Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study
Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study
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DOI：
10.1136/bmjopen-2017-017476
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发表时间：
2019-05-01
期刊：
影响因子：
2.9
通讯作者：
Clark, Alex
中科院分区：
文献类型：
--
作者：
Al Knawy, Bandar Abdulmohsen;Al-Kadri, Hanan M. F.;Clark, Alex
目标 本研究调查了对沙特阿拉伯王国 (KSA) 新型冠状病毒 (MERS-CoV) 引起的中东呼吸综合征 (MERS) 重大疫情的运营和组织管理的看法。我们向关键决策者和临床工作人员征求了关于促进和抑制有效、快速控制疫情的因素的观点。在沙特阿拉伯设立了一个大型教学三级医疗保健中心；疫情从 2015 年 6 月起持续了 6 周。参与者数据是通过对 28 名关键知情参与者（9 名管理决策者和 19 名一线医护人员）进行个人和焦点小组访谈收集的。设计我们使用过程评估的定性方法来检查对疫情的看法以及促成或损害成功管理的因素。使用定性主题内容分析对数据进行分析。结果 发现了 5 个主题和 15 个子主题。这些主题涉及：(1) 疫情的高压力；(2) 被认为有助于疫情发生的因素；(3) 被认为有助于疫情控制成功的因素；(4) 抑制疫情控制的因素；(5) 应对疫情管理的长期机构收益。 结论 工作人员普遍认为，利雅得阿卜杜勒阿齐兹国王医疗城的中东呼吸综合征冠状病毒疫情管理是一次具有地方和国家意义的严重疫情。虽然疫情在 6 周内得到了成功控制，但由于机构缺乏实施感染控制 (IC) 措施和减少患者流量、员工士气低落和高度焦虑的准备，管理进展受到抑制。通过所有员工更多地参与分享疫情的学习和知识、建立信任和团队合作以及利用集体领导，促进了有效的管理。未来的重大IC危机可以通过加强这些领域的措施、更好地协调媒体管理以及积极主动的员工咨询和支持来改善。
Objectives This study examines perceptions of the operational and organisational management of a major outbreak of Middle East Respiratory Syndrome (MERS) caused by a novel coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia (KSA). Perspectives were sought from key decision-makers and clinical staff about the factors perceived to promote and inhibit effective and rapid control of the outbreak.Setting A large teaching tertiary healthcare centre in KSA; the outbreak lasted 6 weeks from June 2015.Participants Data were collected via individual and focus group interviews with 28 key informant participants (9 management decision-makers and 19 frontline healthcare workers).Design We used qualitative methods of process evaluation to examine perceptions of the outbreak and the factors contributing to, or detracting from successful management. Data were analysed using qualitative thematic content analysis.Results Five themes and 15 subthemes were found. The themes were related to: (1) the high stress of the outbreak, (2) factors perceived to contribute to outbreak occurrence, (3) factors perceived to contribute to success of outbreak control, (4) factors inhibiting outbreak control and (5) long-term institutional gains in response to the outbreak management.Conclusion Management of the MERS-CoV outbreak at King Abdulaziz Medical City-Riyadh was widely recognised by staff as a serious outbreak of local and national significance. While the outbreak was controlled successfully in 6 weeks, progress in management was inhibited by a lack of institutional readiness to implement infection control (IC) measures and reduce patient flow, low staff morale and high anxiety. Effective management was promoted by greater involvement of all staff in sharing learning and knowledge of the outbreak, developing trust and teamwork and harnessing collective leadership. Future major IC crises could be improved via measures to strengthen these areas, better coordination of media management and proactive staff counselling and support.