This study assessed the prevalence of burnout, secondary traumatic stress and compassion satisfaction based on ProQOL scale and explored their impact on self-reported hand hygiene behavior among medical aid team during COVID-19 pandemic. Most HCWs experience low and average level of burnout and secondary traumatic stress, and average and high level of compassion satisfaction. HCWs with lower burnout and higher compassion satisfaction reported higher level of hand hygiene.
The overall reported hand hygiene was consistent with previous self-reported hand hygiene during MERS-CoV outbreak[20, 21]. Interestingly, we can find that the level of burnout is lower and secondary traumatic stress is higher than previous researches conducted in China and other countries, during the period without the emerging infectious diseases[14, 16, 17, 22]. In general, HCWs reported more psychological burden, when they were exposed to the center of outbreak, had experience in caring for infected or suspected patient and in the frontline[23, 24]. The opposite result we obtained may be associated with the greater effect of promotion activities acting on the HCWs compared to the pandemic, which includes careful management from hospital, the positive report and higher social status in HCWs from the public during the pandemic. The experience of zero infection in medical aid team also proves the effective management in medical aid team, in the aspect of protective equipment. In addition, we can observe that the environment of management and public may be highly associated with the burnout and compassion satisfaction of HCWs[25, 26].
As for the impact to hand hygiene behavior, we find that burnout, compassion satisfaction, age, career and gender are the influencing factors of hand hygiene behavior. More precisely, lower burnout, higher compassion satisfaction, nurse (vs. doctor), younger age and male (vs. female) promoted hand hygiene behavior, which is consistent with previous studies that high burnout in HCWs frequently is associated with poor-quality care, including adherence to management guidelines, medical error, healthcare-associated infections[12]. Colindres and Manomenidis also found that burnout was an incremental predictor of adherence to the measures of infection control including hand hygiene[7, 8]. And Dasan found that consultants with lower compassion satisfaction were more irritable with patients or colleagues and reducing their standards of care[14]. We also find that the effect of burnout and compassion satisfaction are larger in the hand hygiene of low score compared to the high, which means the improvement of burnout and compassion satisfaction can advance hand hygiene behavior of low score more effectively. That also emphasizes the importance of burnout and compassion satisfaction in hand hygiene behavior. Thus, burnout and compassion satisfaction in HCWs, especially in medical aid team, should be paid more attention [8].
Just like previous studies, nurses career, female and younger age can be associated with higher score of hand hygiene[3], probably because of the differences in the presence and level of training between careers[27], inter gender differences from parents[28], etc..
Relevant intervention is the approach to reduce burnout and increase compassion satisfaction. The individual-based interventions include mindfulness-based technique, educational, emotions empowerment[29, 30]. The organization-directed interventions include increased support for clinical work, structural changes, routine staff meetings, improving the work environment, etc.[20, 31]. To improve hand hygiene behavior and compassion satisfaction and relieve burnout in pandemic, the managers should take more into consideration and intervention targeting should be performed. Based on the relatively lower burnout and compassion satisfaction we obtained, the management of HCWs in Wuhan, China may be constructive for future medical aid team.
This work reveals implications and experience for emergent preparedness and HCW resource management. Firstly, the experience of management of HCWs in medical aid team in China has referential meaning to combat COVID-19, for the zero infection, lower burnout and higher compassion satisfaction in these population. Secondly, as lower burnout and higher compassion satisfaction are associated with better hand hygiene behavior, the improvement of burnout and compassion should be emphasized, which can be obtained by intervention. Thirdly, the public and managers should respect HCWs and emphasize their importance, so as too in general period, which may be highly associated with the burnout in HCWs. This study has limitations that we didn’t assess the effect of intervention of management of medical aid team, because of the baseline data was unavailable.