Introduction: The recent COVID-19 pandemic has prompted concern about the compatibility of IPC guidelines with health care workers, their working practices and behaviours. These guidelines can be difficult and time-consuming to adhere to in practice. By identifying barriers and facilitators to IPC guideline adherence, especially using personal protective equipment (PPE), we can identify focussed strategies that will support health care workers to undertake the IPC measures needed at such a critical time in health care internationally. Material & Methods: This was a cross-sectional study designed during the COVID-19 pandemic management in the South Gujarat region, to analyse the knowledge, attitude and practices of health care workers about their usage of personal protective equipment. A semi-structured questionnaire-based study was prepared, deriving pointers from our previous experience of seasonal flu outbreaks. 225 participants enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. Result: Analysis of the barriers-related questions show good preparedness by the medical institution. Overall we found good knowledge, attitude and practice related to PPE during COVID-19 pandemic management. There are few gaps found in the knowledge of donning of PPE (p-0.0075), N-95 mask related knowledge (p-0.01) and the attitude that PPE use causes discomfort while nursing patients (0.0001).
Personal protective equipment helps prevent the spread of germs in the hospital. PPE is used in healthcare settings to create a barrier between health care workers and infectious agents from the patients, sometimes be used by the patient’s family/visitors if providing direct patient care or assisting patients in their routine. The recent COVID-19 pandemic has prompted concern about the compatibility of IPC guidelines with health care workers; working practices and behaviours. Strategies in these guidelines include the use of Personal Protective Equipment (PPE) such as masks, face shields, gloves and gowns; the separation of patients with respiratory infections from others, and strict cleaning routines [
This was a cross-sectional study designed during COVID-19 pandemic management at tertiary COVID care Hospital in India to analyze the barriers and knowledge, attitude and practices in health care workers for PPE. Semi-structured questionnaires based study based on our previous experience of seasonal flu outbreak. Health care workers both medical and paramedical staff working in COVID-19 pandemic management were targeted for the study. Approximately 300 health care workers were working in COVID-19 management at tertiary care COVID Hospital of south Gujarat, India. Taking the non-response rate of 25% due to a busy schedule, non-consent, working with PPE, 225 participants enrolled. Convenient sampling was done for those willing to participate and who comprehend Gujarati/English [
After the Human Research Ethical Committee of the institute approved the study. The survey was done during June and July 2020. All collected data was entered into an excel sheet. Scoring was done as 0 for wrong answers and 1 for the right answer for barrier, knowledge and practices related questions. For attitude-related question analysis, Likert grading was used for the answer of strongly agree, agree, neutral, disagree and strongly disagree.
SPSS software version-12 was used to analyze the biostatistical data. Chi-square test, Fisher exact test was used for qualitative data analysis. An Independent t-test was used to find out statistically significant. A P-value of less than 0.05 was used to see the statistical significance level.
During June 2020, the study was conducted after ethical approval. During that time, health care workers/frontline workers who were working in COVID-19 and who were willing in COVID 19 study were enrolled. Overall 215 health care workers were enrolled out of which 60(28%) faculty and resident doctors, 26 (12%) intern doctors, 31 (14%) were lab technicians, 62 (29%) were nurses, 36 (17%) were servants.
Out of 215, 27 healthcare workers were experienced with seasonal flu outbreaks in the past; of which 12 were doctors, 4 were nurses, 2 servants and 9 lab technicians were there.
Regarding barriers to PPE related questions, 59 (98%) faculty and resident doctors, 25 (96%) intern doctors, 30 (96%) laboratory technicians, 57 (91%) nurses, 24 (37%) servants have received training regarding PPE donning and doffing. The majority was trained by group training conducted at the institute itself, 20 got training by one to one personal training. Also, they supplemented their learning internet, through tutorial video, through colleagues and by other means. 57 (95%) faculty and resident doctors, 24 (92%) intern doctors, 30 (97%) laboratory technicians, 52 (84%) nurses, 30 (83%) servants have answered that there were separate spaces available for donning and doffing in their working area. As per 57 (95%) faculty and resident doctors, 24 (92%) intern doctors, 30 (97%) laboratory technicians, 59 (95%) nurses, 35 (97%) servants, enough stock of PPE is also available. Quantity of PPE is provided is also good as per 55 (92%) faculty and resident doctors, 15 (58%) intern doctors, 30 (97%) laboratory technicians, 56 (90%) nurses, 33 (92%) servants replied. But only 39 (65%) faculty and resident doctors, 9 (35%) intern doctors, 26 (84%) laboratory technicians, 26 (42%) nurses, 27 (75%) servants healthcare workers have answered that there is no fitting issue. 21 (35%) faculty and resident doctors, 17 (64%) intern doctors, 5 (16%) laboratory technicians, 36 (58%) nurses, 9 (25%) servants have fitting issue.
Regarding knowledge related questionnaires analysis of HCWs is shown in
This suggests that HCWs are well aware of COVID-19 infections and transmission routes so that they have to wear PPE to prevent the spread of infection.
Regarding attitude-related questionnaire, analysis is shown in
| Knowledge Assessment | Answer | Faculty & Resident No (%) n = 60 | Intern Doctor No (%) n = 26 | Lab Technician No (%) n = 31 | Nurse No (%) n = 62 | Servant No (%) n = 36 | Total Health Care workers | P value |
|---|---|---|---|---|---|---|---|---|
| Full Form of PPE | Correct | 60 (100) | 26 (100) | 30 (96.8) | 61 (98.4) | 22 (61.1) | 196 | 0.2 |
| Incorrect | NIL | NIL | 01 (3.2) | 01 (1.6) | 14 (38.9) | 16 | ||
| Sequence of Donning of PPE | Correct | 30 (50.0) | 16 (61.5) | 23 (74.2) | 34 (54.8) | 11 (30.6) | 114 | 0.0075 |
| Incorrect | 30 (50.0) | 10 (38.5) | 08 (25.8) | 28 (45.2) | 25 (69.4) | 101 | ||
| N-95 mask protects against the particle which are of size less than | Correct | 41 (68.3) | 10 (38.46) | 20 (64.5) | 19 (30.64) | 9 (25) | 99 | 0.0174 |
| Incorrect | 19 (31.66) | 14 (53.84) | 11 (35.48) | 37 (59.67) | 21 (58.33) | 102 | ||
| Wear full PPE while transport of patient | Correct | 60 (100) | 26 (100) | 31 (100) | 61 (98.4) | 36 (100) | 214 | 0.6484 |
| Incorrect | NIL | NIL | NIL | 01 (1.6) | NIL | 1 | ||
| Wear full PPE while transport of dead patient | Correct | 57 (95.0) | 26 (100) | 31 (100) | 61 (98.4) | 36 (100) | 211 | 0.285 |
| Incorrect | 03 (5.0) | NIL | NIL | 01 (1.6) | NIL | 4 |
| Attitude Assessment | Result | Faculty & Resident No (%) n = 60 | Intern Doctor No (%) n = 26 | Lab Technician No (%) n = 31 | Nurse No (%) n = 62 | Servant No (%) n = 36 | Total HCW | P value |
|---|---|---|---|---|---|---|---|---|
| Wearing PPE in pandemic outbreak can protect me from COVID-19 infection | SA | 13 (21.7) | 08 (30.8) | 06 (19.3) | 22 (35.5) | 15 (41.7) | 64 | 0.5035 |
| A | 38 (63.3) | 16 (61.5) | 22 (71.0) | 32 (51.6) | 19 (52.8) | 127 | ||
| N | 09 (15.0) | 02 (7.7) | 03 (9.7) | 07 (11.3) | 02 (5.6) | 23 | ||
| D | NIL | NIL | NIL | NIL | NIL | 0 | ||
| SD | NIL | NIL | NIL | 01 (1.6) | NIL | 1 | ||
| For my patients, I can endure the discomfort caused by PPE during COVID-19 Pandemic Management | SA | 14 (23.3) | 10 (38.5) | 06 (19.3) | 14 (22.6) | 20 (55.6) | 64 | 0.2 |
| A | 35 (58.3) | 13 (50.0) | 11 (35.5) | 38 (61.3) | 15 (41.7) | 112 | ||
| N | 11 (18.3) | 02 (7.7) | 14 (45.2) | 10 (16.1) | 01 (2.7) | 38 | ||
| D | NIL | 01 (3.8) | NIL | NIL | NIL | 1 | ||
| SD | NIL | NIL | NIL | NIL | NIL | 0 | ||
| I would work wearing PPE anytime during COVID-19 pandemic outbreak | SA | 13 (21.7) | 09 (34.6) | 09 (29.0) | 24 (38.7) | 17 (47.2) | 72 | 0.0047 |
| A | 41 (68.3) | 08 (30.8) | 18 (58.1) | 33 (53.2) | 17 (47.2) | 117 | ||
| N | 06 (10.0) | 06 (23.1) | 03 (9.7) | 04 (6.5) | 02 (5.6) | 21 | ||
| D | NIL | 03 (11.5) | 01 (3.2) | 01 (1.6) | NIL | 5 | ||
| SD | NIL | NIL | NIL | NIL | NIL | 0 | ||
| Wearing PPE brings discomfort in nursing care to the COVID-19 patients | SA | 08 (13.3) | 06 (23.1) | 11 (35.5) | 22 (35.5) | 15 (41.7) | 62 | 0.0001 |
| A | 39 (65.0) | 17 (65.4) | 18 (58.1) | 36 (58.1) | 19 (52.8) | 129 | ||
| N | 13 (21.7) | NIL | 01 (3.2) | 04 (6.4) | 02 (5.5) | 20 | ||
| D | NIL | 03 (11.5) | 01 (3.2) | NIL | NIL | 4 | ||
| SD | NIL | NIL | NIL | NIL | NIL | 0 | ||
| I know very well how to use PPE | ||||||||
| SA | SA | 24 (40.0) | 06 (23.1) | 24 (77.4) | 33 (53.2) | 20 (55.6) | 107 | 0.0008 |
| A | A | 35 (58.3) | 16 (61.5) | 06 (19.4) | 26 (41.9) | 14 (38.8) | 97 | |
| N | N | 01 (1.7) | 04 (15.4) | NIL | 03 (4.8) | 01 (2.8) | 9 | |
| D | D | NIL | NIL | 01 (3.2) | NIL | 01 (2.8) | 2 | |
| SD | SD | NIL | NIL | NIL | NIL | NIL | 0 |
Regarding practices related questionnaire, the majority has responded correctly. 18 (30%) faculty and resident doctors, 25 (96%) intern doctors, 23 (74%) laboratory technicians, 15 (24%) nurses, 4 (11%) servants responded correctly for their hand hygiene practice before wearing PPE. 58 (97%) faculty and resident doctors, 25 (96%) intern doctors, 31 (100%) laboratory technicians, 59 (95%) nurses, 33 (92%) servants responded correctly about the use of hand rubbing/washing in between two COVID-19 patients. 60 (100%) faculty and resident doctors, 26 (100%) intern doctors, 30 (97%) laboratory technicians, 61 (98%) nurses, 32 (89%) servants having a practice at discarding PPE in a designated doffing room. 59 (98%) faculty and resident doctors, 25 (96%) intern doctors, 30 (97%) laboratory technicians, 59 (95%) nurses, 36 (100%) servants practicing correctly about goggles and gloves discarding, that is in a recorded biohazard bag. 60 (100%) faculty and resident doctors, 26 (100%) intern doctors, 30 (97%) laboratory technicians, 57 (92%) nurses, 33 (92%) servants practicing double-layered gloves while touching patient.
Since its initial outbreak in December 2019, the COVID-19 disease has had a cascading effect worldwide [
| Practice Assessment | Answer | Faculty & Resident No (%) n = 60 | Intern Doctor No (%) n = 26 | Lab Technician No (%) n = 31 | Nurse No (%) n = 62 | Servant No (%) n = 36 | Total HCWs | P value |
|---|---|---|---|---|---|---|---|---|
| Are you doing your hand hygiene before PPE wearing during COVID-19 management? | Correct | 18 (30.0) | 25 (96.2) | 23 (74.2) | 15 (24.2) | 04 (11.1) | 85 | 0.2 |
| Incorrect | 42 (70.0) | 01 (3.8) | 08 (25.8) | 47 (75.8) | 32 (88.9) | 130 | ||
| Do you perform hand-rubbing or hand-washing in between 2 COVID-19 patients? | Correct | 58 (96.7) | 25 (96.2) | 31 (100) | 59 (95.2) | 33 (91.7) | 206 | 0.5445 |
| Incorrect | 02 (3.3) | 01 (3.8) | NIL | 03 (4.8) | 03 (8.3) | 9 | ||
| Are you discarding your PPE in designated doffing room during COVID-19 management? | Correct | 60 (100) | 26 (100) | 30 (96.8) | 61 (98.4) | 32 (88.9) | 209 | 0.0174 |
| Incorrect | NIL | NIL | 01 (3.2) | 01 (1.6) | 04 (11.1) | 6 | ||
| Where you discard your goggles and gloves? | Correct | 59 (98.3) | 25 (96.2) | 30 (96.8) | 59 (95.2) | 36 (100) | 209 | 0.6626 |
| Incorrect | 01 (1.7) | 01 (3.8) | 01 (3.2) | 03 (4.8) | NIL | 6 | ||
| Are you using double layered gloves while touching COVID-19 patient? | Correct | 60 (100) | 26 (100) | 30 (96.8) | 57 (91.9) | 33 (91.7) | 209 | 0.1033 |
| Incorrect | NIL | NIL | 01 (3.2) | 05 (8.1) | 03 (8.3) | 6 |
In barrier related questions, the overall response is good. Healthcare workers are trained by various means. Also dedicated donning and doffing areas were allotted, but due to immediate preparedness, within a short time, different size PPEs would not be made available to them [
Regarding the sequence of donning PPE and N-95 mask protection efficacy related knowledge questions, there is a gap and need training regarding proper PPE donning and doffing [
Overall institutional preparedness along with the help of the Government of Gujarat is good for COVID-19 pandemic management. Staff was trained by various means still, there is a gap found in knowledge regarding donning of PPE and N-95 mask-related knowledge. HCWs have a good attitude and practice regarding PPE use. Few gaps which were found can be corrected by proper training and re-training.
The authors declare no conflicts of interest regarding the publication of this paper.
Chauhan, K., Mullan, S. and Mistry, Y. (2020) Practices and Barriers for Personal Protective Equipment among Health Care Workers during COVID-19 Pandemic Management at Tertiary Care Government Hospital of South Gujarat, India. Advances in Microbiology, 10, 575-582. https://doi.org/10.4236/aim.2020.1011042