|Ahead of print publication
KAP survey among health care professionals (Doctors and nurses) regarding methods of disinfection in ongoing COVID-19 pandemic
Seema Sharma1, Laxmikant Choudhary2, Pravin V Kumar2, Arun Kumar Yadav2, Nitin S Taneja3
1 Station Health Organisation, Chennai, Tamil Nadu, India
2 Department of Community Medicine, AFMC, Pune, Maharashtra, India
3 Military Hospital, Chennai, Tamil Nadu, India
|Date of Submission||20-May-2020|
|Date of Decision||28-Jun-2020|
|Date of Acceptance||10-Jul-2020|
|Date of Web Publication||01-Sep-2020|
Arun Kumar Yadav,
Associate Professor, Department of Community Medicine, AFMC, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: COVID-19 is a viral infectious disease caused by the most recently discovered coronavirus named as SARS-CoV-2. The disease spread from person to person through droplets discharged from the nose or mouth of a person with COVID-19 while coughing or exhaling or through fomites. Hence, disinfection methods play an important role in preventing the COVID-19, which the health-care workers must know for better prevention, control, and the management of COVID-19. Aim: The aim of this study is to assess the knowledge, attitude, and practice (KAP) among health-care workers regarding disinfection measures in an ongoing COVID-19 pandemic. Materials and Methods: The study was a cross-sectional study with a study population as health-care professional (doctors and nurses) directly or indirectly involved in COVID-19. The study conducted partly in Chennai and partly rest over the country between March 2020 and April 2020. A pretested structured questionnaire was used to collect data. Results: A total of 210 participants (87.1% doctors and 21.9% nurses) included the study. Overall, 34 (16.2%) respondents had “adequate” knowledge, “correct” attitude and “proper” practices. Statistically significant association found between occupation and level of attitude (P = 0.003); occupation and level of practice (P = 0.011); qualification and level of knowledge (P = 0.017), attitude (P = 0.002), and practice (P = 0.015); involvement in patient care and level of attitude (P = 0.039) and practice (P = 0.003); involvement in training and level of attitude (P = 0.041) and practice (P = 0.003); ever trained on disinfection and level of attitude (P = 0.036) and practice (P = 0.011). Conclusions: KAPs of health-care workers with respect to methods of disinfection in the present ongoing COVID-19 pandemic are not adequate. These gaps should be addressed through educational initiatives, training, infection control campaigns, and strict implementation of guidelines issued by the WHO, Ministry of Health and Family Welfare India, Indian Council of Medical Research, and other reliable sources.
Keywords: COVID-19, disinfection, health-care workers
|How to cite this URL:|
Sharma S, Choudhary L, Kumar PV, Yadav AK, Taneja NS. KAP survey among health care professionals (Doctors and nurses) regarding methods of disinfection in ongoing COVID-19 pandemic. J Mar Med Soc [Epub ahead of print] [cited 2020 Sep 29]. Available from: http://www.marinemedicalsociety.in/preprintarticle.asp?id=294127
| Introduction|| |
COVID-19 is a viral infectious disease caused by the most recently discovered coronavirus. The infection manifests itself in the form of high fever, cough, breathing difficulty, and, in severe cases, results in respiratory failure requiring ventilatory support. The outbreak began in Wuhan, China, on December 2019. The virus subsequently spread to a large part of the world and with the situation worsening in Europe and America, the WHO declared COVID-19 as a pandemic on March 11, 2020. The disease can spread from person to person through small droplets discharged from the nose or mouth of a person with COVID-19 while coughing or exhaling. These droplets land on objects and surfaces around the person, and other people then contract the infection by coming in contact with these objects or surfaces and then touching their eyes, nose, or mouth with their contaminated hands. The virus can also gain entry into the body through inhaling the droplets from a person with COVID-19. The only effective way to curb the pandemic, therefore, is protection from contracting the virus through effective preventive measures such as hand washing, wearing masks, cleaning the surfaces with disinfectant and maintaining social distance. Studies suggest that coronaviruses (including preliminary information on the COVID-19 virus) may persist on surfaces for a few hours or up to several days. This may vary under different conditions (e.g., type of surface, temperature, or humidity of the environment). A review has shown human coronaviruses can remain infectious on inanimate surfaces for up to 9 days. Surface disinfection with 0.1% sodium hypochlorite or 62%–71% ethanol significantly reduces coronavirus infectivity on surfaces within 1 min exposure time, and a similar effect is expected against the SARS-CoV-2.
As more and more information and evidence are emerging about this disease, the stakeholders (health-care workers) must upgrade themselves regarding effective measures, especially the disinfection methods, for preventing the transmission of COVID-19. Health-care workers continuously keep themselves abreast to know the latest evidence developed for better prevention, control, and management of the new diseases like COVID-19. The aim of this study was, therefore, to assess the knowledge, attitude, and practice (KAP) among health-care workers regarding disinfection measures in ongoing COVID-19 pandemic.
| Materials and Methods|| |
The study was a cross-sectional study done for 1 month from March 2020 to April 2020 when India was witnessing numerous COVID-19 patients across the country, and the health-care workers were involved in managing them by putting their hard efforts. The study population was health-care workers (doctors and nurses) directly or indirectly involved in COVID-19. The study was conducted partly in Chennai and partly rest over the country.
A structured questionnaire was prepared in order to ascertain the KAPs of health-care workers (doctors and nurses) employed at multiple places of action like quarantine centers, isolation wards, hospital wards, intensive care unit (ICU), etc., to assess their existing level of information on the methods of disinfection for current situation of COVID-19. The questionnaire was sent to experts for content validity and face validity.
The questionnaire comprised of three sections, the first section to provide information to the participants about the title of the study and to obtain their consent for participation, the second section to reveal the sociodemographic details of participants and the third section had a set of twenty questions with multiple choices. The questionnaire was pilot tested by distributing it online to thirty health-care workers (doctors and nurses). Necessary modifications in the same were done after evaluating the results of the pilot study. After pilot testing, the questionnaire was distributed to all eligible participants through E-mail, personal message, telephonic conversation, and through personal contact. Questions were divided to assess knowledge, awareness and practice on various aspects of disinfectant use. All questions carried equal weightage (i.e., 1 mark each for every right answer) with a maximum of a total of 20 marks.
Sample size was calculated using the formula,
n = Minimum sample size required
Z(1−α/2)= Z value for level of significance, α
Z(1−β)= Z value for power, β
π = Prevalence of knowledge/attitude/practice
d = Error of margin.
A sample size of 196 was estimated based on the assumption of the prevalence of knowledge/attitude/practice as 50%, with an absolute precision of 5% and acceptable error of margin as 10%. Snowball sampling strategy was used to recruit responders across the country, in addition to their own participation; respondents were encouraged to invite new respondents from his or her contacts.
The piloted questionnaires were sent to 324 health-care workers using E-mail, personal message, and telephonic conversation. We received 234 responses, of which 210 responses were selected after applying the exclusion criteria. All health-care workers involved in the care of COVID-19 patients directly or indirectly were included in the study.
All health-care workers whether they are directly involved in COVID-19 patient treatment/care or not were included in the study.
- Participants unwilling to give consent or participate in the study were excluded
- Health care workers with specialty in community medicine and pathology were excluded as they are key workers dealing routinely with disinfectants.
Approval of the ethical committee was taken before the start of the study, filling up the form was taken as implied consent, and informed consent also taken from each of the participants before start of the study. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The participants of the pilot study not included in the final analysis. Descriptive statistics were used. Each variable was defined as numbers and percentages. The value of P = 0.05 was taken as significant.
| Results|| |
A total of 234 responses were received from doctors and nurses, among which 24 responses were excluded as per exclusion criteria. Of the 210 selected responses, 183 (87.1%) were doctors and 27 (12.9%) were nurses. A total of 159 (75.7%; 95% confidence interval [CI]: 69.3–81.4) of the responders were involved in active patient care, whereas 110 (52.4%; 95% CI: 45.4%–59.3%) were involved in the training of the staff. A total of 111 (52.9; 95% CI: 45.9%–59.8%) had received any form of training on disinfection measures related to COVID-19. Duties of responders varied from ICU (7.1%), isolation wards (10.5%), quarantine facilities (1.4%), outpatient department services (34.3%), and lab services (14.3%) [Figure 1]. Educational qualification of the responders ranged from graduates (MBBS/BSc Nursing) (44.3%), Postgraduates (MD/MS/MSc) (42.9%) to super speciality/PhD (7.1%). Responders belonged to almost all kind of specialties commonly pathology (11.4%) and anesthesia (8.6%) and sports medicine, critical care, dermatology, etc.
Out of 183 doctors, only 93 (50.8%) doctors were imparted training on methods of disinfection, whereas out of 27 nurses, 18 (66.6%) were imparted training on disinfection for COVID-19.
The scores of respondents ranged between 0 and 18. Overall, 154 (73.33%; 95% CI: 66.8%–79.2%) respondents had a total score of 10 or above (Good awareness about disinfection in COVID-19 situation). The mean score was 10.98 (±2.43), and the median score was 11. [Table 1] depicts mean scores for doctors and nurses in KAP related to disinfection in COVID-19.
|Table 1: Mean scores for doctors and nurses in knowledge, attitude and practices related to disinfection in COVID-19|
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[Figure 2] depicts the percentage of correct answers question wise for Doctors and Nurses. Doctors had better performance in knowledge questions while nurses fared better in attitude and practice questions.
|Figure 2: Comparison of knowledge, attitudes and practices on disinfection among doctors and nurses|
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Based on the scores of the responders in the survey, the responders were classified as to having “adequate” or “inadequate” knowledge, “correct” or “incorrect” attitudes and “proper” or “improper” practices related to the disinfection in COVID-19 situation. A score of more than 4 out of 8 knowledge questions was considered “adequate” knowledge, more than or equal to 3 out of 5 attitude questions was considered “correct” attitude and more than or equal to 4 out of 7 was considered “proper” practice. Seventy (33.3%; 95% CI: 27%–40.1%) respondents had “adequate” knowledge, while 132 (62.9%; 95% CI: 56%–69.4%) had “correct” attitudes and 146 (69.5% 95% CI: 62.8%–75.6%) had “proper” practices. Overall, only 34 (16.2% 95% CI: 11.5%–21.9%) respondents had “adequate” knowledge, “correct” attitude, and “proper” practices.
Association between occupation, qualification, involvement in training, ever been trained on disinfection and level of KAP were checked using Chi-square test. Statistically significant association was found between occupation and level of attitude (P = 0.003); occupation and level of practice (P = 0.011); qualification and level of knowledge (P = 0.017), attitude (P = 0.002) and practice (P = 0.015); Involvement in patient care and level of attitude (P = 0.039) and practice (P = 0.003); Involvement in training and level of attitude (P = 0.041) and practice (P = 0.003); ever trained on disinfection and level of attitude (P = 0.036) and practice (P = 0.011).
| Discussion|| |
Disinfection is an important strategy in the prevention and control of the communicable disease. The administrative control of communicable diseases depends on the ability to maintain the two important and closely allied functions of isolation and disinfection. In this KAP assessment study conducted, we made an overall observation that the existing level of KAP among doctors and nurses was unsatisfactory. This is an alarming revelation, and therefore, it is highly recommended to take appropriate steps to address this gap. No study so far has been done to assess the KAP on the use of disinfectants among health care workers in the present COVID-19 scenario. The results of the present study are, therefore, an important breakthrough in this direction. The results of the study can be flagged to chalk out feasible and sustainable solutions to improve the level of knowledge as well as training in order to efficiently combat the COVID pandemic.
Antiseptic and disinfectants are the chemical agents that inhibit or destroy microorganisms on living tissue (antiseptics) and inanimate surfaces and objects (disinfectants). They are a crucial part of infection control practices. Antiseptics and disinfectants are used in hospitals and other health-care settings for a variety of topical and hard surface applications. Hence, the knowledge related to antisepsis and disinfection is important for health-care workers. In our study, it was found that 95.1% of doctors are aware about the basic difference however, only 66.7% nurses are aware of the difference. In one of the studies among staff nurses in a tertiary care hospital Dabhade et al. observed that nurses were aware about the definition of the antiseptic and disinfectant (92% and 90.4% respectively).
Overall, only 34 respondents had “adequate” knowledge, “correct” attitude and “proper” practices on methods of disinfection for COVID-19, which raise the alarm where the whole world if fighting to contain the disease our health care workers are lacking on basics of disinfection measures to be adopted during COVID-19 situation.
Findings suggest that only 50.1% of doctors and 66.6% of nurses were given some kind of training on methods of disinfection during ongoing COVID-19. Training in the hospital is an essential and vital function. More than 5000 articles have been written about training workers to improve quality in healthcare. However, the majority of studies on training have highlighted the training approach and content, and only fewer work has been done to assess the impacts of training or to describe the most useful content or the training methods. There is some evidence that training students and health workers in quality improvement may improve knowledge, skills, and attitudes. However, in our study, no significant association was found between training and KAP.
Studies have shown that in-service training/on the job training improves the performance of health workers, quality of medical services, and organizational commitment and organize regular cascade trainings of staff on infection prevention and control during an outbreak, leads to significantly improved performance among private and public health-care services., Hence, training and re-training of health care workers are important for improving performance and a better understanding of a new disease.
Respondents who are involved in training health-care workers had more chances of proper practice as compared to those not involved in training. No studies author could found which has evaluated that the trainers do have adequate skills when it comes to practice.
The present study suggests that Nurses have a better attitude as compared to Doctors. Graduates are more likely to have a correct attitude compared to postgraduates. Respondents involved in patient care had more chances of proper practice as compared to those not involved inpatient care.
The questionnaire used as an assessment instrument in the present study has been validated by a group of health-care workers; however, no standardized instrument is presently made available by any apex health agency. Another limitation is the study population comprised of participants from various hospitals and institutions, which may lead to differing levels of KAP on methods of disinfection due to differences in the level of training of health care workers.
| Conclusions|| |
Based on the results obtained, it was determined that the KAP of health-care workers with respect to methods of disinfection in the present ongoing COVID-19 pandemic left much to be desired. These gaps should be addressed through educational initiatives, training, infection control campaigns, and strict implementation of guidelines issued by the WHO, Ministry of Health and Family Welfare India, Indian Council of Medical Research, and other reliable sources. Findings of the study may help the health managers to plan and improve on the training of health-care workers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]