Knowledge and compliance to personal protective equipment in emergency department during COVID-19 pandemic in Malaysia: A cross-sectional questionnaire study

ABSTRACT

Background and objectives: Healthcare workers (HCWs) in emergency departments (EDs) are at higher risk of COVID-19 infection due to the unknown status of patients presenting to ED. Strict adherence to personal protective equipment (PPE) is absolute. This study aimed to evaluate the knowledge of and compliance to use of PPE among ED personnel during COVID-19 outbreak. Methods: This is a cross-sectional, web-based questionnaire study conducted in two COVID-19 hospitals and two screening hospitals in Malaysia. A study questionnaire consisted of demographic characteristics, knowledge, and compliance to COVID-19, and PPE was developed and distributed among HCWs in ED. Participation in this study was voluntary and anonymous. Knowledge score, PPE selection, and proportion of compliane to PPE were analyzed using descriptive analysis. Categorical variables were reported as percentages, while continuous variables as mean with standard deviation (SD) or median with interquartile range (IQR). The association between knowledge score and demographic variables was tested using correlation tests, and regression analysis was performed to determine significant predictors for knowledge and compliance. Results: Of the total 233 respondents, 60.5% were females and 58.8% were doctors. In all, 68.2% had attended training, with 77.3% having attended training less than 6 h in total. In all, 48.9% of respondents were from COVID-19 hospitals and 51.1% from screening hospitals. Mean knowledge score was 14.6 of 19. Choice of PPE between COVID-19 and screening hospitals was comparable in respiratory and non-respiratory zone with variation seen in triage area. In total, 85% perceived training as adequate, but compliance to some PPE was observed only in 46.4%. HCWs in COVID-19 hospitals were 52% significantly less compliant to PPE than those in screening hospitals (odds ratio (OR), 0.48;95% confidence interval (CI), 0.26-0.90, p=0.023). Factors associated with compliance to some PPEs include age, designation, years in service, total hours of training, and type of hospitals. Conclusion: Rate of compliance to PPE in ED remains substandard despite being confident with PPE knowledge, donning and doffing technique, as well as adequacy of training received. Poor compliance to PPE is a major concern as it may adversely affect the frontline healthcare system. Further evaluation of underlying issues is worth exploring.