key: cord-0825155-ewtkl86k
authors: Kawasumi, M.; Nagata, T.; Ando, H.; Hino, A.; Tateishi, S.; Tsuji, M.; Matsuda, S.; Fujino, Y.; Mori, K.
title: Association between Preventive Measures against Workplace Infection and Preventive Behavior against Personal Infection
date: 2021-06-09
journal: nan
DOI: 10.1101/2021.06.08.21258584
sha: 5e9ea3d0ed298bc745d28e927e3223c2e643663a
doc_id: 825155
cord_uid: ewtkl86k

Objectives: To prevent the spread of coronavirus disease 2019 (COVID-19) infection, it is necessary for each individual to adopt infection prevention behavior. We investigated the effect of infection control measures implemented in the workplace on personal infection prevention behavior. Methods: We conducted a self-administered questionnaire survey through the Internet from December 22 to 25, 2020, during which period COVID-19 was spreading. Among respondents aged 20 to 65 years (n=27,036), a total of 21,915 workers were included in the analysis after excluding self-employed workers (n=2,202), workers in small/home offices (n=377), and agriculture, forestry, and fisheries workers (n=212), etc., whose personal infection prevention behavior was almost the same as infection control measures taken in the workplace. Results: The results showed that as the number of infection control measures in the workplace increased, implementation of infection prevention behavior by individuals also significantly increased. However, the relationship differed depending on the type of personal infection prevention behavior. Specifically, infection control measures against COVID-19 in the workplace may affect personal infection prevention behavior. Conclusion: Implementation of infection control measures in the workplace appears to deepen personal understanding of infection prevention behaviors, and increases awareness of the importance of individual infection prevention behavior and its implementation by all individuals. These findings may be applicable not only to COVID-19 measures but also to responses to other emerging infections and seasonal influenza.

A portion of the baseline survey responses from the CORoNaWork study was 1 3 2 used to conduct the present cross-sectional study. The study protocol, including the 1 3 3 sampling plan and subject recruitment procedure, has been reported elsewhere in detail. Participants were aged 20-65 years who were working at the time of the baseline survey 1 3 5 (n = 33,087 total). For participation in the CORoNaWork study, they were stratified by 1 3 6 disease cluster sampling for gender, age, region, and occupation. After excluding 6,051 1 3 7 initial subjects who provided invalid responses, we included 27,036 in the database. The flow diagram of this study is shown in Figure 1 . Respondents were asked 1 3 9

to answer yes/no to the following two questions about COVID-19 infection: "Have you 1 4 0 had COVID-19?" and "Have you come in close contact with a person infected with 1 4 1 COVID-19?" Those who answered yes to either question were excluded from the study 1 4 2 (n=399). We also excluded self-employed workers (2, 202) , workers in small/home 1 4 3 offices (377) and those in agriculture, forestry, and fishing (212) because of the need to 1 4 4 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 7 evaluate infection control measures in the workplace. Workplaces with four or fewer 1 4 5 employees were excluded from the analysis because it can be assumed that infection closely similar (one employee (n=2524) and 2-4 employees (n=1974)). We finally 1 4 8 analyzed 21,915 workers. recommendation to telecommute; and (9) Request not to come to work when sick. Implementation was classified into the five categories of 0, 1-2, 3-4, 5-7, and 8-9 1 5 9 measures implemented. For each of the following seven personal infection prevention behaviors, respondents 1 6 2 were asked to select from among four options (almost always; almost often; not often; 1 6 3 or almost never) of how often they had performed the behavior in the last month: (1) 1 6 4 wearing a mask in the presence of others; (2) disinfecting hands with alcohol before 1 6 5 going indoors; (3) washing hands after using the toilet; (4) gargling when returning 1 6 6 home; (5) opening windows and doors to ventilate the room; (6) carrying alcohol 1 6 7 disinfectant when going out; and (7) disinfecting hands and washing hands after 1 6 8 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 8 touching things that many people have touched. We created a binary variable by 1 6 9 defining almost always as having good behavior, and the other responses as not having 1 7 0 good behavior. JPY. Education was classified into four categories: junior high school or high school, 1 7 8 vocational school, junior college or technical school, and university or graduate school. Marital status was classified into three categories: married; divorce or widowed; or of these categories were excluded from this study, as mentioned above, so occupation conduct of the survey in the prefecture of residence was used as a community-level 1 9 0 variable. Information was collected from the websites of public institutions. 

CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 9

The odds ratios (ORs) of having good personal infection prevention behavior associated 1 9 3 with infection control measures in the workplace were estimated using a multilevel 1 9 4 logistic model nested in the prefectures of residence. An analysis was conducted for 1 9 5 each of the seven personal infection prevention behaviors. The multivariate model was 1 9 6 adjusted for age and sex, income (by category), educational background (by category), 1 9 7 marital status, occupation and number of employees in the workplace (by category). The 1 9 8 incidence rate of COVID-19 by prefecture was also used as a prefecture-level variable. The present study was approved by the Ethics Committee of the University of Occupational and Environmental Health, Japan (reference No. R2-079 and R3-006).

Informed consent was obtained from all participants. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. Table 2 shows the proportion of each good personal infection preventive dose-response relationship was observed for this association (p for trend; p<0.001). The number of infection control measures in the workplace was also associated 2 3 9 with disinfection of hands and washing hands after touching things that many people 2 4 0 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. In this study, we classified the implementation status of infection control measures in With regard to the significant relationship found between workplace infection 2 7 7 control measures and personal infection prevention behavior, it has been reported that 2 7 8 workplace-initiated health promotion programs encourage workers to adopt better 2 7 9 health behavior. 6-8 In a survey of Japanese people, it was reported that "the number of is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 1 3 together; and avoiding crowded places) but the perceived severity of COVID-19 was workplace. 14,15 Therefore, it is possible that guidance may be provided as part of behavior of individuals. In this survey, the number of infection control measures in the workplace was 2 9 9

found to be associated with good personal infection prevention behavior. The same In the future, attainment of herd immunity through vaccination is considered to 3 1 2 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 1 4 be the most effective way to prevent However, given the time required to 3 1 3 acquire herd immunity in many countries and the impact of variants on vaccine 3 1 4 effectiveness, it can be said that a thorough implementation of personal behavior aimed 3 1 5 at infection prevention will continue to be an essential measure against pandemic. 17 In 3 1 6

Japan, even at of the end of March 2020, when the government's request for cooperation where workers spend many hours of the day. In addition, it is desirable to combine 3 2 3 multiple infection control measures, as it has been reported that the pandemic can be restrictions on telecommuting and interviews, and it is considered more effective to There are two limitations to this study. First, those who did not have Internet access or were not registered as monitors were excluded from the study. However, since 3 3 5 subject bias was reduced by random sampling for each region/occupation/prefecture 3 3 6 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 1 5 based on the incidence of infections, our results appear to be generalizable within Japan.

However, since the survey was conducted in a Japanese population, generalizability to 3 3 8 other countries appears limited. It is said that Japanese people characteristically adjust behavior. This study appears to support this idea, given that implementation of also to responses to other emerging infections and seasonal influenza. 

Educational background Junior high or high school 556 (42.3%) 737 (37.1%) 1041 (31.9%) 1999 (25.4%) 1528 (20.4%) Vocational school, junior college or technical school 303

Professional occupation (lawyer, tax accountant, medical-related

This study was supported and partly funded by the University of Occupational and CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 1 6 Small-sized Enterprises; Health, Labour and Welfare Sciences Research Grants; Ltd., the Collabo-Health Study Group, and Hitachi Systems, Ltd. Yoshihisa Fujino (present chairperson of the study group), Dr. Akira Ogami, Dr. Arisa Occupational and Environmental Health, Japan. Ethical approval: This study was approved by the Ethics Committee of the University 3 7 5 of Occupational and Environmental Health, Japan (reference No. R2-079 and R3-006).

Informed Consent: Informed consent was obtained in the form of the website. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 1 7 [internet]. 31 Jan 2020. Available from:https://www.euro.who.int/en/health-topics/health-emergencies/pages/news/news/20 3 9 4 20/01/2019-ncov-outbreak-is-an-emergency-of-international-concern 3 9 5 Available from: https://www.mhlw.go.jp/content/000725573.pdf 4 0 8 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 2 2 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint 2 3 5 0 0 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 9, 2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted June 9, 2021. ; https://doi.org/10.1101/2021.06.08.21258584 doi: medRxiv preprint