key: cord-0899332-8k371xlt authors: MA, Li; ZOU, Shiyue; LIU, Yanyi; LAI, Jing; YANG, Junhua title: The Application of Hazard Vulnerability Analysis in the Prevention and Control of COVID-19 in Medical Institutions date: 2021-02-03 journal: Iran J Public Health DOI: 10.18502/ijph.v50i2.5339 sha: deb4b5a937ff6de6619e5fcaeb92b7917c637caa doc_id: 899332 cord_uid: 8k371xlt BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused massive casualties, severe economic losses, and poses a threat to the world. This study’s primary objective was to analyze the hospital’s potential hazards of COVID-19 prevention and control. The second objective was to review the disaster plan and make recommendations to minimize the spread of COVID-19 in hospitals. METHODS: An expert group for the prevention and control of COVID-19 in the First People’s Hospital of Long-quanyi Dis-trict, Chengdu, China was established. We adopted the hazard vulnerability analysis (HVA) to risk-stratify potential hazards and calculated relative risk values. We used the Delphi expert consultation method to propose and implement targeted improvement measures for the top five potential hazards. Then, the effects before and after the intervention were compared. RESULTS: The top five hazards were: insufficient Personal Protective Equipment (PPE) (25.68%), inadequate diagnosis ability of clinicians (22.55%), and inadequate management strategies of patients and caregivers (22.38%), lack of professional ability of pre-checking and triage staff (16.96%), lack of knowledge of COVID-19 of medical staff (15.59%). After taking targeted improvement measures, the average score of the hospital staff’s COVID-19 knowledge test increased from 73.26 points to 90.44 points, the average test score of the outsourcing company employees increased from 68.55 to 89.75 points. The differences were statistically significant (P<0.05). CONCLUSION: HVA can be used to systematically risk-stratify potential threats, measure the probability of those potential hazards, and develop various hospital prevention and control measures for COVID-19 epidemics. The Coronavirus disease 2019 (COVID-19) is the Class-B infectious disease managed as the Class-A infectious disease that first appeared in Wuhan in 2019. It spreads rapidly. There are no targeted drugs currently (1, 2) , which has brought a massive threat to human life (3) . Thus, preventing and controlling the spread of COVID-19 is very important. COVID-19 has atypical symptoms and a long incubation period. Humans are generally susceptible to COVID-19. As a densely populated place, hospitals have become a high-risk area for spreading . Additionally, the spread of COVID-19 has occurred in many hospitals in China and worldwide. It is necessary to prevent and control the spread of COVID-19 in hospitals. However, the current hospital infection prevention and control management model cannot effectively control the spread of COVID-19. Therefore, this study used the hazard vulnerability analysis (HVA) by Kaiser Permanente (KP) to implement COVID-19 prevention and control vulnerability assessment. It was implemented in the hospital's key departments and critical links combined with the various prevention and control policies, guidelines, and literature of the country, provinces, and cities. The potential hazards in epidemic prevention and control were identified, and the corresponding hospital process was optimized in a targeted manner to minimize the occurrence of nosocomial cross-infection COVID-19. We adopted the First People's Hospital of Longquanyi District, Chengdu, as the research institute. Our hospital is one of the 17 COVID-19 designated treatment hospitals in Chengdu and the only hospital in Longquanyi District responsible for epidemic prevention and control of nearly 1.5 million people. The HVA of the hospital's COVID-19 prevention and control were implemented in our hospital. The Emergency Management Office took the lead in setting up an expert group for HVA of COVID-19. The group members were chiefs and backbones of the hospital infection and control department, medical quality control department, clinical departments, and logistics departments. The expert group members searched and analyzed the articles, regulations, and documents of COVID-19 prevention and control published na-tionally and internationally. On this basis, the hospital's procedures and the list of potential hazards for the spread of COVID-19 were sorted out. The list contains 14 first-level indicators and 37 second-level indicators. According to the prepared list of potential hazards, an expert standardized evaluation questionnaire was developed based on the KP HVA tool. The HVA tool can generate a quantitative summary that includes hazard-specific relative risk scores (percentages) and graphs. It includes seven evaluation dimensions: probability, human impact, property impact, business impact, preparedness, internal response, and external response. Possibility and severity evaluation of loss is scored into four levels (0 = N/A, 1 = High, 2 = Moderate, 3 = Low or none). The evaluation of the completeness of prevention work (emergency preparation, internal response, and external support) is divided into four levels (0 = N/A, 1 = High, 2 = Moderate, 3 = Low or none) (5, 6). Expert team members who analyze the hospital's vulnerabilities received comprehensive training. The training content was the use of the HVA tool and the requirements for the questionnaire. Then the standardized questionnaire was published through so jump, 'a platform providing functions equivalent to Amazon Mechanical Turk.' The expert group members scored the possibility and severity of various risk hazards in our hospital. A total of 49 questionnaires were returned, with a 100% response rate. Each potential hazard's relative risk values were calculated based on the probability and severity score and ranked high to low. The top priority was the main high-risk hazard that the hospital should pay attention to. Relative risk value (%) = (probability/3) × {(human impact + property impact+ business impact+ preparedness + internal response + external response) / 18}. The top five potential hazards were considered as the priorities, which the hospital should input attention and resource. The team members used Delphi's method to propose targeted improvement measures to increase the hospital's epidemic prevention and control capabilities. All data were statistically analyzed using SPSS (Chicago, IL, USA) 18.0 software. Quantitative data were described with̄± ; the t-test was used for comparison between groups. A P-value of less than 0.05 is statistically significant. As shown in Table 1 , the top five hazards of our hospital's COVID-19 prevention and control management were insufficient Personal Protective Equipment (PPE) (25.68%), the insufficient diagnostic ability of clinicians (22.55%), inadequate management of patients and caregivers (22.38%), insufficient professional capabilities of pre-examination and triage staff (16.96%), and insufficient of knowledge about COVID-19 prevention and control (15.59%). In response to the high-risk hazard of insufficient PPE, the average daily consumption of medical surgical masks dropped from 1933 to 1136 after the targeted interventions, and the difference was statistically significant (P<0.05) ( Table 3) . The COVID-19 is the Class-B infectious disease managed as the Class-A infectious disease that first appeared in Wuhan, China, in 2019. It spread quickly throughout the country, posing a considerable threat to human life and health. Due to atypical symptoms, long incubation period, and general susceptibility to COVID-19, hospitals have become high-risk transmission areas. From Jan 1 to 28, 2020, among the 138 cases of COVID-19 confirmed in a hospital in Wuhan, China, the human-to-human transmission rate was as high as 41.3%. Hospital staff accounted for 29%, and inpatients accounted for 12.3% (7) . It can be seen that the current nosocomial infection prevention and control management model cannot effectively control the spread of COVID-19 in the hospital. Therefore, it is very urgent to find the potential hazards in the medical treatment process and nosocomial infection prevention and control measures of COVID-19. The corresponding preventive and response measures should also be taken. The HVA tool is a mature tool used by institutions to evaluate specific hazards, intervene in advance, and eliminate hidden dangers in time (8) . It is easy to access and widely used. During the assessment, HVA can be adjusted or appropriately modified for individual use. The HVA tool adopts a quantitative method to evaluate vulnerability, which ensures the objective evaluation results. The HVA tool has been widely used in hospital safety management, emergency management, hospital infection control management (9) (10) (11) (12) . We adopted the HVA tool in optimizing COVID-19 prevention and control management. In this study, the HVA tool was used to analyze the vul- As an anti-COVID-19 epidemic weapon for medical staff, PPEs protect medical staff from infection. Facing the rapid epidemic of COVID-19, the problem of insufficient PPE has become more prominent. Therefore, the possibility and severity of the shortage of PPE in our hospital were both high. The relative risk value was 25.68%, which was the most urgent potential hazard to be solved. Our hospital initiated a special management project to solve this problem: ①Homemade protective masks. We checked the relevant literature and invented self-made non-woven masks. The filtration efficiency of bacteria and non-oily particles was no less than 99%, which met medical surgical masks' standards. ② Monitor inventory and allocate reasonably. The hospital infection management department monitored the daily inventory and the distribution of PPEs to determine whether the PPEs in key departments were sufficient and provided a basis for the hospital to deploy PPEs-③Daily consumption monitoring. We monitored the daily consumption of each department and intervened in time if abnormal usage was observed. The results showed that the average daily consumption of medical surgical masks dropped from 1933 to 1,136 before and after the targeted management. The management and control of PPE were effective. Early detection and early diagnosis are the basis for early isolation, diagnosis, and treatment. The rapid and frequent update of clinical guidelines of COVID-19 brings difficulties to medical staff in mastering prevention and treatment knowledge. Therefore, the possibility of clinicians' insufficient professional ability and pre-examination triage point staff is high, which is similar to our investigation results. Our investigation showed that the relative risk value of medical staff's insufficient knowledge of prevention and treatment was as high as 15.59%. In response to this risk, our hospital established a training assessment team to apply the SMART principle to the training and managing the COVID-19 epidemic. The training course changed with different groups of people and different stages of the COVID-19 epidemic. Simultaneously, we conducted regular COVID-19 knowledge assessments and incorporated high error rates into the next exam questions. The results showed that the hospital staff's average score had increased from 73.26 to 90.44 points after targeted training. The average score of employees in outsourcing companies had increased from 68.55 points to 89.75 points. The COVID-19 knowledge of medical staff increased significantly. We also strengthened health education, epidemiological history investigation, body temperature monitoring, and control of the number of accompanying persons, family members, and caregivers. Simultaneously, some management documents were formulated to manage the inpatient ward, outpatient department, and elevator use that apply to our hospital. These documents effectively managed patients and caregivers entering our hospital and reduced the hidden dangers of COVID-19 transmission. In this study, KP HVAs were successfully used to discover our hospital's potential hazards of COVID-19 epidemic prevention and control and formulate the optimal procedures and measures to minimize the risks of COVID-19 nosocomial infection. Moreover, the potential hazards faced by hospitals are not static. It will vary with the external environment and internal factors. Therefore, regular HVAs could be carried out in hospitals to assess the levels of hazards and enhance response measures in time to improve the hospital's emergency management ability continuously. Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors. 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Sichuan Da Xue Xue Bao Yi Xue Ban Research Prevention and Treatment of the Novel Coronavirus Pneumonia Application effect of hazard vulnerability analysis in cope with 2019 novel coronavirus transmission in non-closed hematology ward The Applied Research of Hospital Vulnerability Analysis Based on Kaiser Model Rethinking vulnerability analysis and governance with emphasis on a participatory approach Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan American Society for Healthcare Engineering of the American Hospital Hazard Vulnerability Analysis of a Foreignrelated Hospital in Jiangsu Province Based on KAISER Model Application of Risk Management Theory in Nursing Emergency Management An empirical study of hazard vulnerability analysis based on Kaiser model in hospital emergency management Application Research on Hospital Emergency Management Based on the Hazard Vulnerability Support for this study came from the fund of Chengdu Science and Technology Bureau (Project number: 2020-YF05-00031-SN) The authors declare that there is no conflict of interest. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.