A Study of Factors Associated with Hospitals’ Compliance with COVID Free Setting Measures During the COVID-19 Pandemic in Thailand: A Case Study of Ministry of Public Health Hospitals

Abstract

        Thailand adopted the COVID Free Setting (CFS) measures to control three major risk domains: environment, personnel, and customer during the global COVID-19pandemic. High-risk venues involving gatherings, such as hospitals, were required to conduct safety assessments. This survey research employed a multi - method data collection approach, which comprised a cross-sectional study to analyze factors associated with hospital compliance with COVID Free Setting (CFS) measures and to identify measures that could not be implemented. The qualitative component further examined the driving mechanisms behind the CFS measure through the PIRAB strategy to formulate future recommendations. Data were obtained from the self-assessment results of 9,276 hospitals under the Ministry of Public Health, collected via the Thai Stop COVID Plus digital platform. Statistical analyses included the Fisher’s Exact test to examine associations and cross-tabulation to describe frequency distributions.
        The results showed a statistically significant association (p<0.05) between hospital type and accreditation level under the GREEN and CLEAN Hospital Standard (GCH) with compliance with COVID Free Setting (CFS) measures. Hospital type was significantly associated with overall measures and all domains of compliance with CFS measures, while GCH accreditation was significantly associated with overall compliance, environment domain, and personnel domain, but showed no significant association with the customer domain. A small proportion of hospitals which were 0.2% of hospitals, reported difficulties in implementing daily staff screening, and 0.1% surface disinfection, and enforcement of Universal Prevention for COVID-19 and DMHTA, while 0.1% of large hospitals lacked adequate ventilation and 0.4% of small hospitals did not conduct pre-procedure COVID-19 testing before undertaking high-risk procedures. The Partnership Investment Regulation Advocacy and Building capacity (PIRAB) strategy was considered an appropriate mechanism to drive implementation for hospitals. It is suggested that the type of hospital and its ventilation systems should be considered when formulating measures, and CFS measures should be integrated into GCH standards.