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COVID-19 Awareness among Healthcare Workers - A Questionnaire Based Survey

Fathima Bareera Rezvi Graduate student

Saveetha Dental College and Hospitals,

Saveetha Institute of Medical and Technical Sciences, Tamil Nadu, India

Dr. Mebin George Mathew Senior lecturer

Department of Pedodontics Saveetha Dental College and Hospitals

Saveetha Institute of Medical and Technical Sciences 162, Poonamallee High Road

Chennai 600077 Tamil Nadu, India

Email id: [email protected] Contact no: 8951748659

Dr. Deepa Gurunathan Professor and Head Department of Pedodontics Saveetha Dental College and Hospitals Saveetha Institute of Medical and Technical Sciences

162, Poonamallee High Road Chennai 600077 Tamil Nadu, India

Corresponding author Mebin George Mathew

Senior Lecturer Department of Pedodontics Saveetha Dental College And Hospitals

Saveetha Institute Of Medical And Technical Sciences Chennai, India

E mail: [email protected] ABSTRACT

INTRODUCTION : The aim of the present study is to determine the knowledge of healthcare workers on COVID-19

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MATERIALS AND METHODS: Self designed questionnaire was prepared to collect information pertaining to the study. The questionnaire consists of different types of basic multiple choice questions which were used to determine awareness. It was distributed to healthcare workers of different practicing age groups.

RESULTS: Healthcare professionals and students showed adequate, satisfactory awareness of COVID-19 in the healthcare setting with an overall percentage of 76.5% correct answers.

CONCLUSION: Although theoretically participants’ awareness was satisfactory, practically this study shows that periodic educational interventions and infection control training practices for COVID-19 among all healthcare professionals should be conducted.

Key Words: Healthcare workers; students; awareness; knowledge;

INTRODUCTION

The entire world’s attention was caught by an ongoing outbreak of infection by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), known as COVID-19. On Dec 31, 2019 the first infected case of coronavirus was reported in Wuhan, China, in which the infections spread across China and to other parts of the world within a few weeks [(1)].

The novel coronavirus outbreak was declared a public health emergency of international concern, by the World Health Organization (WHO) on January 30, 2020 [(2), (3)]. This has been the 6th declaration of its kind in WHO history. Alarmingly, during the first week of March 2020, surprising numbers of several new cases were reported globally and the COVID-19 outbreak situation was declared as a “pandemic” on March 11, by the WHO [(4)].

This viral outbreak has spread to more than 200 countries around the world, territories or areas beyond China [(2)]. This SARS-CoV-2 is a novel strain of the coronavirus family and it has not been previously identified in humans [(5)]. The disease has a potential public health threat which is very high and the disease spreads through person-to-person contact. It has been estimated that COVID-19 could cost the globe more than ten trillion dollars, although there is considerable uncertainty existing concerning the transmission of the virus [(6)].

According to the World Health Organization (WHO), this pandemic has said to have affected more than 9 million people and caused more than 0.46 million confirmed deaths all over the world [(7)]. As of June 3rd, 2020, the virus has affected over 2,30,000 healthcare workers (HCWs), more than 600 nurses died globally[(8)]. The HCWs help to control the outbreak but it has become a critical issue due to the fact they are at a risk of infection in the epidemic chain. Hence, all possible actions must be carried out in order to control the spread of infection to HCWs. This could be done first by identifying the risk factors that cause the infection and then taking required actions to reduce these risks.

Overcrowding, absence of isolation room facilities and environmental contamination are methods in which the transmission is associated with. Moreover, this could also be due to the fact that some HCWs have inadequate awareness when it comes to infection prevention

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practices [(9)]. Awareness and knowledge of a disease may influence HCWs’ practices and attitudes, while incorrect practices and attitudes have a direct increase in the risk of infection [(10)]. Understanding HCWs’ awareness and possible risk factors helps to predict the outcomes of planned behaviour. Thus, this study aimed to determine the knowledge of healthcare workers on COVID-19. If the HCWs awareness regarding the virus can be determined in early stages, then this information can guide them toward relevant training and policies during the outbreak and help HCWs in prioritizing protection and avoiding occupational exposure.Our institution is passionate about high quality evidence based research and has excelled in various fields ( (11–21)

MATERIALS AND METHODS

Self-designed questionnaire with 10 questions was prepared to collect the information pertaining to the study. The questionnaire consists of different types of basic multiple choice questions which were used to determine awareness. It was distributed to healthcare workers of different practicing age groups. A total of 102 questionnaires were distributed. The questionnaire consisted of the following questions.

1. The virus causing the COVID-19 infection is called:

A. SARS

B. 2(SARS-CoV-2) C. 2019-nCoV D. Both B&C

2. Is this COVID-19 disease contagious?

A. Yes B. No

3. What is the incubation period of COVID-19?

A. 2-14 days B. 10-14 days C. 5-14 days

4. The main mode of transmission of virus from person to person is via?

A. Respiratory droplets

B. Spread from contact with contaminated surfaces or objects

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5. Which of the following is considered as “close contact”?

A. Being within approximately 10 feet (3 meters) of a patient with COVID- 19 for a prolonged period of time

B. Being within approximately 6 feet (2 meters) of a patient with COVID- 19 for a prolonged period of time

C. Having direct contact with infectious secretions (sputum, serum, blood) from a patient with COVID-19

D. Both B & C

6. A recommended infection prevention and control measure is to perform aerosol- generating procedures, including collection of diagnostic respiratory specimens, in an AIIR (Airborne Infection Isolation Room).

A. True B. False

7. Preferred method of hand hygiene for visibly soiled hands is:

A. Hand rub with soap and water for at least 10 seconds B. Hand rub with soap and water for at least 20 seconds C. Use of alcohol based sanitizer with at least 60 % alcohol 8. Use of face masks is not essential in which of the following groups?

A. People who are well, to protect themselves from COVID-19 infection B. Being in close contact of a person suspended of a or known to have COVID-19 infection

C. Healthcare professionals

9. Clinical management includes prompt implementation of recommended infection prevention and control measures and supportive management of complications. No specific treatment for COVID-19 is currently available.

A. True B. False

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10. What personal protective equipment should be worn by individuals transporting patients who are confirmed with or under investigation for COVID-19 within a healthcare facility?

A. Gloves B. Gown

C. Eye protection

D. Respirator – N95 mask E. All of the above RESULTS

The following results were obtained from the study. When questioned about the virus causing the COVID-19 infection, 5.2% answered (A) SARS, 22.4% answered (B) 2(SARS-CoV-2), 22.4% answered (C) 2019-nCoV while 50% answered (D) Both B&C [Figure 1]. When questioned is this COVID-19 disease contagious, 98.3% said Yes and 1.7% said No [Figure 2]. When questioned about the incubation period of COVID-19, 44.8% answered 2-14 days, 41.4% answered 10-14 days while 13.8% answered 5-14 days [Figure 3]. When questioned about the main mode of transmission of virus from person to person, 77.6% answered respiratory droplets and 22.4% answered spread from contact with contaminated surfaces or objects [Figure 4]. When questioned which of the following is considered as “close contact”, 1.7% answered(A) Being within approximately 10 feet (3 meters) of a patient with COVID- 19 for a prolonged period of time, 12.1% answered (B) Being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time, 22.4% (C) Having direct contact with infectious secretions (sputum, serum, blood) from a patient with COVID-19 , while 63.8% answered (D) Both B & C [Figure 5]. “A recommended infection prevention and control measure is to perform aerosol-generating procedures, including collection of diagnostic respiratory specimens, in an AIIR (Airborne Infection Isolation Room)”, 82.8%

answered this statement is true, while 17.2% answered this statement is false [Figure 6].

When questioned about the preferred method of hand hygiene for visibly soiled hands, 10.3%

answered hand rub with soap and water for at least 10 seconds, 63.8% answered hand rub with soap and water for at least 20 seconds, 25.9% answered use of alcohol based sanitizer with at least 60 % alcohol [Figure 7]. When questioned use of face masks is not essential in which of the following groups, 93.1% answered people who are well, to protect themselves from COVID-19 infection, 1.7% answered being in close contact of a person suspended of a or known to have COVID-19 infection, 5.2% answered healthcare professionals [Figure 8].

“Clinical management includes prompt implementation of recommended infection prevention and control measures and supportive management of complications. No specific treatment for COVID-19 is currently available”, 98.3% answered True for this statement and 1.7%

answered False for this statement. When questioned what personal protective equipment should be worn by individuals transporting patients who are confirmed with or under

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investigation for COVID-19 within a healthcare facility, 3.4% answered Eye protection, 1.8%

answered Respirator – N95 mask, while 94.8% answered All of the above.

Figure 1 This pie chart shows the percentage of each participant for the question-virus causing the COVID-19 infection? 5.2% answered (A)SARS, 22.4% answered (B)2(SARS- CoV-2), 22.4% answered (C)2019-nCoV while 50% answered (D)Both B&C

Figure 2 This pie chart shows the percentage of each participant for the question-is this COVID-19 disease contagious? 98.3% said Yes and 1.7% said No.

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Figure 3 This pie chart shows the percentage of each participant for the question-incubation period of COVID-19? 44.8% answered 2-14 days, 41.4% answered 10-14 days while 13.8%

answered 5-14 days.

Figure 4 This pie chart shows the percentage of each participant for the question-main mode of transmission of virus from person to person is? 77.6% answered respiratory droplets and 22.4% answered spread from contact with contaminated surfaces or objects.

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Figure 5 This pie chart shows the percentage of each participant for the question-which of the following is considered as “close contact”, 1.7% answered(A) Being within approximately 10 feet (3 meters) of a patient with COVID-19 for a prolonged period of time, 12.1% answered (B) Being within approximately 6 feet (2 meters) of a patient with COVID- 19 for a prolonged period of time, 22.4% (C) Having direct contact with infectious secretions (sputum, serum, blood) from a patient with COVID-19 , while 63.8% answered (D) Both B &

C

Figure 6 This pie chart shows the percentage of each participant for the statement “A recommended infection prevention and control measure is to perform aerosol-generating procedures, including collection of diagnostic respiratory specimens, in an AIIR (Airborne Infection Isolation Room)”, 82.8% answered this statement is true, while 17.2% answered this statement is false.

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Figure 7 This pie chart shows the percentage of each participant for the question-preferred method of hand hygiene for visibly soiled hands? 10.3% answered hand rub with soap and water for at least 10 seconds, 63.8% answered hand rub with soap and water for at least 20 seconds, 25.9% answered use of alcohol based sanitizer with at least 60 % alcohol

Figure 8 This pie chart shows the percentage of each participant for the question-use of face masks is not essential in which of the following groups, 93.1% answered people who are well, to protect themselves from COVID-19 infection, 1.7% answered being in close contact of a person suspended of a or known to have COVID-19 infection, 5.2% answered healthcare professionals.

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Figure 9 This pie chart shows the percentage of each participant for the statement “Clinical management includes prompt implementation of recommended infection prevention and control measures and supportive management of complications. No specific treatment for COVID-19 is currently available”. 98.3% answered True for this statement and 1.7%

answered False for this statement.

Figure 10 This pie chart shows the percentage of each participant for the question-When questioned what personal protective equipment should be worn by individuals transporting patients who are confirmed with or under investigation for COVID-19 within a healthcare facility, 3.4% answered Eye protection, 1.8% answered Respirator – N95 mask, while 94.8%

answered All of the above.

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DISCUSSION

The COVID-19 disease has had a cascading effect worldwide since its initial outbreak in China in December 2019. Identifying and isolating the suspected case is the most vital step in controlling the spread of COVID-19. In our study more than half of the participants were aware of the definition of a “close contact”. The US Centers for Disease Control (CDC) defines it as: “being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time or having direct contact with infectious secretions of a COVID-19 case. More than 50% of the participants were aware of all the answers. These participants are actively involved in managing patients, hence there are high chances of them having patient contact at any point in the healthcare set up and carry the risk of contracting and spreading the virus.

To prevent the spread of infection, correct hand hygiene practices play an important role.

“Five Moments of hand hygiene”by WHO defines the key moments when healthcare workers must carry out hand hygiene [(22)]. The two very basic methods of cleaning hands are hand washing and hand rubbing. Alcohol based hand rub (ABHR) is recommended by CDC most of the time [(23)]. The question in our questionnaire focussed on the recommended hand hygiene technique for visibly soiled hands which is washing hands with soap and water for at least 20 seconds with the entire process lasting upto 40-60 seconds [(24)

Awareness was high among the participants about the use of personal protective equipment (PPE) for COVID-19 cases. The CDC has given Interim Infection Prevention and Control Recommendations for suspected or confirmed coronavirus disease in healthcare set up for PPE [(25)]. Face mask or N95 respirator should be worn when visiting the patient room.

When performing aerosol generating procedure N95 respirator is preferred over face mask.

Used masks should be properly disposed. A clean gown along with a disposable face shield or goggles, clean non sterile gloves are recommended when visiting the patient room area. If shortage occurs gowns should be prioritized for aerosol generating procedures. The correct sequence “donning and doffing” should also be known. The sequence of donning a face mask is securing elastic bands or ties in the middle of the head or neck, fitting of the flexible band to the bridge of the nose, fit snug to face and below the chin, fit check respirator mask [(26)]

More than 90% of the respondents answered that the use of a facemask is not essential for people who are well and not in contact with a suspected or infected COVID-19 patient.

Isolation of patient and aerosol performing procedures should be done in the Airborne Infection Isolation Room (AIIR) which are kept under negative pressure. Suspected or confirmed patients should not be kept in a room with an exhaust that recirculates air within the hospital building. Air from these rooms should be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation.More than 80% of responders were aware of this concept.

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This current situation expects several strategies to be implemented to prevent the risk of infection among populations. Drugs such as antimalarials and antivirals are being under trial.

It has been shown in in-vitro drug testing that antimalarial hydroxychloroquine to possess antiviral activity against SARS-CoV-2 and could be used as chemoprophylaxis for healthcare workers. Clinical trials for the treatment of COVID-19 pneumonia with hydroxychloroquine are going on and the results will be monitored closely [(27)]

The main drawback of this study is that most participants are from urban areas which truly do not represent the healthcare professionals of the entire state and country.

CONCLUSION

Healthcare professionals and students showed adequate, satisfactory awareness of COVID-19 in the healthcare setting with an overall percentage of 76.5% correct answers. Although theoretically participants’ awareness was satisfactory, practically this study shows that periodic educational interventions and infection control training practices for COVID-19 among all healthcare professionals should be conducted. Webinars for educational interventions for all healthcare students and professionals which includes administrative staff, nursing and paramedical sub-groups as this could be helpful to create more awareness.

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