiology and outcome of severe sepsis and septic shock in mixed ICU in mainland China, as well as the independent predictors of mortality.</p><p>Methods</p><p>We performed a 2-month prospective, observational cohort study in 22 closed multi-disciplinary intensive care units (ICUs). All admissions into those ICUs during the study period were screened and patients with severe sepsis or septic shock were included.</p><p>Results</p><p>A total of 484 patients, 37.3 per 100 ICU admissions were diagnosed with severe sepsis (n = 365) or septic shock (n = 119) according to clinical criteria and included into this study. The most frequent sites of infection were the lung and abdomen. The overall ICU and hospital mortality rates were 28.7% (n = 139) and 33.5% (n = 162), respectively. In multivariate analyses, APACHE II score (odds ratio[OR], 1.068; 95% confidential interval[CI], 1.027–1.109), presence of ARDS (OR, 2.676; 95%CI, 1.691–4.235), bloodstream infection (OR, 2.520; 95%CI, 1.142–5.564) and comorbidity of cancer (OR, 2.246; 95%CI, 1.141–4.420) were significantly associated with mortality.</p><p>Conclusions</p><p>Our results indicated that severe sepsis and septic shock were common complications in ICU patients and with high mortality in China, and can be of help to know more about severe sepsis and septic shock in China and to improve characterization and risk stratification in these patients.</p></div

Predictors of high compliance to PPE use among ICU clinicians: results of univariate and multivariate analyses.

<p>Predictors of high compliance to PPE use among ICU clinicians: results of univariate and multivariate analyses.</p

Distribution of microorganisms isolated from 148 patients.

<p>*including Burkholderia cepacia, Chryseobacter iumindologenes, Enterobacter cloacae, Enterobacteraerogenes, and Serratialiquefaciens.</p><p>**fungal infection here refers to the invasive fungal infection and fungemia.</p><p>Distribution of microorganisms isolated from 148 patients.</p

Flow diagram of enrolled patients and their outcome.

<p>ICU, intensive care unit; LOS, length of stay.</p

Characteristics of participating ICUs.

<p>ICU, intensive care unit; IQR, interquartile range.</p><p>Characteristics of participating ICUs.</p

The source of infection of patients with severe sepsis (total >100% because 167 patients had more than one infection sites).

<p>The source of infection of patients with severe sepsis (total >100% because 167 patients had more than one infection sites).</p

Characteristics and outcome of patients with severe sepsis.

<p>APACHE II, Acute Physiology and Chronic Health Evaluation II; ARDS, acute respiratory distress syndrome; COPD, Chronic obstructive pulmonary disease; ICU, Intensive care unit; IQR, interquartile range; SOFA, Sequential Organ Failure Assessment.</p><p>Characteristics and outcome of patients with severe sepsis.</p