key: cord-274562-0mtwbwkk
authors: Olesen, Bente; Gyrup, Helene Bjergegaard; Troelstrup, Martin Winther; Marloth, Tina; Mølmer, Michael
title: Infection prevention partners up with psychology in a Danish Hospital successfully addressing staffs fear during the COVID-19 pandemic
date: 2020-04-24
journal: J Hosp Infect
DOI: 10.1016/j.jhin.2020.04.033
sha: 
doc_id: 274562
cord_uid: 0mtwbwkk

nan

In relation a recent paper "Risk of nosocomial transmission of Coronavirus Disease 2019: an experience in a general ward setting in Hong Kong" [1] we would like to share an interesting experience from Denmark. Nordsjaellands Hospital (NOH) is a 600-bed hospital situated north of Copenhagen, Denmark. The first Danish COVID-19 patient was diagnosed February 27 th , 2020 (https://www.ssi.dk). A (first?) peak of the Danish outbreak was reached around April 1, 2020 and is and presently, in mid-April 2020, on the way down (https://politi.dk/coronavirus-i-danmark/in-english). NOH follows national infection control guidelines for COVID-19 from National Board of Health (www.sst.dk).

We have worked hard at NOH hard to prepare for the pandemic building COVID-19 cohort isolation wards using existing wards, creating new workflows, tripling the available number of intensive care beds, and initiating intensive education of literally all groups of staff. We pride ourselves to be used to a high standard regarding hand hygiene [2] , we are well familiar with the occasional seasonal occurrence of influenza, norovirus, CDIFF and VRE [3] ; However, COVID19 is a new virus and reports of deaths among healthcare staff from Italy, China and Spain are scary reading, especially for front line healthcare personal.

Recently the mental health care for medical staff in China during the COVID-19 outbreak including various remedial actions was reported [4, 5] . The frontline staff at NOH predominately expressed fear of not being sufficiently protected from infection when using personal protection equipment (PPE). This problem was hospital wide but particularly pronounced at the COVID cohort wards since the workflow was new and unfamiliar and the exposure intense. Accordingly, a new and unusual collaboration between an infection prevention and control nurse and a psychologist was initiated. An inductive change strategy (bottom-up) addressing staffs fear and anxiety was used in the attempt to release defense mechanisms blocking rational thinking and change of behavior. The Intervention was based on Edgar H. Schein's Process Consultation and how to help people change [6, 7] . The psychologist acted as a process facilitator and the infection prevention and control nurse acted as a teacher during the process. Facilitation was combined with psychoeducation in coping strategies towards fear and high level of stress, and the education focused primarily on recalling staffs existing knowledge of infection prevention and secondly on how to use PPE correctly. So far, this new approach has been used in five sessions comprising 20 nurses and 15 physicians. The response from staff has been overwhelmingly positive. Most were relieved that their worries were acknowledged and became eager to discuss different scenarios of virus transmission. Many were reassured of their professional ability to risk assess behavior when close to patients with COVID-19 and began trusting their knowledge of infection prevention and correct use of PPE.

Combining the professional angles of psychology and infection prevention proved fruitful. Addressing and acknowledging fear of health care staff might lead to reappearance of rational thinking and a professional attitude in the fearful time of a pandemic.

Risk of nosocomial transmission of Coronavirus Disease 2019: an experience in a general ward in Hong Kong

Hand Hygiene Excellence Award Winner

A new successful approach to combating vancomycin-resistant enterococcus

Mental health care for medical staff in China during the COVID-19 outbreak

Online mental health services in China during the COVID-19 outbreak

Helping: How to Offer, Give, and Receive Help

Process Consultation