Knowledge, Attitude and Practice Regarding Personal Protective Equipment During COVID–19 Pandemic Among Healthcare Workers in Hetauda

Methods: A descriptive cross-sectional study was conducted among 138 HCWs from three hospitals in Hetauda: Hetauda Hospital, Makwanpur Sahakari hospital and Hetauda Orthopedic Hospital between December 2020 and January 2021 for two weeks. A validated self-administered questionnaire, Likert scale and Observational checklist were used for data collection. The simple descriptive statistics (percentage, mean) and inferential statistics (Chi-square test) were used for the data analysis.

in Feb, 2021 showed that there was good knowledge, positive attitude and poor practice. 5 Various global studies show that there are significant gaps in the area of practice regarding PPE. 5,20 Since the pandemic hit Nepal, many HCWs were infected while some were succumbed. 6 Therefore, the researcher felt it necessary to assess the knowledge, attitude and practice regarding the use of PPE among the HCWs in Hetauda during COVID-19 pandemic.
This was a descriptive cross sectional study. This study was conducted at three different hospitals in Hetauda District (i.e. Hetauda hospital, Makwanpur Sahakari Hospital and Hetauda Orthopedic Hospital). Hetauda hospital was working as a referral center for the treatment of COVID-19 patients with the facility of COVID-19 isolation wards. The data collection was started from the last week of December 2020 to the first week of January 2021.
The study population was all the healthcare workers of the three hospitals in Hetauda at the time of data collection. Knowledge and attitude of the health care workers was assessed from all the departments of three hospitals through questionnaires while practice was observed only in the COVID-19 isolation ward of Hetauda hospital. The sample size was 138 and convenient sampling technique was used to select the sample. The areas were selected purposively. A semi-structured questionnaire was applied to collect socio-demographic information and assess the knowledge while Likert scale was used to measure attitude towards the use of PPE. An observational checklist was used to assess practice regarding the use of PPE (donning and doffing PPE) among 10% of healthcare workers working in the COVID-19 isolation ward of Hetauda Hospital.
The tool was prepared through an extensive review of literature, WHO and CDC guideline 7,8 and with the help of research advisor. Validity of the instrument was maintained by calculating the content validity index (CVI) which was obtained (0.9). The research instrument was sent to two professors of nursing department of the same institute for its content validation. A small scale pilot study was conducted by pre-testing 10% of the study population of similar group at Sancho hospital in Hetauda for feasibility testing, where or and is suitable the number of items related to the knowledge was reduced due to its repetition.
The study comprised question evaluating socio demographic variables, knowledge, attitude and practice regarding the use of PPE. Socio demographic information included age, gender, educational qualification, profession, working hour, working experience, working area, continue education on COVID-19 and training on use of PPE. The knowledge section included twenty five questions including multiple responses. The correct response was provided '1' mark and incorrect '0' mark. The total highest score was 24 out of 25 where mean score was (17.04). The mean knowledge score was used to categorize adequate knowledge (ie. above mean) and inadequate knowledge (ie. below mean). 9 Similarly, the attitude section consisted eleven items and responses of each item were documented on a 5-point Likert scale as follows: strongly agree (5-point), agree (4-point), undecided (3-point), disagree (2-point), and strongly disagree (1-point). Total highest attitude score was 51 out of 55 where mean score was (40.87). The mean attitude score was used to assess positive attitude (i.e. above mean) and negative attitude (i.e. below mean). 9 An observation checklist was used to assess the practice (ie Donning and doffing PPE according to WHO guideline). 7 The practice section consisted 20 items and each item comprised two responses: Yes (1-point) and No (0-point). The respondents performing complete donning and doffing PPE were indicated good practice while respondents performing incomplete donning and doffing PPE were indicated poor practice. The practice of donning and doffing PPE was observed by the researcher wearing all the necessary PPE kits at the time of their duty exchange in the morning and evening shift for three days without having them knowing that they were being observed.
The collected data was entered into EPI-Data version 3.1 and analyzed through Statistical Package for Social Sciences (SPSS) version 16.0 software. The data was interpreted based on objectives of the study by using METHODS simple descriptive statistics such as frequency, mean, percentage and presented in the table while the inferential statistics such as Chi-square test was used to find the association between the demographic variables at 95% confidence level (p-value < 0.05) The ethical approval was obtained from the Institutional Review Committee (IRC) of Nepal Institute of Health Sciences (NIHS), Purbanchal University, Gokarneshwor-5, Jorpati, Kathmandu (Ref No. 01/77). Written permission was taken from all the three hospitals (Hetauda hospital, Makwanpur Sahakari Hospital and Hetauda Orthopedic Hospital).
Informed verbal and written consent was taken from each respondent after explaining the objective of the study before the study commencement. The participation in the study was voluntary. They had the right to ask question and they could withdraw from the study at any time without having to give any reason. The privacy and confidentiality of the data was maintained by using respondent codes to label the data instead of using their names and securing the data by encryption of folders. The information collected was utilized only for this study.  (29.7%) were working in General ward, 10 (7.2%) in Covid isolation ward. The mean working hour was 6.62 hours. The mean working experience was 4.16 years while the minimum working experience was 0.3 years and maximum 32 years. Similarly, majority of the respondents 75 (54.3%) had Diploma level of educational qualification.

Physical barriers between wearer and microorganism
Special equipment used to reduce the chance of touching, being exposed to and spreading germs to other HCWs and patients    In this study, among the 10 percent of total 138 respondents (total 10 health care workers from Covid isolation ward) showed that less than half of respondents 4 (40%) had good practice and more than half of respondents 6 (60%) had poor practice regarding the use of PPE (donning and doffing PPE). A contradict result was found in a cross sectional study conducted among Health care among 393 healthcare workers from 5 different districts of Bangladesh in february 2021 which showed that the health care workers (51.7%) had good practice of using PPE. 5 In this study, it was found that there was significant association between knowledge regarding the use of PPE and training/ continue education (p= <0.001), This study concludes that the periodic training program for newly recruited health care workers and refresher training or continue education for old health care workers to update about the proper use of PPE would enhance the knowledge, attitude and practice of the health care workers. This is an effective strategy to prevent COVID-19 spread among health care workers and patients in the hospital. The study also concludes that the hospitals should follow the standard PPE guidelines by CDC or WHO while donning and doffing the PPE during this COVID-19 pandemic.