We conducted a retrospective, national cross-sectional survey of HCWs in the IPC network in Thailand between May 5, 2020 and May 15, 2020. The study protocol was reviewed and approved by Institutional Review Board of BIDI, Ministry of Public Health, Thailand. The reference approval letter number is SO42h/63_ExPD. Informed consent was waived as participant data were de-identified. The primary objective was to estimate the prevalence of HCW who used optimized PPE. The secondary objective was identification of the independent predictors of optimized PPE use and non-optimized PPE use. Optimized PPE use was defined as HCWs using PPE including medical masks, gowns, gloves, eye protection (goggles or face shields), performing appropriate hand hygiene as well as not using coveralls, double gloves, or head covers (hoods) . Non-optimized PPE was defined as HCWs using incomplete appropriate PPE or over-using PPE.
We extracted demographic, work experience and setting, knowledge, attitudes and practices data, including established sex, age, education (bachelor degree or postgraduate degree), experience in hospital work (< 1 y, 1–5 y, 6–10 y,11–20 y, and ≥ 20 y), experience in IPC (< 1 y, 1–5 y, 6–10 y,11–20 y, and ≥ 20 y), hospital type (primary, secondary, tertiary, university, private, army, and other), care type (adult only, child only, as well as both adult and child), experience with COVID-19 (yes or no), droplet and contact precaution(yes or no), ABHR practice (yes or no), wash with soap and water (yes or no), appropriate disinfectant regimen use (i.e. 70% ethyl alcohol, sodium hypochlorite-based, or both alcohol and sodium hypochlorite), appropriate negative pressure room selection (negative pressure rooms for all situation or not), selecting N95 respirator for all situations (yes or no), single room (use air conditioning all the time or not), knowledge that symptom severity in children is apparently milder than in adults (yes or no), spraying disinfectant (yes or no), advising influenza vaccine (yes or no), visit strategy (yes or no), discharge plan for patients including social distancing, HH, and mask (yes or no), discharge plan for family including social distancing, HH, and mask (yes or no), advising people to wear masks (yes: advise cloth mask or no), fear of COVID-19 infection (yes: afraid or no), and fear of sickness and 14-day quarantine (yes or no).
The definitions for appropriate hand hygiene, social and physical distancing, as well as 14-day quarantine for items used in the questionnaire survey are listed below. All HCWs should use droplet and contact precautions in routine practice for care of patients with suspected or confirmed COVID-19 [14–17,20]. For our questionnaire survey, appropriate hand hygiene practice by HCWs was defined as an ABHR that contained at least 60% alcohol for a minimum of 20 seconds or washing with soap and water at the beginning of the workday, before and after touching residents, after using the toilet, before and after preparing food, and before eating [22,23]. We defined social distancing or physical distancing according to the Centers of Disease Control and Prevention of the United States’ definition of maintaining a physical distance of 2 m or more from other people . We defined appropriate 14-day quarantine as 14-day quarantine of close contacts of a HCW infected with COVID-19 . Influenza vaccination was advised for the public including HCWs during the COVID-19 pandemic . All HCWs should be checked twice a day for ARIS symptoms, and body temperature to increase the chances of early diagnosis. If a member of the team is infected with COVID-19, all close contacts should take quarantine measures .
Descriptive statistics are presented as mean (SD) for normally distributed continuous variables, median (Q1, Q3) for non-normally distributed continuous variables, and frequency (%) for categorical variables. All continuous data were compared with the Student´s t-test or the Mann-Whitney U test as appropriate. Categorical data were compared with the chi-square test. A p-value of < 0.05 was considered statistically significant. Multivariable logistic regression was used to identify independent predictors of optimized PPE use. All variables with p-value < 0.05 in univariate analyses were selected for multivariate analysis. Factors considered were sex, age, education level, experience in hospital work, experience in IPC work, hospital type, care type, experience in COVID-19, droplet and contact precaution, ABHR practice, hand hygiene by washing with soap and water, disinfectant, knowledge of appropriate negative pressure room selection, selecting N95 respirator in all situations, single room, knowledge of apparently milder symptoms in children than adults, spray disinfectant, advising influenza vaccination, visit strategy, discharge plan for patient, discharge plan for family, advising people to wear mask, fear of COVID-19 infection, and fear of sickness and 14-day quarantine.