AUTHOR=Qin Jun-Jian , Xing Yan-Fang , Ren Jian-Hua , Chen Yong-Jian , Gan Ying-Fei , Jiang Yan-Qiu , Chen Jie , Li Xing 

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

JOURNAL=Frontiers in Public Health

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.678738

DOI=10.3389/fpubh.2021.678738

ISSN=2296-2565

ABSTRACT=<p><bold>Background:</bold> 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.</p><p><bold>Objective:</bold> To investigate the incidence of infectious diseases before and during the coronavirus disease (COVID-19) pandemic.</p><p><bold>Design:</bold> A historical comparative study of a prospective cohort.</p><p><bold>Setting(s):</bold> 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.</p><p><bold>Participants:</bold> 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.</p><p><bold>Methods:</bold> 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.</p><p><bold>Results:</bold> 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 (<italic>p</italic> &lt; 0.001). Notably, catheter-related and digestive tract infections also decreased during the pandemic (<italic>p</italic> = 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.</p><p><bold>Conclusions:</bold> 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.</p>