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

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).


Introduction
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 [1]. These strategies can be difficult and time-consuming to adhere to in practice. By identifying barriers and facilitators to IPC guideline adherence, we can more easily identify strategies that will support health care workers to undertake the IPC measures needed at such a critical time in health care intentionally [2]. It can help to minimize the risk of developing COVID-19 while working in clinical laboratories/hospitals. The novel coronavirus outbreak may be especially hazardous to health care personnel. National Institute of Health revealed that the infection rate of health care workers among the total number of COVID-19 patients is as high as 10.7%.

Material & Methods
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 [3]. Treating doctors, resident doctors, nurses, lab technicians, ward boys, food distributors were included [4]. This was the only COVID healthcare sector of the southern zone of Gujarat which is a Teaching institute of Government. Participants were enrolled during their break time or before entering or leaving duty hours for the study. Every participant was interacted with individually. They were informed briefly about the study by a participant information sheet and also informed that have to spend only 10 minutes times once for filling up questionnaires. Informed consent was taken from every The identity of them was decoded by giving them a unique ID number [5].

Data Collection
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.

Data Analysis
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.

Result
During June 2020, the study was conducted after ethical approval.

Discussion
Since its initial outbreak in December 2019, the COVID-19 disease has had a cascading effect worldwide [6]. The identification and isolation of a suspected case is the most important step in preventing the spread of COVID-19. Awareness of the use of personal protective equipment (PPE) for suspected/confirmed COVID-19 cases was high among all groups of healthcare professionals similar to other studies [7]. 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 [8].
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 [9]. As they are already trained for the same but not practicing properly and that's why it is seen in knowledge also. HCWs are well aware of COVID-19 infections and transmission routes so that they have to consistently wear PPE in hospitals to prevent the spread of infection. Attitude and practices related questions are also answered correctly overall.

Conclusion
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.