Healthcare workers (HCWs) are at risk of contracting coronavirus disease-2019 (COVID-19) in their workplace. Infection prevention guidelines and standard operating procedures were introduced to reduce risk of exposure and prevent transmission. Safe practices during interaction with patients with COVID-19 are crucial for infection prevention and control (IPC). This study aimed to assess HCWs' compliance to IPC and to determine its association with sociodemographic and organizational factors. A cross-sectional study was conducted between March and April 2021 at public healthcare facilities in the east coast of Peninsular Malaysia. HCWs who were involved with COVID-19-related works were invited to participate in the online survey. The questionnaire was adapted from the World Health Organization (WHO) Interim Guidance: WHO Risk Assessment and Management of Exposure of Healthcare Workers in the Context of COVID-19. Respondents were categorized as compliant or non-compliant to IPC. A total of 600 HCWs involved in COVID-19-related works participated in the survey. Most of them (63.7%) were compliant to IPC as they responded to all items as “always, as recommended” during interaction with patients with COVID-19. The multivariate analysis showed that non-compliance was significantly associated with working in the emergency department (AOR = 3.16; 95% CI = 1.07–9.31), working as laboratory personnel (AOR = 15.13; 95% CI = 1.36–168.44), health attendant (AOR = 4.42; 95% CI = 1.74–11.24), and others (AOR = 3.63; 95% CI = 1.1–12.01), as well as work experience of more than 10 years (AOR = 4.71; 95% CI = 1.28–17.27). The odds of non-compliance among respondents without adequate new norms and personal protective equipment training were 2.02 (95% CI = 1.08–3.81) more than those with adequate training. Although most of the respondents complied to IPC protocols, compliance status differed according to department, work category, and years of service. Ensuring adequate training that will hopefully lead to behavioral change is crucial to prevent breach in IPC and thus minimize the risk of exposure to and transmission of COVID-19 in healthcare facilities.

This study examined the association of various brands of NIOSH-certified N95 filtering face-piece respirators (FFR) fit with facial dimensions and gender. One hundred and thirty-five participants (77 females and 58 males) were recruited from the previous facial anthropometry study among Malaysians in 2020. Quantitative respirator fit testing of six FFR were performed using the TSI Portacount Pro+ 8038 which comprised of four exercises (bending over, talking, up-down head movement, and side to side head movement). An overall fit factor (FF) of ≥ 100 was considered a pass for each FFR. Analysis was done using T-test, Pearson’s correlations, and generalised linear regression. The passing rates for the six FFR were 36.3% (Cup B), 50.4% (Trifold A), 54.1% (Duckbill A), 57.0% (Cup A), 74.1% (Trifold B), and 83.7% (Duckbill B). Both Duckbill B and Trifold B had the highest passing rates for both genders. However, certain FFR models (Cup B, Trifold A, Trifold B, and Duckbill A) fit better for participants with large facial size who were mostly males, while others (Cup A and Duckbill B) specifically fit better for those with small facial size, who were mostly females. This study showed significant positive effect of nose protrusion, nasal root and subnasale-sellion and the negative effect of menton-sellion, bigonial breadth and nose breadth on fit factors of various FFR. The results of this study emphasized the importance of choosing and designing FFR based on local anthropometry data, with careful consideration on the dimensions that affect the respirator fit. Since N95 are commonly used in the healthcare settings to prevent airborne transmission, the practice of respirator fit testing and selecting N95 with high passing rates for healthcare workers need to be emphasized.

Introduction Environmental tobacco smoke (ETS) is generally known as secondhand smoke. Assessing the magnitude of children’s exposure to ETS from early infancy is essential for public health and research endeavours. Urinary cotinine is now widely recognised as the primary indicator for assessing exposure to ETS across all age groups. This systematic review and meta-analysis aim to synthesise all the published evidence on the urinary cotinine cut-off concentrations used to categorise children under 5 years as being exposed to ETS. Methods and analysis We will conduct a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A comprehensive search will be conducted from various databases including PubMed, EMBASE, Scopus and Cochrane Library. This search will be performed from the earliest published articles up to the latest available studies until February 2025. We will include all the experimental and observational studies, such as cohort, case–control and cross-sectional, that measure urinary cotinine concentrations in children under 5 years old. Data extraction will be conducted using a standardised data extraction form, and the study quality will be evaluated according to the guidelines specified by the Newcastle-Ottawa Scale. The extracted data will be pooled and combined for meta-analysis. Two reviewers will independently screen, select and assess the quality of the included study. The result will be tabulated in a table of characteristics of the included study, which consists of the cut-off cotinine concentrations, analytical technique, method referred, study design, study area and respondents’ characteristics. Ethics and dissemination Ethics approval is not required as this is a review of collected published data. Findings will be disseminated in peer-reviewed publications and conference presentations, as well as with key stakeholders, health policymakers and healthcare professionals. PROSPERO registration number CRD42024556969.

Background: The COVID-19 pandemic significantly affected the mental health of frontline healthcare workers. This study investigated the mental health and occupational stressors faced by frontline workers in Selangor during the pandemic. Methods: A cross-sectional study was conducted using secondary data from the Mental Health and Psychosocial Support Services team, collected from March to August 2020. A total of 4593 frontline workers participated in the Depression, Anxiety, and Stress Scale screening. Results: Mental health symptoms were common among frontline workers during the COVID-19 pandemic, with 14.8% reporting stress, 30.7% anxiety, and 20.4% depression. Female workers had significantly higher odds of all three conditions, with adjusted odds ratios (aOR) of 1.35 (95% CI: 1.10–1.66) for stress, 1.25 (95% CI: 1.07–1.47) for anxiety, and 1.23 (95% CI: 1.03–1.47) for depression. Workers aged 18–30 had higher odds of stress (aOR 1.88; 95% CI: 1.42–2.47), anxiety (aOR 1.74; 95% CI: 1.43–2.12), and depression (aOR 1.80; 95% CI: 1.43–2.27) compared with those over 40. Employment in hospitals was associated with increased odds of all three conditions, with aORs ranging from 1.71 to 2.05. Among 711 respondents who reported occupational stressors, lack of mental health support was the strongest predictor (aORs 4.91–5.20), followed by poor work rotation and conflict with supervisors. Conclusions: Women, younger staff, and hospital workers were more vulnerable to mental health symptoms during the pandemic. Organizational factors, especially limited support and poor work arrangements, played a major role. Targeted mental health services and improved working conditions are needed to support healthcare workers in future emergencies.

Many studies have shown that healthcare workers are exposed to higher levels of stress than other occupations. However, little research has been conducted on the use of biomarker tools to assess chronic stress and assess the effectiveness of stress management programs for healthcare workers. The aim of this study was to measure the effectiveness of a Stress Management Program by measuring Depression Anxiety Stress Scale (DASS-21) scores and hair cortisol concentration (HCC) levels of healthcare workers in public healthcare facilities. This study was a three-group, quasi-experiment study with pre- and post-study assessment sessions. A total of 119 healthcare workers (28 from Group A, 21 from Group B, and 70 from Group C) were followed for 6 months. Significant favorable intervention effects on DASS-21 scores were found in Group A (Effect size =0.6) as compared to Group B (Effect size=0.2) and Group C (Effect size =02) at the end of the program. Time and group interaction effects were examined using the repeated measure ANOVA test in which there was a significant group *time interaction and effect size of 0.2 (p-value <0.01) across all the groups with a reduction in hair cortisol concentrations following the program. The study showed that stress management under healthy communities, building the nation (KOSPEN PLUS) program was successful in reducing stress levels, as seen through a decrease in both stress scores and hair cortisol levels. This is the first study in Malaysia to use hair cortisol as a biomarker for stress management, suggesting its reliability.

During the COVID-19 pandemic, persons under surveillance (PUS) were isolated in quarantine centres instead of at home. However, there is limited knowledge regarding the mental health issues experienced by these persons. This study aimed to assess mental health outcomes and associated factors among PUS and frontline workers at quarantine centres. This study conducted an analysis of secondary data from a cross-sectional survey carried out by the Mental Health and Psychosocial Support Services (MHPSS). The MHPSS employed the Depression, Anxiety, and Stress Scale (DASS-21) to evaluate mental health outcomes across 49 quarantine centres in Malaysia. The study included a total of 4577 respondents. The prevalence of stress, anxiety, and depression was found to be 0.9%, 11.4%, and 10.2%, respectively. Frontline workers and being part of the younger age group were found to be associated with depression, anxiety, and stress. Other factors associated with mental health issues were being female, staying at an institution-type centre, and a longer duration of the stay or work at the centre. In conclusion, assessing the mental health status and its associated factors among quarantine centre occupants is crucial for developing future strategies to safeguard their mental well-being.