Abstract
Background
Healthcare-associated infections impose a significant burden on antibiotic usage, healthcare expenditures, and morbidity. Therefore, it is crucial to revise policies to minimize such losses. This nationwide survey aimed to evaluate infection prevention and control (IPC) components in healthcare facilities and encourage improvements in acute care hospitals with inadequate infection prevention settings. This study aims to enhance the infection control capabilities of healthcare facilities.
Methods
From December 27, 2021, to May 13, 2022, we conducted a survey of 1,767 acute care hospitals in the Republic of Korea. A survey was conducted to evaluate the infection control components in 1,767 acute care hospitals. Infection control officers provided direct responses to a systematically developed questionnaire. Subsequently, 10% of the respondents were randomly selected for the site investigation.
Results
Overall, 1,197 (67.7%) hospitals responded to the online survey. On-site investigations were conducted at 125 hospitals. Hospitals with ≥ 150 beds are advised to have an IPC team under Article 3 of the Medical Service Act; however, only 87.0% (598/687) of hospitals with ≥ 100 beds had one. Conversely, 22.7% (116/510) of hospitals with < 100 beds had an IPC team. Regulations for hand hygiene, waste management, healthcare worker protection and safety, environmental cleaning, standard precautions, and prevention of the transmission of multidrug-resistant pathogens were present in 84.2%, 80.1%, 77.4%, 76.2%, 75.8%, and 63.5% of the hospitals, respectively. Hospitals with < 100 beds had low availability of all categories of standard operating procedures.
Conclusion
This study is the first national survey of acute care hospitals in the Republic of Korea. The data presented in the current study will improve the understanding of IPC status and will help establish a survey system. Our survey provides a basis for improving policies related to IPC in healthcare facilities.
Keywords: Infection Prevention and Control, Acute Care Hospitals, Nationwide Survey
Graphical Abstract
INTRODUCTION
Healthcare-associated infections (HAIs) are serious and persistent public health problems that pose a major threat to the safety of patients, healthcare workers, and visitors in healthcare facilities.1 HAIs lead to excessive use of antibiotics, a rise in antimicrobial resistance among microorganisms, prolonged hospital stay, burden on healthcare expenditures, and increased morbidity.2
An estimated 3,000 cases of nosocomial bloodstream infection for methicillin-resistant Staphylococcus aureus (MRSA) are reported annually in South Korea.3 In a nationwide study, the additional economic burden of nosocomial MRSA bacteremia was $60 million annually.3 Another study estimated the socioeconomic burden of pneumonia caused by multidrug-resistant Acinetobacter baumannii (MRAB) and multidrug-resistant Pseudomonas aeruginosa (MRPA). The additional hospital costs attributable to MRAB and MRPA were $42,203 and $35,556, respectively.4 The socioeconomic burden of MRAB was approximately $64,549,723–122,533,585, whereas that of MRPA was approximately $15,241,883–28,994,008.4 Song et al.5 reported that multidrug-resistant organisms infected 7,979 patients, leading to 3,280 deaths and causing a $294,505,002 socioeconomic burden, ranging from $170,627,020 to $416,094,679, in South Korea over 1 year.
The spread of the Middle East respiratory syndrome coronavirus in Korean healthcare facilities in 2015 has strengthened legal regulations for infection prevention and control (IPC) personnel. Since the outbreak of coronavirus disease 2019 (COVID-19) began in 2019, HAIs have received increasing attention. Healthcare facilities have introduced a range of policies related to IPC and have equipped their IPC facilities and personnel. Despite these efforts, IPC activities remain insufficient, and there is a lack of educational systems, consultations, and guidelines to support them.
IPC plays an important role in health systems worldwide and affects the health and safety of both patients and healthcare workers.6 Effective IPC programs that are well-designed and properly implemented decrease morbidity, mortality, and costs.7 It is important to conduct regular nationwide surveys of IPC in accordance with Article 17 of the Infectious Disease Control and Prevention Act and Article 15 of the Enforcement Rule of the same Act.8 This study aimed to assess the status of IPC in Korean acute care hospitals through a survey of IPC facilities and personnel based on a revised law8 following the Middle East respiratory syndrome coronavirus epidemic. Furthermore, this study aimed to analyze the status of vulnerable IPCs and suggest ways to improve it. A brief overview of this study was previously reported in the Korea Disease Control and Prevention Agency (KDCA) Weekly Report.9
METHODS
Questionnaire development
The questionnaire development committee comprised infection control experts recommended by the Korean Society for HAI Control and Korean Association of Infection Control Nurses. The questionnaire revision committee developed a questionnaire based on the Guidelines for Prevention and Control of HAIs10 published in 2017 to adapt to the national IPC system. The survey items were modified to align with the latest infection control guidelines based on a systematic literature review and input from committee experts. The revised version of the survey was finalized by the General Operations Committee and KDCA. This survey was developed to assess the surveillance and control activities of the IPC program in national acute care hospitals using a standardized tool.
The online survey included questions about the respondent’s hospital type, accreditation, number of beds, region. The accreditation system for medical institutions is administered by the Korea Institute for Healthcare Accreditation (KOIHA) under Article 58 of the Medical Service Act.11 The accreditation standards consist of basic value system, patient care system, administrative management system, and performance management system. Hospitals that meet the accreditation standards can be accredited for a period of four years, and accreditation is practically mandatory for tertiary general hospitals, specialized hospitals, long-term care hospitals, and mental hospitals.12 The questionnaire consisted of nine components and 107 questions regarding IPC in healthcare facilities. The components included the IPC system, hand hygiene, injection safety, standard precautions and isolation guidelines, environmental management, prevention of device-associated infections, prevention of surgical site infections, disinfection and sterilization, and infection control facility-specific management (Supplementary Data 1). For the IPC component, we evaluated the existence of the IPC team and its staff, the existence of the IPC committee, the number of times per year, its members, and their responsibilities.
An onsite survey questionnaire was developed based on an online survey questionnaire. The survey questions were organized into questions to be confirmed through documents and questions to be checked in the field. The nine components of the site survey were the same as those of the online survey. Twelve new questions were added to the online questionnaire in three areas: IPC system, disinfection and sterilization, and infection control facility-specific management. In the IPC system component, the actual role of the IPC committee, the frequency of periodic revisions of the regulations, reasons for the lack of intervention, and whether new personnel should be tested for immunity were added. For disinfection and sterilization, we added instructions for disinfection of endoscopes, ultrasound probes, respiratory therapy instruments, and sterilizer type. In the infection control facility-specific management section, questions regarding handwashing facilities and bed spacing in general wards and intensive care units were added.
Online investigation
According to Article 3 of the Medical Service Act, Korean medical institutions are divided into clinic-level institutions that mainly serve outpatients and hospital-level institutions that serve inpatients. Hospital-level institutions included hospitals (over 30 beds), general hospitals (over 100 beds and treatment of > 7 specialized subjects), tertiary general hospitals (over 100 beds and treatment of > 20 specialized subjects), dental hospitals, Korean medicine hospitals (the same as Oriental medicine hospitals), nursing hospitals, and psychiatric hospitals. This study was conducted in acute care hospitals, defined as hospitals, general hospitals, and tertiary general hospitals.
Between December 27, 2021, and May 13, 2022, we conducted an online investigation of 1,767 acute care hospitals in South Korea. Acute care hospitals included 45 tertiary general hospitals, 319 general hospitals, and 1,403 hospitals. These numbers were as of November 30, 2021, according to the Health Insurance Review and Assessment Service guidelines. The data were collected using an online KDCA system (https://is.kdca.go.kr). The respondents accessed the computerized system and entered their answers to questions using a self-completion method.
The KDCA and KOIHA announced the investigation period in a pop-up on their websites and asked relevant organizations to provide information on relevant matters. Promotional materials were created to explain the survey and encourage participation. We also distributed the Healthcare Infection Control Survey Guide, which provided explanations and evidence for questions, and the Standard Guidelines for HAI to the hospitals participating in the questionnaires.
On-site investigation
After completing the online survey, two-person teams of investigators visited healthcare facilities and conducted an on-site investigation between February 17 and May 13, 2022. The site investigation consisted of a review of written documentation on the survey instruments, field observations, and interviews. The purpose of the on-site investigation was to verify the reliability of the self-reported written survey results and provide IPC training or consultation.
Approximately 10% of the respondents to the written online survey were randomly selected for the on-site survey according to the type of hospital and accreditation status of the medical institutions. Statistical advice was provided on the sampling of hospitals for the site survey, which led to the selection of stratification variables and allocation of sample sizes. After the initial selection, further selection was required, depending on the circumstances of the target hospital (cohort isolation, staff infection, designation of hospitals dedicated to infectious diseases due to the COVID-19 pandemic). The selected hospitals included 6 accredited tertiary general hospitals, 21 accredited general hospitals, 11 nonaccredited general hospitals, 14 accredited hospitals, and 73 nonaccredited hospitals.
Statistical analysis
This study analyzed data according to hospital type and bed size. Continuous variables are presented as means ± standard deviations, and dichotomous data are reported as number (percentage). Student’s t-test or Mann–Whitney U test was used to compare quantitative data, and Pearson’s χ2 test was used to compare qualitative data. The R software (R Foundation for Statistical Computing, Vienna, Austria) was used for statistical analyses.
All data were analyzed anonymously, and individual hospitals could not be identified. This study was conducted and analysed in accordance with article 17 of the Infectious Disease Control and Prevention Act and Article 15 of the Enforcement Rule of the same Act.8 Therefore, the requirement for ethical approval and informed consent was waived.
RESULTS
Overall, 1,197 acute care hospitals completed the survey, with a response rate of 67.7% (1,197 of 1,767). Altogether, 100%, 92.2%, and 61.2% of the subjects participated in the survey in tertiary general hospitals, general hospitals, and hospitals, respectively. There were 1,385 nonaccredited medical institutions, 59.6% of which responded to the questions, compared with 97.4% of the 382 accredited medical institutions. Hospitals with a greater number of beds reported the higher response rate, and hospitals with < 100 beds had the lowest response rate (56.0%). The other characteristics of the respondent hospitals are listed in Table 1.
Table 1. Response rates based on hospital characteristics.
| Characteristics | Respondents (%) | |
|---|---|---|
| Type of hospitals | ||
| Tertiary general hospitals | 45/45 (100) | |
| General hospitals | 294/319 (92.2) | |
| Hospitals | 858/1,403 (61.2) | |
| Accredited | ||
| Accredited | 372/382 (97.4) | |
| Non-accredited | 825/1,385 (59.6) | |
| No. of beds | ||
| < 100 | 510/910 (56.0) | |
| 100–299 | 487/645 (75.5) | |
| 300–499 | 91/102 (89.2) | |
| 500–999 | 85/86 (98.8) | |
| > 1,000 | 24/24 (100) | |
| Region | ||
| Seoul, Gyeonggi, Incheon | 468/702 (66.7) | |
| Gangwon | 42/52 (80.8) | |
| Chungcheong | 112/169 (66.3) | |
| Jeolla | 161/284 (56.7) | |
| Gyeongsang | 401/547 (73.3) | |
| Jeju | 13/13 (100) | |
All tertiary and general hospitals had an IPC team. Of the hospitals with ≥ 100 beds, 87.0% (598/687) had a team, whereas only 22.7% (116/510) of the hospitals with < 100 beds had a team. The rates of having at least one dedicated IPC-trained member on the IPC team were 100% for tertiary general hospitals, 97.3% for general hospitals, 64.9% for hospitals with ≥ 100 beds, and 44.0% for hospitals with < 100 beds. Tertiary general hospitals met the IPC training standards at 100% and general hospitals at > 90.0%, whereas hospitals with < 100 beds met the standards at < 70.0% (Table 2).
Table 2. Minimum requirements of IPC program.
| Operating component | Tertiary general hospitals (n = 45) | General hospitals (n = 294) | ≥ 100 beds hospitals (n = 348) | < 100 beds hospitals (n = 510) | |
|---|---|---|---|---|---|
| IPC team | 45/45 (100) | 294/294 (100) | 259/348 (74.4) | 116/510 (22.7) | |
| At least one dedicated IPC trained medical staff | 45/45 (100) | 286/294 (97.3) | 168/259 (64.9) | 51/116 (44) | |
| Doctor | |||||
| Average number, person | 5 | 1.9 | 1 | 1 | |
| Complete IPC traininga | 45/45 (100) | 267/294 (90.8) | 136/259 (52.5) | 49/116 (42.2) | |
| Nurse | |||||
| Average number, person | 8.2 | 2.7 | 1.4 | 1.6 | |
| Completed IPC traininga | 45/45 (100) | 284/294 (96.6) | 204/259 (78.8) | 76/116 (65.5) | |
Values are presented as number (%).
IPC = infection prevention and control.
aCompletion of a minimum of 16 hours of IPC training per year, as required by law.
The presence of regulations for hand hygiene, waste management, healthcare worker protection and safety, environmental cleaning, standard precautions, and prevention of transmission of multidrug-resistant pathogens were reported in 84.2% (1,008/1,197), 80.1% (959/1,197), 77.4% (926/1,197), 76.2% (912/1,197), 75.8% (907/1,197), and 63.5% (760/1,197) of hospitals, respectively. Smaller hospitals had a low availability of all categories of standard operating procedures. Periodic review and revision of regulations were conducted in > 90.0% of tertiary general hospitals and general hospitals, 82.5% of hospitals with ≥ 100 beds, and 79.5% of hospitals with < 100 beds (Table 3). The mean revision periods were 2.4 years for overall, 2.5 years in tertiary general and general hospitals, and 2.3 years for hospitals.
Table 3. Minimum requirements of IPC guidelines.
| Facility standard operating procedures | Tertiary general hospitals (n = 45) | General hospitals (n = 294) | ≥ 100 beds hospitals (n = 348) | < 100 beds hospitals (n = 510) | |
|---|---|---|---|---|---|
| Regulations adapted to the facility | 45/45 (100) | 290/294 (98.6) | 314/348 (90.2) | 381/510 (74.7) | |
| Regulations available for | |||||
| Standard precautions | 44/45 (97.8) | 281/294 (95.6) | 284/348 (81.6) | 298/510 (58.4) | |
| Hand hygiene | 45/45 (100) | 289/294 (98.3) | 305/348 (87.6) | 369/510 (72.4) | |
| Disinfection and sterilization | 45/45 (100) | 280/294 (95.2) | 251/348 (72.1) | 272/510 (53.3) | |
| Environmental cleaning | 45/45 (100) | 284/294 (96.6) | 272/348 (78.2) | 311/510 (61.0) | |
| Injection safety | 44/45 (97.8) | 269/294 (91.5) | 237/348 (68.1) | 268/510 (52.5) | |
| Health care worker protection and safety | 45/45 (100) | 283/294 (96.3) | 283/348 (81.3) | 315/510 (61.8) | |
| Prevention of transmission of multidrug-resistant pathogens | 45/45 (100) | 282/294 (95.9) | 240/348 (69.0) | 193/510 (37.8) | |
| Waste management | 44/45 (97.8) | 287/294 (97.6) | 287/348 (82.5) | 341/510 (66.9) | |
| Periodic review of regulations | 45/45 (100) | 274/290 (94.5) | 259/314 (82.5) | 303/381 (79.5) | |
Values are presented as number (%).
IPC = infection prevention and control.
Most respondents included both new and existing employees in their educational and training programs. The most popular training method among tertiary general hospitals, general hospitals, and hospitals with ≥ 100 beds was “using written information,” whereas “on-line study” was the most common in hospitals with < 100 beds (Table 4).
Table 4. Minimum requirements of IPC education and training.
| Status of IPC training for healthcare worker | Tertiary general hospitals (n = 45) | General hospitals (n = 294) | ≥ 100 beds hospitals (n = 348) | < 100 beds hospitals (n = 510) | |
|---|---|---|---|---|---|
| Healthcare worker regularly receive education and training | |||||
| Only new employee | - | 7/294 (2.4) | 7/348 (2.0) | 20/510 (3.9) | |
| Existing employee | - | 7/294 (2.4) | 24/348 (6.9) | 24/510 (4.7) | |
| All employee | 45/45 (100) | 276/294 (93.9) | 272/348 (78.2) | 351/510 (68.8) | |
| Never or rarely | - | 4/294 (1.4) | 45/348 (12.9) | 115/510 (22.5) | |
| How are healthcare worker trained (multiple choice) | |||||
| Using written information | 45/45 (100) | 263/294 (89.5) | 245/334 (73.4) | 239/452 (52.9) | |
| Oral instruction | 44/45 (97.8) | 233/294 (79.3) | 175/334 (52.4) | 205/452 (45.4) | |
| On-line study | 41/45 (91.1) | 219/294 (74.5) | 214/334 (64.1) | 256/452 (56.6) | |
| Group training | 44/45 (97.8) | 244/294 (83.0) | 144/334 (43.1) | 139/452 (30.8) | |
| Practical training | 45/45 (100) | 233/294 (79.3) | 112/334 (33.5) | 86/452 (19.0) | |
Values are presented as number (%).
IPC = infection prevention and control.
More than 95% of tertiary general hospitals and general hospitals conducted HAI surveys. The surveillance activity of hospitals with < 100 beds was < 60%, and the surveillance of hospitals with ≥ 100 beds was similar, except for infection with multidrug-resistant pathogens. The survey data for the computerization and standardization of the surveillance system are presented in Table 5. In all types of hospitals, lack of manpower and inexperience were common barriers to surveillance of outbreaks.
Table 5. Minimum requirements of HAI surveillance.
| HAI surveillance | Tertiary general hospitals (n = 45) | General hospitals (n = 294) | ≥ 100 beds hospitals (n = 348) | < 100 beds hospitals (n = 510) | |
|---|---|---|---|---|---|
| Facilities with at least one HAI surveillance | 45/45 (100) | 289/294 (98.3) | 275/348 (79.0) | 302/510 (59.2) | |
| Surveillance conducted for | |||||
| Surgical site infections | 45/45 (100) | 229/294 (77.9) | 92/348 (26.4) | 143/510 (28.0) | |
| Vascular catheter-associated bloodstream infections | 45/45 (100) | 240/294 (81.6) | 68/348 (19.5) | 47/510 (9.2) | |
| Ventilator-associated pneumonia | 45/45 (100) | 230/294 (78.2) | 40/348 (11.5) | 38/510 (7.5) | |
| Catheter-associated urinary tract infections | 45/45 (100) | 243/294 (82.7) | 114/348 (32.8) | 103/510 (20.2) | |
| Infection of multidrug-resistant pathogens | 45/45 (100) | 263/294 (89.5) | 204/348 (58.6) | 145/510 (28.4) | |
| Computerization of the surveillance system | |||||
| All | 11/45 (24.4) | 49/289 (17.0) | 32/275 (11.6) | 36/302 (11.9) | |
| Partial | 32/45 (71.1) | 172/289 (59.5) | 95/275 (34.5) | 70/302 (23.2) | |
| None | 2/45 (4.4) | 68/289 (23.5) | 148/275 (53.8) | 196/302 (64.9) | |
| Standardization of surveillance system index | |||||
| Yes | 45/45 (100) | 266/289 (92.0) | 206/275 (74.9) | 161/302 (53.3) | |
| No | - | 23/289 (8.0) | 69/275 (25.1) | 141/302 (46.7) | |
| Regular feedback on surveillance results | 45/45 (100) | 274/289 (94.8) | 232/275 (84.4) | 212/302 (70.2) | |
Values are presented as number (%).
HAI = healthcare-associated infection.
We conducted the same on-site investigation in one healthcare facility as the online investigation to confirm the consistency of the results. For most questions, the agreement coefficient was reported to be adequate at 0.41 or better. In tertiary general hospitals, all areas of agreement were > 0.80. Hospitals with ≥ 100 beds had an agreement coefficient above 0.50 in all areas, whereas those with < 100 beds reported a range of 0.212–0.868.
DISCUSSION
This study was the first national survey to evaluate the status of IPC in acute care hospitals in South Korea. In 2018, a legal basis was established for conducting a survey on IPC, along with the development of a standardized assessment tool for this objective. Previous studies have surveyed IPC in Korea. Woo et al.13 conducted their study in 1997, when there was insufficient awareness of IPC in Korea. These results are difficult to interpret because of the low response rate and incomplete answers. Kang14 investigated general hospitals with > 300 beds. Therefore, there are limitations in recognizing problems in smaller healthcare facilities. Other surveys only included small sample sizes or specific regions; therefore, it is difficult to provide precise information on nationwide acute care hospitals.15,16 The head of a hospital with 100 beds shall establish and operate an IPC team under Article 3 of the Medical Service Act.11 Only 87.0% of hospitals with ≥ 100 beds that are legally required to have an IPC team have implemented them. In contrast, 22.7% of the non-mandated hospitals with < 100 beds have done so. Most tertiary and general hospitals had at least one dedicated IPC-trained medical staff member, whereas other hospitals did not. The average number of doctors in tertiary general hospitals, general hospitals, hospitals with ≥ 100 beds, and hospitals with < 100 beds were 5.0, 1.9, 1.0, and 1.0, respectively. The average number of nurses were 8.2, 2.7, 1.4, and 1.6 for tertiary general hospitals, general hospitals, hospitals with ≥ 100 beds, and hospitals with < 100 beds, respectively. The difference in manpower was significant by hospital type, even accounting for the higher number of beds in tertiary and general hospitals.
Regulations for hand hygiene were included in most healthcare facilities, irrespective of bed size. Furthermore, guidelines for waste management, environmental cleaning, and healthcare worker protection and safety were present in > 60% of the cases. However, adherence to regulations for the prevention of the transmission of multidrug-resistant pathogens was relatively low, especially in hospitals with < 100 beds. This was because of the difference in severity according to hospital size. The number of these patients is small in small hospitals; therefore, they have fewer needs.
Hospitals with ≥ 100 beds should provide regular IPC education to healthcare workers in accordance with the Medical Service Act. All staff in tertiary general hospitals receive education and training, and > 85% of general hospitals and hospitals with ≥ 100 beds receive regular care. Even in hospitals with < 100 beds that are not subject to legal obligations, 77.5% provide education. Increased interest in HAIs in recent years has emphasized the importance of IPC education for employees.
Compared with the high educational performance rate, the form of education differs according to the size of the hospital. Tertiary and general hospitals use both written information and practical training. Hospitals with ≥ 100 beds and < 100 beds mainly depend on written materials and online studies, with practical training reported to be particularly low. We identified areas for improvement in the education program and highlighted the need to focus on strengthening online education programs for small hospitals and implementing systematic practical training in the future.
This study found that HAI surveillance was implemented in > 70% of tertiary and general hospitals. However, hospitals with ≥ 100 beds and < 100 beds had lower HAI surveillance rates. In the survey, all respondents pointed out the lack of manpower as one of the difficulties in conducting surveillance, which is the cause of low surveillance rates in small hospitals. Evidence suggests that understaffing is a known risk factor for HAIs.17 In addition, the computerization rate of the surveillance system is 54.6%, and the nonstandardization of the system may also affect the surveillance rate. These findings highlight the need for measures to improve HAI surveillance in acute care hospitals.
This study did not assess the overall IPC Assessment Framework score for each hospital but only collected data on specific components. Hospitals with ≥ 100 beds reported higher numbers in most categories, which may be attributed to legislative mandates. Hospitals with < 100 beds, which were not included in the policy, had inadequate infrastructure and systems for IPC. Policies targeting vulnerable hospitals outside their boundaries are necessary.
HAIs are critical to the safety of employees, patients, and caregivers and require ongoing management and monitoring. Therefore, it is necessary to continuously acquire reliable data through IPC surveys to identify gaps and make improvements. This requires a shift from the traditional survey approach of collecting data at regular intervals and within a fixed period to a continuous observation system.
This study has some limitations. First, we distributed a survey guide and standard guidelines along with the questionnaire to the target hospitals to help them understand the survey. Nevertheless, there is the possibility of misunderstanding and false reporting, as not all respondents fully understood the relevant terminology and underlying concepts. Second, this study used self-reported data. Individual respondents may have overestimated or underestimated the frequency with which various practices were used.18 We aimed to validate the reliability of a written survey by conducting on-site investigations. Third, acute care hospitals without IPC personnel had difficulty conducting surveys. Some hospitals did not participate in the survey because they were unaware that the survey was being conducted. Conversely, facilities with higher interest in IPC may have had higher interest and response rates to the survey, resulting in overrepresentation. Finally, although we identified differences in IPC across different types of hospitals, we did not evaluate infection rates and medical expenses. Therefore, it is not possible to suggest an association between IPC and infection outcomes, and additional studies are required to confirm this association.
This study represents the first national survey conducted to assess IPC status in acute care hospitals in South Korea. We compared the IPC of tertiary general hospitals, general hospitals, hospitals with ≥ 100 beds, and hospitals with < 100 beds. Our study revealed differences in IPC among healthcare facilities based on the number of beds required. This survey improves our understanding of the current IPC status and helps establish a survey system. This study also provides a basis for improving policies related to IPC in healthcare settings.
Footnotes
Funding: This research was supported by a fund (2021-288) by Research of Korea Disease Control and Prevention Agency.
Disclosure: The authors have no potential conflicts of interest to disclose.
- Conceptualization: Lee J, Eom JS.
- Data curation: Shi HJ, Hwang IS, Shin KA, Son KY, Song J, Kim N.
- Formal analysis: Na SH, Seo Y, Song J, Kim N.
- Investigation: Kim SR, Shin M, Son HJ, Choi JY, Chun H, Park SK, Song J, Kim N.
- Methodology: Na SH, Seo Y, Song J, Kim N.
- Software: Na SH.
- Validation: Lee J, Eom JS, Park SK, Song J, Kim N.
- Writing - original draft: Na SH.
- Writing - review & editing: Lee J, Eom JS.
SUPPLEMENTARY MATERIAL
Surveytool (English)
References
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