Perception of response governance and collaborative attitude of hospital infection outbreak and their association with perceived stress among healthcare workers: a cross-sectional study in North-Eastern China.

OBJECTIVES: Healthcare-acquired infection outbreaks impose significant psychological stress on healthcare workers, yet limited research has examined stress perception and protective factors during institutional-level outbreak scenarios. Grounded in the Job Demands-Resources model, this study examines the relationships among healthcare workers' perceptions of response governance, collaborative attitudes and perceived stress, and tests the moderating role of collaborative attitudes. DESIGN: A cross-sectional study was conducted using an online questionnaire from May to October 2025. SETTING: Healthcare workers from hospitals in North-Eastern China. PARTICIPANTS: 1017 valid healthcare workers, including clinicians, nurses, clinical technicians, administrative personnel, support staff and others with at least 1 year of continuous employment at the hospital. Purposive and snowball sampling were used. MAIN OUTCOME MEASURES: Perception of response governance collaborative attitude towards hospital infection outbreaks and perceived stress scores were assessed using validated self-report questionnaires. RESULTS: The mean perceived stress score among study participants was 2.03 (SD=0.97, range 1-5), indicating low to moderate levels. However, 11.9% of individuals still experienced high stress levels. Perception of response governance showed a significant negative correlation with perceived stress (r=-0.224, p<0.001) and the collaborative attitude towards hospital infection outbreaks also showed a significant negative correlation with perceived stress (r=-0.305, p<0.001). Hierarchical multiple regression, after adjusting for demographic covariates, showed that perception of response governance (β=-0.400, p<0.001) and collaborative attitude (β=-0.210, p=0.008) negatively predicted perceived stress, thereby increasing model explanatory power by 10.2% (ΔR²=0.102, p<0.001). Interaction analysis revealed that the interaction term between perception of response governance and collaborative attitude significantly predicted perceived stress (β=-0.202, p=0.022). Simple slope tests indicated that at higher levels of collaborative attitude, the negative predictive effect of perception of response governance on perceived stress intensified (low level: simple slope=-0.247; high level: simple slope=-0.402). Additionally, years of service between 11 and 15 years (β=0.381, p=0.012) and prior experience in managing healthcare-associated infection outbreaks (β=0.468, p<0.001) were identified as risk factors for perceived stress. CONCLUSION: While most healthcare workers reported low-to-moderate stress levels, identifiable high-risk subgroups remained. Given the cross-sectional design, causal inferences cannot be drawn; however, perceived governance and collaborative attitudes showed a synergistic moderating effect on perceived stress. Administrators should implement integrated interventions combining cognitive empowerment with collaborative support to strengthen organisational resilience.