Journal of Radiology Nursing xxx (2021) 1e5

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Journal of Radiology Nursing

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journal-of-radiology-nursing

Knowledge of Handling the Personal Protective Equipment by

Frontline Allied Health Professionals in COVID-19 OutbreakdA
Web-Based Survey Study
Santosh Ojha, MSc *, Manna Debnath, MSc, Dolly Sharma, MSc, Anupam Niraula, MSc
Department of Medical Imaging Technology, Charotar Institute of Paramedical Sciences (CIPS), Charotar University of Science and Technology, Anand,
Gujarat, India

a b s t r a c t

Keywords: Ever since the coronavirus disease 2019 (COVID-19) has emerged, the number of affected individuals has
Personal protective equipment (PPE) been increasing exponentially. The frontline health workers are in constant risk because of the etiology
Knowledge and mode of transmission of the disease. Thus, the proper use of personal protective equipment (PPE) is
Pandemic
very crucial during this pandemic. This study is to assess the knowledge regarding the handling of PPE
COVID-19
among frontline allied health professionals who are directly in contact with patients with COVID-19. A
standard questionnaire was prepared in Google Forms and circulated within the network of health-care
workers via online platforms. A total of 143 frontline health workers participated in the questionnaire
survey. It was found that only 44.1% of the total participants had previously undergone training regarding
the handling of PPE. About 86.0% of participants gave correct response to the safety etiquette questions.
For another knowledge-based question about using the N95 respirator in conjunction with a face shield,
86.7% of participants responded correctly. Only 67.8% of participants gave the right response to the
question regarding the sequence of donning and doffing of PPE. The last question was regarding
knowledge about the disposal of PPE, where 95.8% of participants responded correctly. Despite the safety
precautions and procedures set forth by the Centers for Disease Control and Prevention for handling
patients with COVID-19, the health-care workers are still prone to occupational hazards. The only barrier
standing between the health-care workers and COVID-19 is the PPE. Thus, in-depth training and edu-
cation should be imparted on the health-care workers in the present pandemic situation.
© 2020 Association for Radiologic & Imaging Nursing. Published by Elsevier Inc. All rights reserved.

Background Based on the studies conducted until now, the main mode of
transmission of this disease seems to be via droplet or direct con-
In December 2019, patients with lower respiratory tract in- tact, symptomatic people being the main cause of transmission.
fections started emerging in Wuhan City, Hubei province in China. However, many studies suggested that the presymptomatic trans-
The microbe responsible for this outbreak was found to be severe mission and asymptomatic transmission also account for trans-
acute respiratory syndrome coronavirus-2 initially called as novel mitting the virus, suggesting that isolation is the best way to stifle
coronavirus. In February 2020, the WHO named the infection as this epidemic (Cascella et al., 2020; World Health Organization,
coronavirus disease 2019 (COVID-19) (Cascella et al., 2020; Park, 2020a).
2020). Since then, there has been an exponential rise in the num- In the present scenario, frontline health-care professionals being
ber of cases because of its etiology and mode of transmission. at constant contact with patients with COVID-19 possess a sub-
stantial risk in their working environment. Personal protective
equipment (PPE) is the only protective barrier for working staff and
other patients from COVID-19 transmission (Cook, 2020; Holland
There are no conflicts of interest regarding the publication of this article. et al., 2020). The PPE kits should be appropriately chosen accord-
* Corresponding author: Santosh Ojha, Department of Medical Imaging Tech-
ing to each setting.
nology, Charotar Institute of Paramedical Sciences (CIPS), Charotar University of
Science and Technology, Anand, Gujarat, India. The use of the contact precaution PPE, that is, fluid-resistant
E-mail address: santdastan@gmail.com (S. Ojha). surgical face mask, apron, and gloves are appropriate for

https://doi.org/10.1016/j.jradnu.2020.12.012
1546-0843/$36.00/© 2020 Association for Radiologic & Imaging Nursing. Published by Elsevier Inc. All rights reserved.

Please cite this article in press as: Ojha S et al., Knowledge of Handling the Personal Protective Equipment by Frontline Allied Health
Professionals in COVID-19 OutbreakdA Web-Based Survey Study, Journal of Radiology Nursing, https://doi.org/10.1016/j.jradnu.2020.12.012
2 S. Ojha et al. / Journal of Radiology Nursing xxx (2021) 1e5

protection against direct contact infection when at least 2 m away previous training experience of PPE before the COVID-19 outbreak
from the patient. As for droplet precaution PPE, when handling (Table 1).
patients in the close range, that is, less than 2 m, eye protection is
added, depending on the risk estimation. During high-risk pro- Statistical Analysis
cedures such as airway management where respiratory aerosol are
produced, airborne precaution PPE should be used by everyone The collected data were analyzed by using descriptive statistics,
involved during the procedure. The airborne precaution PPE kit that is, the mean and standard deviation (SD) of samples. The data
includes the gloves, fluid-repellent long-sleeve gown, high filtering analysis was performed by IBM SPSS Statistics for Windows, version
face piece such as N95 masks or a powered air-purifying respirator, 20.0 (IBM Corp., Armonk, NY) and presented in the form of fre-
and face shield. When appropriate and feasible, it is crucial that an quency and percentage.
infected person use a fluid-resistant face mask to reduce the risk of
transmission via droplets (Cook, 2020; World Health Organization,
2020b). Results
Apart from using the appropriate PPE, the staff should always
follow safety protocols set forth by the Centers for Disease Control A total of 143 frontline health-care workers participated in the
and Prevention (CDC) regarding the personal hygiene, handling, questionnaire survey, among which 66 (46.2%) were men and 77
and the dooming of used PPE kits. The staff should be well trained (53.8%) were women (Figure 1). The mean age of the male partic-
and should be made aware of the safety aspects and guidelines to ipants was 29.14 years with an SD of 7.3 and that of female par-
reduce the cross-infection. Apart from all the precautions and ticipants was 24.62 years with an SD of 4.03 (range 18e48 years).
safety protocols, the frontline health workers are at constant The maximum participation of health-care workers for the
occupational risk despite the standard safety conventions. survey study was from the Nursing Department (n ¼ 54) followed
by the Radiology Department (n ¼ 51), Department of Operation
Aim Theater and Anesthesia Technology (n ¼ 23), Medical Laboratory
Department (n ¼ 12), and Physiotherapy (n ¼ 3) as shown in the bar
The main purpose of this study is to assess the knowledge graph in percentage (Figure 2).
regarding the handling of PPE among frontline allied health pro- The total of 67.1% (n ¼ 96) of participants had a graduate degree
fessionals who are directly in contact with patients with COVID-19. followed by postgraduate participants 18.2% (n ¼ 26) and diploma
degree 14.7% (n ¼ 21). The samples were collected from 20 states of
Material and methods India and of all participants, the majority of them were from the
Gujarat state (28.67%) followed by other locations as shown in the
A web-based survey study was conducted from May 3, 2020 to graph in percentage (Figure 3).
May 8, 2020 during the pandemic lockdown COVID-19 among As shown in Table 2, only 44.1% of the total participants had
frontline health-care workers because they are directly associated previously undergone training regarding the handling of PPE in the
with the diagnosis and treatment of patients with COVID-19. Hos- epidemic/pandemic disease outbreak. About 86.0% of participants
pital frontline health-care workers within India were included in gave a positive response against the question about the safety
this study. A standard questionnaire was prepared after the dis- etiquette of touching and adjusting the face mask with the gloves
cussion with other experienced faculties. Owing to the pandemic after handling a patient. For another knowledge-based question
lockdown, the institutional ethical board was not approachable; about using the N95 respirator in conjunction with a face shield,
thus, telephonic approval was taken from the University Hospital- 86.7% of participants responded positively. For another knowledge-
dCharusat Healthcare and Research Foundation, Changa, Gujarat. based question regarding the donning and doffing of the PPE, 67.8%
Questionnaires were prepared in Google Forms and circulated of participants gave the right response, whereas 25.2% gave the
through the social media platforms and e-mail of health-care wrong response and 7% responded as maybe. The last question was
workers and employers within India. regarding knowledge about the disposal of PPE, where 95.8% of
The study PROforma was categorized into three sections. The participants responded positively (Table 2).
first section consisted of the title and objective of the study, in-
structions, and the declaration of anonymity. The willingness of Discussion
participants was recorded in the first section with close-end
questions, that is, yeseno response and forwarded to further sec- The outbreak of COVID-19 has caused fear among the world
tions if participants agreed to participate in the survey. De- population and the government. The etiology and mode of trans-
mographic data such as gender, age, education, department of mission of this disease make the treatment of the patients more
employment, and location were included in the second section. The challenging for health-care workers. The use of PPE is the only
third section consisted of 5 questions among which 4 questions barrier that minimizes the occupational risk of these workers. Thus,
were purely knowledge based and 1 question was about the to assess the knowledge of handling the PPE among the health-care

Table 1
Table showing the questionnaire of knowledge based on PPE and previous experience

Questions Response

1. Do you have any previous training experience in handling personal protective equipment before the Corona outbreak? Yes, No
2. Can you touch your face or adjust personal protective equipment with gloves after or while handling the patient? Yes, No, Maybe
3. According to you, is it beneficial to use both the N95 respirators and a face shield that covers the forehead, extends below Yes, No, Maybe
the chin, and wraps around the side of the face while handling patients with COVID-19?
4. Is the sequence of wearing and removing the personal protective equipment the same? Yes, No, Maybe
5. After handling the patient with COVID-19, do you dispose of your personal protective equipment kits according to standard guidelines? Yes, No, Maybe

PPE ¼ personal protective equipment; COVID-19 ¼ coronavirus disease 2019.

Please cite this article in press as: Ojha S et al., Knowledge of Handling the Personal Protective Equipment by Frontline Allied Health
Professionals in COVID-19 OutbreakdA Web-Based Survey Study, Journal of Radiology Nursing, https://doi.org/10.1016/j.jradnu.2020.12.012
 S. Ojha et al. / Journal of Radiology Nursing xxx (2021) 1e5 3

Figure 1. Distribution according to gender.

workers, a survey was conducted among frontline health-care respirators with face shield during aerosols producing procedures
professionals from different hospitals. (Taghrir et al., 2020).
Taghrir et al. (2020) conducted a study on COVID-19 based on Kotian et al. (2020) also conducted a study on COVID-19 based
knowledge, preventive behaviors, and risk perception among on knowledge and understanding among medical imaging pro-
Iranian medical students, on which they reported that only 43.3% fessionals, on which they reported that only 46.5% of participants
had received any kind of education about COVID-19; however, have undergone training for the safe use of PPE (Kotian, Faujdar, &
there was no significant difference of response between those Kotian, 2020).
who had not attained any kind of education in his study. In the In the present study, the results were similar to the other
same study, 85.5% of the participants responded the use of PPE studies; only 44.1% of participants had attended direct training
such as face mask can help prevent the transmission of COVID-19 from their health-care institute regarding the PPE handling and
and 79.2% of the study population knew the use of N95 safety in epidemic/pandemic situation before involving in the

Figure 2. Distribution according to the department.

Please cite this article in press as: Ojha S et al., Knowledge of Handling the Personal Protective Equipment by Frontline Allied Health
Professionals in COVID-19 OutbreakdA Web-Based Survey Study, Journal of Radiology Nursing, https://doi.org/10.1016/j.jradnu.2020.12.012
4 S. Ojha et al. / Journal of Radiology Nursing xxx (2021) 1e5

Figure 3. Distribution of participants by location.

treatment and diagnosis of patients with COVID-19. This increases about handling and disposal of used PPE, which is crucial in a
the risk of getting exposed to viral infection as the safety protocols pandemic situation such as COVID-19.
vary while handling the patients in a pandemic outbreak such as
COVID-19. Although the health-care professionals did not have any Limitations of the Study
training about the safe use of PPE in the COVID-19 outbreak, the
majority of participants have responded correctly against the Because the survey was conducted within the author's circle for
questions regarding the safety aspects, etiquettes, and knowledge a short duration and due to the busy schedule of health workers, a
about the PPE. limited study sample was obtained. Furthermore, the reliability of
A study conducted by Modi et al. (2020) among the health-care the questionnaire was not tested. There may be potential bias in the
students and professionals in the Mumbai metropolitan area response because of the participation of responders with good
showed 45.4% of responders knew the right sequence of donning knowledge of PPE. Despite the limitations, this study was con-
and doffing of the PPE. The results were slightly higher in the ducted during the mid-phase of COVID-19 lockdowns to review the
present study; about 67.8% of the study population responded knowledge of the health-care workers after their experience with
correctly. However, there is still the need for in-depth training and patients with COVID-19.
briefing of the health-care workers regarding the different safety
aspects about the use of PPE such as using a right PPE kit for a Conclusion
different scenario, the sequence of donning and doffing of soiled
PPE, standard etiquette while using PPE, and maintaining personal Despite the safety precautions and procedures set forth by the
hygiene (Modi et al., 2020). CDC for handling patients with COVID-19, the health-care workers
This study shows the awareness among the health-care workers are still prone to occupational hazards. The only barrier standing
regarding the use of PPE is good but lacks in-depth knowledge between the health-care workers and COVID-19 is the PPE. This

Table 2
Table showing the questionnaire and frequency/percentage of their responses

SN Questions Response (n ¼ 143)

Yes No Maybe

1 Do you have any previous training experience in handling personal protective equipment before the corona outbreak? 63 (44.1%) 80 (55.9%) e
2 Can you touch your face or adjust personal protective equipment with gloves after or while handling the patient? 8 (8.0%) 123 (86.0%) 12 (8.4%)
3 According to you, is it beneficial to use both the N95 respirators and a face shield that covers the forehead, extends 124 (86.7%) 10 (7.0%) 9 (6.3%)
below the chin, and wraps around the side of the face while handling patients with COVID-19?
4 Is the sequence of wearing and removing the personal protective equipment the same? 36 (25.2%) 94 (67.8%) 10 (7.0%)
5 After handling the patient with COVID-19, do you dispose of your personal protective equipment kits according to 137 (95.8%) 3 (2.1%) 3 (2.1%)
standard guidelines?

COVID-19 ¼ coronavirus disease 2019.

Please cite this article in press as: Ojha S et al., Knowledge of Handling the Personal Protective Equipment by Frontline Allied Health
Professionals in COVID-19 OutbreakdA Web-Based Survey Study, Journal of Radiology Nursing, https://doi.org/10.1016/j.jradnu.2020.12.012
 S. Ojha et al. / Journal of Radiology Nursing xxx (2021) 1e5 5

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Please cite this article in press as: Ojha S et al., Knowledge of Handling the Personal Protective Equipment by Frontline Allied Health
Professionals in COVID-19 OutbreakdA Web-Based Survey Study, Journal of Radiology Nursing, https://doi.org/10.1016/j.jradnu.2020.12.012