Frontline Healthcare Workers’ Knowledge, Perception and Risk Prevention Practices Regarding COVID-19 in Afghanistan: A Cross-Sectional Study
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(1) Background: As of 13 December 2020, Afghanistan reported around 48,952 confirmed COVID-19 cases and 1960 deaths. Lack of knowledge and perceptions among healthcare workers (HCWs) can pose challenges to disease control. Therefore, targeted, timely assessment of knowledge and perceptions are needed to address practices that might hinder efforts to stop the spreading of COVID-19 in Afghanistan. This study aimed to assess COVID-19-related knowledge, perceptions, and risk prevention practices (KPP) among frontline HCWs in Afghanistan; (2) Methods: A cross-sectional study was conducted with the support of field teams who were deployed in Afghanistan, surveyed from 14 to 22 April 2020 in eight provinces in Afghanistan with varying cumulative incidence of COVID-19 cases. A 28-item KPP survey instrument was adapted from other internationally validated questionnaires related to COVID-19. (3) Results: The survey was conducted among 213 frontline HCWs engaged in screening and treating COVID-19 patients. Survey results indicated that basic awareness of COVID-19 was 100% across all the participants. Knowledge and understanding of COVID-19 transmission, symptoms, incubation period and complications associated with COVID-19 are comprehensive and high (>90%), except available treatment for COVID-19 (84%). HCWs’ perceptions towards the prevention and control of COVID-19 were positive. However, only 63% believed that the use of N-95 face masks and disposable and fluid-resistant gowns (76%) could prevent COVID-19 transmission. This survey showed high knowledge and positive perception (72%), and only 48% of frontline HCWs had shown risk prevention practices. Addressing their perceptions and placing additional focus on practices across all health facilities is recommended as a preparedness measure.Keywords:
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The purpose of this study was to find out problems encountered by Foskor Mine workers in Phalaborwa with the use of personal protective equipment and also to find out how these problems can be prevented or solved. A quantitative research study was done using a questionnaire as a data gathering tool on workers who are exposed to occupational injuries and illnesses and who use personal protective equipment for their protection. The findings revealed that even though workers were using personal protective equipment they still got occupational injuries and illnesses. They also had problems with their protective equipment like incompatible types of personal protective equipment, such as weight where heavy personal protective equipment like boots were issued and very hot or cold personal protective equipment incompatible with the temperature of the environment. Some personal protective equipment like gloves were of a wrong size and caused allergy. In some instances unavailability of or unsuitable personal protective equipment posed challenges to these workers.
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In the COVID-19 pandemic, global health care systems have become overwhelmed with potentially infectious patients seeking testing and care. Preventing spread of infection to and from health care workers (HCWs) and patients relies on effective use of personal protective equipment(PPE). The most critical part in due course of managing this pandemic is adequate supply of PPEs. We have customized a PPE which is economical and reusable after proper disinfection. This customized PPE can be a solution to conservation of supply during this pandemic.
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Background: The number of cases infected with COVID-19 continues to increase, so it is very necessary to handle Covid-19 cases. One of them is the use of personal protective equipment (PPE) for corpse recovery officers in handling Covid-19 bodies. The purpose of the study was to analyze the impact of the use of PPE on the Covid-19 corpse recovery officers at the Macanda Gowa Cemetery.
Methods: This research is qualitative research with a phenomenological approach. The number of research is 5 main informants, 2 supporting informants, and 1 key informant.
Results: The results of this study showed that the behavior of the mortuary officers was anxious, afraid, worried, had experience in handling Covid-19 corpses, wore personal protective equipment (PPE) for 2-3 hours, burned PPE, removed PPE at the specified location, size The PPE is not suitable for the Covid-19 relocation officer. The impacts of PPE are heat, heat, skin injuries, headaches, dehydration, hot skin (prickly heat), fever, Covid-19 positive, difficulty breathing. Managing the negative impact of using PPE by turning on the air conditioning (AC), opening the windshield, unzipping the hazmat shirt a little, and removing the mask and face shield, smearing the body with eucalyptus oil, cleaning the body, drinking water and exercising.
Conclusions and suggestions: The behavior of the Covid-19 corpse recovery officer in using PPE does not comply with the use of personal protective equipment correctly. This is due to the lack of knowledge of the mortuary staff regarding the proper use of PPE. So that the effects of PPE are not correct. There is a need for supervision and awareness-raising on the understanding of the use of PPE for COVID-19 corpses.
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Background Correct use of personal protective equipment is vital to minimise the risk of patients acquiring healthcare-associated infections. These measures are also important in preventing exposure to occupational infection. During the COVID-19 pandemic, the use of personal protective equipment was associated with anxiety, uncertainty and additional training requirements. This study investigated midwives’ experiences using personal protective equipment during the pandemic. Methods This systematic scoping review searched seven academic databases and grey literature. Data analysis was conducted using a thematic analysis framework. Results A total of 16 studies were included. Four themes were found: ‘fear and anxiety’, ‘personal protective equipment/resources’, ‘education and training needs’ and ‘communication’. Conclusions Management and administration inconsistences, logistical issues and lack of training on personal protective equipment led to midwives’ negative feedback. A gap has been identified in the exploration of midwives’ experiences as personal protective equipment end-users during the COVID-19 pandemic.
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To the Editor: There have been an increasing number of reports of occupationally induced skin conditions in health care workers related to the use of personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic.1Gheisari M, Araghi F, Moravvej H, et al. Skin reactions to non-glove personal protective equipment: an emerging issue in the COVID-19 pandemic [e-pub ahead of print]. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.16492. Accessed May 7, 2020.Google Scholar,2Lan J. Song Z. Miao X. et al.Skin damage among health care workers managing coronavirus disease-2019.J Am Acad Dermatol. 2020; 82: 1215-1216Abstract Full Text Full Text PDF PubMed Scopus (379) Google Scholar The breadth and variety of different types of PPE, such as facemasks, gloves, and respiratory equipment, as well as the extended use beyond previous standards, have led to a spectrum of common dermatologic conditions, including contact/irritant dermatitis, pressure-related skin injury, acneiform eruptions, and moisture-associated skin irritation (Table I).Table ISkin condition related to masks—treatment and prevention strategiesSkin conditionSurgical maskN95 maskContact/irritant dermatitisUse alcohol-free barrier film wipe behind the ears before wearing, orApply thin foam dressing behind the ear beneath ear loop of surgical mask.N95 mask straps should be worn on the crown of the head, so should not be sitting on top of the ears.Pressure-related skin injuryApply thin foam dressing behind the ears beneath ear loop of surgical mask.Prophylactic dressings can be used under surgical masks for treatment/prevention. Proposed materials include a thin hydrocolloid dressing or thin foam dressing. Cut/adjust material to application site and apply dressing to skin without tension. Once PPE is removed at end of shift, wash hands, don clean gloves, gently remove dressings, and wash hands again. When removing prophylactic dressings, close eyes and avoid inhaling any aerosolized virus or particles.Apply alcohol-free barrier film wipe (not spray) on areas of direct PPE contact (eg, nose, cheeks, forehead, behind the ears) to protect skin from moisture and friction. Before applying, ensure the area is free of make-up, etc. Do not apply to eyes or eyelids. Allow to dry for 90 seconds before donning PPE.Wear facial PPE correctly and make sure size is correct.If skin damage is present, consider applying petrolatum to open areas 3-4 times a day when away from work. If an open area of skin is present, a hydrocolloid dressing may be used to help it heal; however, using these dressings under N95 masks requires refit testing to ensure adequate seal.AcneWash your face with gentle, mild fragrance free, noncomedogenic cleanser in the morning and at the end of the day. Take appropriate breaks from the mask: 15 minutes off every 2 hours.Wash your face with gentle, mild fragrance-free, noncomedogenic cleanser in the morning and at the end of the day.Take appropriate breaks from the mask: 15 minutes off every 2 hours.Moisture- associated skin irritationWash your face with gentle, mild fragrance-free, noncomedogenic cleanser in the morning and at the end of the day. Take appropriate breaks from the mask: 15 minutes off every 2 hours.Wash your face with gentle, mild fragrance-free, noncomedogenic cleanser in the morning and at the end of the day.Take appropriate breaks from the mask: 15 minutes off every 2 hours—if safe and practical to do so.PPE, Personal protective equipment. Open table in a new tab PPE, Personal protective equipment. Surgical and N95 masks, as well as goggles and face shields, have been reported to cause contact dermatitis, typically behind the ears (from elastic straps), on the bridge of the nose, or rarely on the entire face. Mask-induced contact dermatitis and contact urticaria can occur due to adhesives, rubber in straps, free formaldehyde released from the nonwoven polypropylene, and from metals in clips.3Foo C. Goon A.T. Leow Y.H. et al.Adverse skin reactions to personal protective equipment against severe acute severe acute respiratory syndrome-a descriptive study in Singapore.Contact Dermatitis. 2006; 55: 291-294Crossref PubMed Scopus (227) Google Scholar,4Donovan J. Kudla I. Holness L. et al.Skin reactions following use of N95 facial masks.Dermatitis. 2007; 18: 104Crossref Google Scholar The tighter and more secure N95 masks can cause significant skin damage due to pressure on anatomic points such as the bridge of the nose and across the zygoma. Moisture can accumulate under either type of facemask and predispose to skin breakdown and, potentially, superinfection. Facial PPE should be adjusted to fit correctly and should not lead to excess pressure or discomfort on any one particular area of the face. Skin should be routinely cleaned and moisturized using noncomedogenic emollients at least 1 hour before using facial PPE. Petrolatum-based products are not recommended as a skin sealing or repair agent because they may interfere with the integrity of the mask itself, in particular, the N95.5National Pressure Injury Advisory Panel (NPIAP)NPIAP position statements on preventing injury with N95 masks.https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/Mask_Position_Paper_FINAL_fo.pdfDate: 2020Date accessed: May 7, 2020Google Scholar According to the Centers for Diseases Control and Prevention, contact dermatitis accounts for 10% to 15% of all health care occupational illnesses. Glove-related allergic contact dermatitis is relatively common in health care workers. The most common causes are rubber accelerators used in the manufacturing of gloves. Skin manifestations include pruritus, erythema, scale, vesicles, and in prolonged cases, hyperpigmentation and lichenification. Health care workers should be encouraged to use moisturizers frequently, especially when not in direct patient care, and ensure hands are clean and dry before the use of gloves and other PPE during patient contact time. For more severe cases of contact dermatitis, topical corticosteroids and other prescription therapies may be warranted. In addition to masks, gloves, and respirators, the repetitive and prolonged use of sterilizing agents, including hand soaps, detergents, and repeated exposure to water, can lead to irritated skin and an increased risk for contact sensitization. To reduce this risk, especially after handwashing, emollients with ceramides or petrolatum, or both, may be beneficial.6Beiu C. Mihai M. Popa L. et al.Frequent hand washing for COVID-19 prevention can cause hand dermatitis: management tips.Cureus. 2020; 12: e7506PubMed Google Scholar As health care workers, we are ultimately responsible for protecting our patients, ourselves, and the broader community. Wearing PPE for extended periods, as has occurred in the era of COVID-19, can have potentially serious consequences for health care workers. Recognizing occupationally induced skin conditions from PPE, and which of these can be prevented or minimized with proper measures, is critical to help mitigate long-term skin sequelae and maintain compliance. We would like to thank staff at the American Academy of Dermatology for their logistical and administrative support. We would also like to thank, in particular, Theresa Carbone, BSN, RN, CWOCN, William Falone, MSN, RN, CWON, and Shawn Parsons, MSN, CRNP, CWON, along with the Penn Medicine Wound Care Nursing Collaborative, for their ongoing efforts to educate health care workers and the public on the occupational risks in the era of COVID-19.
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Do people in other areas perceive less risk from the COVID-19 pandemic than those in Hubei Province in the pandemic area? Do people in communities with COVID-19 infections perceive a higher level of risk of the virus? What media do people use to get information about the pandemic, and how do the chosen information source influence risk perception? To answer these questions, this study conducted an online questionnaire survey among the public in Guangdong and Hubei Provinces (N = 407) between January and April 2020, and systematically analyzed the impact of proximity to the pandemic and different types of information media on pandemic risk perception. It found that during this period, there was no difference in residents' pandemic risk perception between Hubei and other provinces, and that the greater the number of relatives and friends infected with the virus, the higher people's pandemic risk perception. Individual social media use positively influences perception, and it is the most powerful variable for predicting pandemic risk perception.
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To the Editor We read with great interest the article by Brown et al1 who worked with a multidisciplinary team to deploy a standardized guideline for airway management of coronavirus disease (COVID)–positive or unknown patients. We applaud their insight in recognizing the difficulty in implementing a guideline amid the rapid emergence of new information and in adapting the guideline to different environments within the hospital, while still prioritizing the safety of health care providers (HCPs) in the presence of personal protective equipment (PPE) shortage. A long and ever-growing list of HCPs have lost their lives amid the coronavirus disease 2019 (COVID-19) pandemic.2 A large proportion of HCPs acquired the infection at the beginning of the outbreak, probably secondary to the lack of awareness of the pathogen and inadequate PPE.3 Other aspects of infection control are paramount in preventing nosocomial infection, such as strict screening protocols for hospital staff, visitor restrictions, widely available and highly sensitive testing, good hand hygiene, and clear infection prevention and control (IPC) protocols.4 Internationally, there is a wide variation of PPE, ranging from powered air-purifying respirator (PAPR) to separate facemasks, goggles, gown, and gloves. Countries (eg, China, Taiwan, and South Korea), where PAPR or Hazmat suits are available, had previously experienced epidemics, such as severe acute respiratory syndrome coronavirus 2003 (SARS-CoV-1) or Middle East respiratory syndrome-related coronavirus (MERS). One of the most notable advantages of PAPR is its sustainability by being reusable while offering protection for aerosol-generating medical procedures (AGMPs). Shortage of PPE has been experienced in many countries leading to low level or absence of PPE, hence, exposing HCPs to potential infection.5 Some HCPs are required to don the same PPE for days or to reuse single-use N95 respirators. This prompted the Food and Drug Administration to approve the reusable industrial elastomeric respirators and decontamination systems for N95 masks in a timely fashion amid the pandemic. Local IPC guidelines vary internationally. They should err on the side of caution though, when robust evidence is unavailable due a short time frame, and with new data continuously emerging. This is particularly relevant with the recognition of asymptomatic transmission of the disease which also translates to higher level of PPE required for AGMPs for asymptomatic patients.5 As treatment protocols evolve with emerging evidence, treatments like noninvasive ventilation usage change the level of PPE necessary to ensure HCPs protection. Whether HCPs adhere to local IPC guidelines are dependent on the element of the guidelines as highlighted in the recent Cochrane review.6 HCPs felt unsure as to how to adhere to local guidelines when they were long and ambiguous or did not reflect national or international guidelines.6 While the likely mode of COVID-19 transmission is droplet and contact, guidelines should be carefully tailored to different subspecialties rather than a "one size fits all" approach. Ideally, representatives from each specialty should be consulted. Transparency regarding resources such as PPE also fosters trusts among HCPs to implement IPC guidelines.6 These guidelines should not overlook AGMPs (eg, airway manipulation or noninvasive ventilation) and should protect those who work in the hospital "hot zone."5 Furthermore, they should consider an impossibility to practice the globally recommended social distancing at the hospital or other health care settings (eg, nursing homes) which potentially expose HCPs to droplet and/or short range aerosol spread, while interacting with patients and other staff. This will contribute to further spread of disease to HCPs and patients. Therefore, continuous masking should be implemented. Many Asian countries have taken the lead in this respect. The rapidly evolving COVID-19 pandemic necessitates constantly changing IPC guidelines. This tends to overwhelm HCPs, and without support from management, compliance may lapse.6 Education is also paramount because the novelty of the highly contagious disease means a rapid emergence of data and information. Virtual education sessions and simulations outlined by Brown et al1 are certainly invaluable to keep HCPs informed and up-to-date with the current guidelines. Within the health care setting, different international practices regarding PPE and guidelines are understandable due to the global difference in disease prevalence, the amount of testing available, the sensitivity of the tests, and resources. Nonetheless, the principles should be the same regarding the basics of infection control with early disease identification by vigilant screening, thorough contact tracing by mandatory record keeping, containment by proper PPE with exploration of sustainable options amid shortages, and strict implementation of clear IPC guidelines which should be designed to protect HCPs in individualized subspecialties or health care settings. Robust guidelines are particularly important as more countries are moving toward "reopening." With different institutional IPC guidelines for PPE and ventilation strategies, a collaborative international network to establish the rate of nosocomial infection within HCPs could be a valuable resource going forward. Vivian H. Y. Ip, MBChB, FRCADepartment of Anesthesia and Pain MedicineUniversity of AlbertaEdmonton, Alberta, Canada[email protected] Rakesh V. Sondekoppam, MBBS, MDDepartment of AnesthesiaUniversity of Iowa HospitalIowa City, Iowa Timur J. P. Özelsel, MD, DESADepartment of Anesthesia and Pain MedicineUniversity of AlbertaEdmonton, Alberta, Canada Ban C. H. Tsui, MD, MSC, FRCPCDepartment of AnesthesiologyPerioperative, and Pain MedicineStanford University School of MedicinePalo Alto, California
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Personal Protective Equipment and Covid-19 This video demonstrates a procedure for donning and doffing one type of PPE recommended by the CDC for use in hospitals to minimize the risk of exposure t...
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