Systematic review of determinants influencing antibiotic prescribing for uncomplicated acute respiratory tract infections in adult patients at the emergency department.

OBJECTIVE: Overuse of antibiotics in the emergency department (ED) for uncomplicated acute respiratory tract infections (uARTIs) is a public health issue that needs to be addressed. We aimed to identify factors associated with antibiotic use for uARTIs in adults presenting at the ED. DESIGN: We searched Medline, Embase, PsycINFO and the Cochrane Library for articles published from 1 January 2005 to 30 June 2017 using a predetermined search strategy. Titles and abstracts of English articles on antibiotic prescription and inappropriate antibiotic use for adult ARTI at EDs were assessed, followed by full article review, by 2 authors. SETTING: Emergency departments. PARTICIPANTS: Adults aged 18 years and older. RESULTS: Of the 2,591 articles retrieved, 12 articles met the inclusion criteria and 11 studies were conducted in the United States. Patients with normal C-reactive protein levels and positive influenza tests were less likely to receive antibiotic treatment. Nonclinical factors associated with antibiotic use were longer waiting time and perceived patient desire for antibiotics. Patients attended by internal medicine physicians comanaged by house staff or who visited an ED which provided education to healthcare providers on antibiotics use were less likely to receive antibiotics. CONCLUSIONS: English-language articles that fulfilled the selection criteria outside the United States were limited. Factors associated with antibiotics use are multifaceted. Education of healthcare providers presents an opportunity to improve antibiotic use.

Responding to the COVID-19 Outbreak in Singapore: Staff Protection and Staff Temperature and Sickness Surveillance Systems.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a novel coronavirus (SARS-CoV-2) and first reported in Wuhan, China, in December 2019. Since the severe acute respiratory syndrome (SARS) outbreak in 2003, Tan Tock Seng Hospital (TTSH) in Singapore has routinely fit-tested staff for high-filtration N95 respirators and established Web-based staff surveillance systems. The routine systems were enhanced in response to Singapore's first imported COVID-19 case on 23 January 2020. METHODS: We conducted a cross-sectional study from 23 January to 23 February 2020 among healthcare workers to evaluate the effectiveness of the staff protection and surveillance strategy in TTSH, a 1600-bed multidisciplinary acute-care hospital colocated with the 330-bed National Centre for Infectious Diseases (NCID). As of 23 February 2020, TTSH/NCID has managed 76% of confirmed COVID-19 cases in Singapore. The hospital adopted a multipronged approach to protect and monitor staff with potential COVID-19 exposures: (1) risk-based personal protective equipment, (2) staff fever and sickness surveillance, and (3) enhanced medical surveillance of unwell staff. RESULTS: A total of 10 583 staff were placed on hospitalwide fever and sickness surveillance, with 1524 frontline staff working in COVID-19 areas under close surveillance. Among frontline staff, a median of 8 staff illness episodes was seen per day; almost 10% (n = 29) resulted in hospitalization. None of the staff was found to be infected with COVID-19. CONCLUSIONS: A robust staff protection and health surveillance system that is routinely implemented during non-outbreak periods and enhanced during the COVID-19 outbreak is effective in protecting frontline staff from the infection.

Determinants of change in intention to receive influenza vaccination among health-care workers in Singapore.

Understanding the change in intention for influenza vaccine among health-care workers (HCWs) is important to increase influenza vaccination uptake. We aimed to investigate the psychosocial beliefs associated with a change in the intention for influenza vaccine. An anonymous cross-sectional survey was distributed to tertiary hospital HCWs in 2016. Of 3007 HCWs, 70% were compliant (vaccinated, with an intention to revaccinate), 8% were resistant (unvaccinated, without intention to vaccinate), 10% had positive change (unvaccinated, but with intention) and 12% had negative change (vaccinated, but without intention). Across HCW groups, medical staff had both the highest proportion receiving all influenza vaccinations in the last 5 years (101, 28.4%), as well as the highest proportion who had never received vaccination (41, 11.5%). With increasing age, HCWs were less likely to have a negative (p = .02) or positive change (p = .06) in intention, compared to the vaccine-resistant group. HCWs were more likely to be compliant or have a positive change in intention to receive influenza vaccine, if they perceived the vaccine as effective, safe, or had a higher frequency of influenza vaccination in the last 5 years (all with p < .05). HCWs who were medical staff, who believed that side effects of the vaccine were common, or had worked for 6 to 10 years (vs 5 years or less) were less likely to be compliant (all with p < .05). In conclusion, older HCWs were more likely to maintain the status quo in their behavior toward influenza vaccination. Influenza vaccination strategies should place emphasis on vaccine effectiveness and safety.

Psychosocial determinants of influenza vaccination intention: A cross-sectional study on inpatient nurses in Singapore.

Nurses have the closest interaction with inpatients and could transmit influenza to patients. From a self-administered questionnaire survey among inpatient nurses at a tertiary hospital, we observed that the strongest factors associated with intention for future vaccination were perceived benefits of and motivations for vaccination (adjusted odds ratio [aOR], 3.30; 95% confidence interval [CI], 2.55-4.27), and perceived nonsusceptibility to influenza and preference for vaccination alternatives (aOR, 0.26; 95% CI, 0.20-0.34). These factors need to be addressed to increase vaccination uptake and prevent nosocomial transmission.