The finding of this study demonstrated that the greater part (93.3%) of the study participant had self-reported good knowledge towards COVID-19. Findings are consistent with a study in District 2 Hospital, Ho Chi Minh (98.2%) (19), a study in Pakistan (93.2%) (21), and the finding from China (89%) (22). This high percentage of knowledge about COVID-19 among healthcare workers is due to prolonged exposure to information since its global topic of discussion on the media and public. Another reason could be the effort of government and media in providing information starting from the time of the outbreak.
The study further showed that 64.2% of the study participants had self-reported good infection prevention practices towards COVID-19. This finding is in an agreement with the study in Northern Ethiopia among nurses in which 67% had good infection prevention practice towards the COVID–19(23) but lower than the finding of a study from Makerere University Teaching Hospitals, Uganda that showed 74% of the study participants demonstrated good practice towards COVID-19 prevention(20). The possible reason for the current low practice might be due to variation in the cut of point which is used to determine the outcome variable and variation in type and number of healthcare facilities included in these studies.
The study further revealed that HCWs perceived overcrowding in the emergency room and limited availability of infection prevention material as the major barriers to infection prevention practice. This finding is supported by the study in Pakistan where overcrowding in emergency rooms and limited infection control material were the major barriers in infection control practice (21).
On multivariable logistic regression analysis, gender, educational status, profession, years of service, Knowledge, and availability of personal protective equipment were significantly associated with good infection prevention practices. Accordingly, male HCWs were more likely to have good infection prevention practices than female health care workers. This study is supported by a study among health care workers in selected hospitals that revealed male HCWs promoted IPC behavior compared to females(24).
Healthcare workers having bachelor's degrees were more likely to have good infection prevention practices compared to diploma holders. The finding from a study at Makerere University Teaching Hospital, Uganda in which holding a diploma is significantly associated with good practices contradicts this study finding(20). This difference could be attributed to the difference in workload of staff wherein our study the degree holders might be overburdened with different responsibilities.
The health workers' profession was another factor significantly associated with infection prevention practices. Physicians were more likely to practice infection prevention than nurses. This difference could be due to disparities of knowledge among HCWs. Doctors are actively involved in seeking information due to their active roles in improving treatment outcomes of patients with COVID-19. This finding is inconsistent with another study conducted in Pakistan in which Pharmacists were more likely to practice infection prevention practice(21).
The study revealed that service year was significantly associated with infection prevention practice. Healthcare workers having longer years of service were more likely to have good infection prevention practices compared to those who have served for less than five years. This finding is in line with the finding of the study conducted in Pakistan that revealed experienced (>5 years) HCWs were more likely to follow precautionary practices(21). The possible explanation is that experienced workers have skills and experience in dealing with public health emergencies.
Knowledge of the health care workers towards COVID-19 was significantly associated with infection prevention practice. Healthcare workers who had self-reported good knowledge were more likely to have self-reported good practice scores towards COVID-19 than those who had poor knowledge. This finding is supported by a study finding from Chitwan, Nepal that revealed higher knowledge scores were significantly associated with higher practice scores(25).
The study revealed that the availability of personal protective equipment at the work unit was significantly associated with good infection prevention practices towards COVID-19. In contrary to this study, finding from a study among Orthopedic Surgeons in Wuhan, People’s Republic of China revealed that insufficient supply of PPE was not associated with Exposures and the COVID-19 Morbidity(26). This difference could be due to the difference in the supply of personal protective equipment and study settings.
The limitation of this study is that the knowledge level and preventive practice of HCWs may be overestimated, as the HCWs might have answered the questions in a way that they believed was socially acceptable rather than being completely accurate. To make the self-reported compliance closer to the actual, the authors devoted all the staff in the research group and trained carefully, to orient the HCWs to complete the questionnaires based on the actual situation.