Mandatory Mask-Wearing and Hand Hygiene Associated With Decreased Infectious Diseases Among Patients Undergoing Regular Hemodialysis: A Historical-Control Study

Abstract

Background: Infections are the second leading cause of death among patients undergoing hemodialysis. However, preventive measures against infectious diseases are limited and have not been made mandatory for patients.Objective: To investigate the incidence of infectious diseases before and during the coronavirus disease (COVID-19) pandemic.Design: A historical comparative study of a prospective cohort.Setting(s): February 1, 2015 to January 31, 2020 was defined as the period before the mitigative confrontation of the COVID-19 pandemic in China. The period from February 1 to June 29, 2020 was defined as the period of mitigative confrontation of the COVID-19 pandemic in China.Participants: A cohort of patients undergoing hemodialysis whose infectious disease episodes were documented prospectively in the hemodialysis unit of the Third Affiliated Hospital of Guangzhou Medical University since February 1, 2015.Methods: Mandatory mask-wearing and reinforced hand-hygiene education were implemented to prevent COVID-19 from January 23, 2020 in China. The incidence of infectious episodes, including catheter-related infection, digestive tract infection, upper respiratory tract infection (UTRI), pneumonia, and infection at other sites, were documented and compared in the periods before and during the pandemic.Results: The historical control group consisted of 157 patients, with 79 patients in the COVID-19 prevention group. The mask-wearing rate of patients increased from 1.5 to 100%. Hand sanitizer consumption increased significantly during the COVID-19 pandemic. The compliance rates of hand hygiene increased from 66, 75.5, to 55% in physicians, nurses, and other employees before the pandemic to 90.5, 92.5, and 76.5%, respectively. The incidences of UTRI and pneumonia decreased during the pandemic (p < 0.001). Notably, catheter-related and digestive tract infections also decreased during the pandemic (p = 0.003 and 0.034, respectively). A matched-pair study was conducted to further analyze the 79 individual changes in the incidences of infectious disease before and during the pandemic. As a result, the incidences of UTRI, pneumonia, catheter-related infections, digestive tract infections, and infections at other sites all decreased during the pandemic.Conclusions: The present study indicated an association between mandatory mask-wearing and reinforced hand hygiene education and decreased respiratory, catheter-related, and digestive tract infection episodes in the hemodialysis unit.

Weakening personal protective behavior by Chinese university students after COVID-19 vaccination

“…Surgical mask was considered reducing the infection risk by around 50% [ 17 ], and approaching 80% of infection risk could be reduced if all people wear a mask indoors [ 18 ]. People were mandatorily asked for mask wearing when entering all types of public indoor environments in China [ 19 ]. Although fomite is not a main transmission route for SARS-CoV-2, action self-efficacy was positively associated with hand washing [ 20 ].…”

Decreased Hospital-Acquired Respiratory Infections among elder Inpatients in General Hospital during the COVID-19 Pandemic

“…A historical control study in China showed the adherence of hand hygiene and mask-wearing during the COVID-19 pandemic (from February 1 to June 29, 2020) increased from 66-92%. The mean incidence of HAP decreased from 0.0538 to 0.0204 per month per patient [20] .…”

Hospitalizations for non‐SARS‐CoV‐2 respiratory infectious diseases among patients on hemodialysis: A comparison before and during the coronavirus disease 2019 pandemic

“…In a retrospective analysis of data from the Centers for Medicare and Medicaid Services (CMS) Renal Management Information System in the United States (REMIS), the rate of non‐COVID‐19 hospitalization among dialysis patients during weeks 13–27 in 2020 was 17% lower than that during the same weeks in 2017–2019 [13]. In a historical‐control study among HD patients in China, mask‐wearing and hand hygiene education against COVID‐19 for patients undergoing dialysis have been progressing, and the incidence of respiratory, catheter‐related, and gastrointestinal IDs decreased during the COVID‐19 pandemic [14]. In our study, the rates of hospitalization for all‐cause and non‐SARS‐CoV‐2 respiratory IDs among patients undergoing HD decreased during the COVID‐19 pandemic, which is consistent with the results of the aforementioned studies.…”