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Minisymposium 7

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Epidemiology of SARS in healthcare workers

M7.1 ANXIETY AND ITS DETERMINANTS AMONG HEALTHCARE WORKERS DURING THE SARS EPIDEMIC IN HONG KONG

T. W. Wong1, W. Q. Chen2, Y. Gao1.1Department and Community & Family Medicine, The Chinese University of Hong Kong, Hong Kong, China; 2Department of Medical Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

Objective: To study the anxiety experienced by healthcare workers (HCWs) during the severe acute respiratory syndrome (SARS) epidemic in Hong Kong and the influence of psychosocial factors on their anxiety levels.

Methods: Using a self administered questionnaire that measured anxiety, perceived stress, coping style, social support, and demographic characteristics, 714 HCWs in a major teaching hospital in Hong Kong (where the first and largest hospital outbreak of SARS occurred) were surveyed. Factor analysis was used to obtain different sources of stress and patterns of coping style. Hierarchical linear regression analysis was used to explore the association between the subjects’ anxiety levels and these psychosocial factors.

Results: The mean (SD) score of anxiety among the HCWs was 36.52 (10.48) (range 20 to 77). Those working in SARS wards had a significantly higher mean score than those working in other wards (40.17 v 34.61). Seven sources of stress were obtained by factor analysis from 36 stressors, which explained 65.6% of the total variance. They were respectively defined as “perceived stress from SARS”, “perceived stress from SARS spread”, “being afraid of presenting at public place”, “being afraid of less social support due to SARS”, “perceived stress from environment at workplace”, “perceived stress from current job”, and “perceived stress from using protective measures”. Five patterns of coping style were identified by factor analysis from 22 coping methods and explained 49.96% of the total variance. They were respectively referred to as “eating behaviours”, “negative emotional behaviours”, “active coping behaviours”, “escaping behaviours” and “protective behaviours”. Hierarchical linear regression analysis indicated that anxiety was positively and significantly associated with working in SARS wards (which explained 5% of the total variance), six of seven sources of stress except “perceived stress from environment at workplace” (30.7% of total variance), and three of five coping patterns: “negative emotional behaviours”, “protective behaviours”, and “eating behaviours” (8.5% of variance).

Conclusion: The anxiety level among hospital HCWs during the SARS outbreak was significantly higher among HCWs working in SARS wards than elsewhere. Anxiety level was significantly associated with several sources of perceived stress from SARS and coping styles.

M7.2 SARS: PERCEPTION OF RISK AND PREVENTIVE MEASURES AMONG HEALTHCARE WORKERS

D. Koh1, M. K. Lim1, S. E. Chia1, S. M. Ko1, F. Qian1, V. Ng1, B. H. Tan2, K. S. Wong2, W. N. Chew3, H. K. Tang3, W. Ng4, Z. Muttakin4, S. Emmanuel5, N. P. Fong6, G. Koh7, C. T. Kwa8, K. B. Tan9, C. Fones1.1Faculty of Medicine, National University of Singapore; 2Singapore General Hospital; 3Tan Tock Seng Hospital; 4Kandang Kerbau Hospital; 5National Health Group Polyclinics; 6St Luke’s Hospital; 7Ang Mo Kio Community Hospital; 8National Dental Centre; 9Faculty of Dentistry, National University of Singapore

Introduction: Healthcare workers (HCWs) accounted for 41% of all the cases of severe acute respiratory syndrome (SARS) in Singapore from March to June 2003. We studied the perceptions of risk of SARS infection and work and non-work related problems faced by HCWs in Singapore during this outbreak.

Methods: A self administered questionnaire survey was administered to 15 025 HCWs in nine healthcare settings (tertiary care hospitals, community hospitals, and polyclinics) from May–July 2003.

Results: There was a 70% response (10 511 valid questionnaires were returned). Respondents were doctors (9%), nurses (43%), pharmacists/physiotherapists (3%), administrative/clerical/counter staff (19%), attendants/cleaners (6%), and other staff (20%). Two thirds (66%) of HCWs felt “at great risk of exposure”, and 76% were “afraid of falling ill” with SARS. Nearly all (96%) felt that implementation of protective measures at work were “generally effective”, and 95% were “satisfied with the explanation of their necessity and importance”. Slightly fewer (93%) agreed there were “clear policies and protocols for everyone to follow”. As for compliance, 92% thought most staff adhered to the recommended measures consistently, while 72% reported little difficulty in adhering to the measures. In addition, 56% reported feeling “more stressed at work”, 53% felt “an increase in workload”, 36% had to work overtime, and 54% had to perform work they “normally don’t do”. As for impacts on family and social life, 82% were concerned about passing SARS to family members/close friends/work colleagues. Most HCWs (87%) agreed that “people close to me are worried for my health”; 69% felt that “people close to me are worried they might get infected through me”; 49% thought that “people avoid me because of my job”, while 31% felt that “people avoid my family members because of my job”. On the positive side, 82% of respondents felt “appreciated by the hospital/clinic/my employer”, while 77% felt “appreciated by society”.

Conclusions: Most HCWs in Singapore perceived a great risk of exposure to SARS at work and feared contracting the illness. They reported increased work stress and workload, and concerns for the health of their close associates. However, most were reassured with the preventive measures taken, which they viewed as effective. They also felt that the policies and protocols implemented at their workplace were clear and practical.

M7.3 PERCEPTION OF RISK AND PREVENTIVE MEASURES AMONG HEALTHCARE WORKERS AFTER THE SARS OUTBREAK IN TAIWAN

Y. L. Guo1, J. S. C. Shiao2, Y. C. Lin1, L. H. Lo3, T. S. Shieh1, Y. C. Kuo1, M. K. Lim4, D. Koh4.1Department of Environmental and Occupational Health; 3Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Nursing, Chung Hwa College of Medical Technology, Tainan, Taiwan; 3Department of Community, Occupational and Family Medicine, Faculty of Medicine, National University of Singapore, Singapore

Introduction: Taiwan was affected by an outbreak of Severe acute respiratory syndrome (SARS) from March to June 2003, with 346 probable cases and 73 deaths. We studied the perceptions of risk of SARS infection, and the work related and non-work related problems faced by healthcare workers (HCWs) in Taiwan as a result of the SARS outbreak.

Methods: This was a self administered questionnaire survey of 1527 HCWs in four healthcare settings in May–June 2003. Participating healthcare settings included tertiary care and community hospitals.

Results: There was an 83% response (1269 valid questionnaires returned). The respondents were doctors (4%), nurses (67%), pharmacists/physiotherapists (2%), administrative, clerical, or counter staff (12%), attendants/cleaners (6%), and other staff (9%). Two thirds (64%) of HCWs believed they were “at great risk of exposure to SARS”, and 73% were “afraid of falling ill with SARS”. In the case of protective measures, 84% felt that implementation of protective measures at work were “generally effective”, and 85% were “satisfied with the explanation of their necessity and importance to me”. In terms of effect on work, 71% reported feeling “more stressed at work”, 47% felt “an increase in workload”, 49% had to perform work that they “normally don’t do”, while 35% had to work overtime. More than half of the participants (58%) were concerned about passing SARS to family members, close friends, or work colleagues.

Conclusion: Most HCWs in Taiwan perceived a great risk of exposure to SARS at work and feared contracting the illness. They reported increased work stress and workload, and concerns for the health of their close associates. Protective measures were generally considered adequate by the HCWs.

M7.4 PERCEPTION OF RISK AND COUNTERMEASURES FOR SARS AMONG HEALTHCARE WORKERS IN JAPAN

K. Takahashi1, T. Imai1, T. Hoshuyama1, N. Hasegawa2, D. Koh3.1Department of Environmental Epidemiology, University of Occupational and Environmental Health, Japan; 2School of Medicine, Keio University; 3Faculty of Medicine, National University of Singapore, Singapore

Introduction: Japan was uniquely spared from the SARS epidemic of 2003 that swept through neighbouring countries. Various countermeasures were devised and implemented at multiple layers of society, although their effectiveness had never been tested against “real” situations. However, the state of preparedness should be improved for future potential outbreaks of this and other emerging and re-emerging infectious diseases. Among the countermeasures, the protection of healthcare workers (HCWs) is essential from the standpoint of both public and occupational health. A Japanese research team joined the international collaborative effort to study perceptions of risk and countermeasures for SARS among HCWs in Japan.

Methods: The questionnaire developed at the National University of Singapore was translated into Japanese and adapted to accommodate background conditions (no outbreak). Subjects were HCWs at seven tertiary level hospitals distributed throughout Japan, of which four are university attached, two private, and one municipal. The questionnaire was administered during July–September 2003.

Results: From 9978 HCWs surveyed, 7282 valid responses (73%) were received and analysed. Respondents (2205 males, 30%; 5077 females, 70%) were grouped into physicians (1370; 19%), nurses (3274; 45%), and others (2638; 36%). Overall, two thirds (65%) of HCWs felt “at great risk of exposure”, and 55% were “afraid of falling ill” with SARS. While 65% agreed that there were “clear policies and protocols for everyone to follow,” only 31% felt that the implementation of protective measures at work were “generally effective”. The “knowledge score” (total number of correct answers to questions regarding protective measures) was highest for nurses, intermediate for physicians, and lowest for others.

Conclusions: Most HCWs in Japan perceived a great risk of exposure to SARS at work and feared contracting the illness. Although most were aware of the presence of institutional policies and protocols, less than one third viewed them as effective. The fact that physicians scored lower than nurses in terms of knowledge of protective measures may reflect a higher level of “suspicion” among physicians, deeming the policies/protocols as yet untested amid a hypothetical situation.

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