| Abstract|| |
Aim: To evaluate knowledge, attitude and practices among sanitation workers regarding SARS-CoV-2 prevention during hospital waste management. Materials and Methods: A cross-sectional study was conducted among 426 sanitation workers using an interviewer-administered questionnaire to assess the knowledge, attitude and practices of the study participants. The unpaired t-test and Spearman's correlation were used to find the mean difference and correlation among different study variables. Statistical significance was set at 5% (confidence interval 95%). Results: The mean knowledge score of the participants was found to be 7.15 ± 2.02. About 93.7% of the participants had good knowledge about COVID-19. About 64.3% of the participants strongly agreed that COVID-19 is a life-threatening disease. Regarding practices, a majority reported (69.7%) that they washed hands frequently using water and soap. A significant positive correlation was found between knowledge, attitude, practices and education, indicating a favourable work environment in hospital settings. Conclusion: More than half of the sanitation workers and housekeeping staff had adequate knowledge of COVID-19, and their attitudes were found to be favourable. They also had satisfactory practices, which may be a result of the prompt training and sensitization of sanitation workers by the authorities. Clinical Relevance: Sanitation workers come under the essential services category and their knowledge, attitude and practices needed to be assessed and updated in the concerned area for their protection and better management of biomedical waste, especially in the current pandemic situation.
Keywords: Attitude, COVID-19, healthcare workers, knowledge, practices, sanitation workers
|How to cite this article:|
Kumar JS, Manjunath B C, Sabbarwal B, Chauhan N, Yadav V, Kumar A. Knowledge, attitude and practices among sanitation workers regarding SARS-CoV-2 prevention – A cross-sectional study. Indian J Dent Res 2022;33:130-4
|How to cite this URL:|
Kumar JS, Manjunath B C, Sabbarwal B, Chauhan N, Yadav V, Kumar A. Knowledge, attitude and practices among sanitation workers regarding SARS-CoV-2 prevention – A cross-sectional study. Indian J Dent Res [serial online] 2022 [cited 2022 Nov 30];33:130-4. Available from: https://www.ijdr.in/text.asp?2022/33/2/130/358439
| Introduction|| |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen that causes coronavirus disease 2019 (COVID-19), is one of the most infectious viruses in human history. On 11 March 2020, the World Health Organization (WHO) declared that COVID-19 is a pandemic disease, and since then, COVID-19 has rapidly spread across the countries with estimated 4,248,389 cases and 294,046 mortalities within 5 months from the start of the outbreak to 14 May 2020., Over a period of 6 weeks, the number of COVID-19-positive cases in Nigeria rose from 38 cases on 24 March to 4,791 cases by 14 May 2020. This devastating infection has spread beyond boundaries and race and has a predilection for senior citizens.
Various regulatory bodies such as WHO, Centers for Disease Control and Prevention, the International Labour Organization, and European Agency for Safety and Health have given guidelines and protocols to prevent infections among healthcare and non-healthcare workers. These include regular and proper hand washing, facility cleaning, proper use of face masks, respiratory hygiene and etiquette, advice on national and international travel, emphasis on staying at home for infection containment, case notification and management, events, and meeting arrangement rules.
Globally, thousands of healthcare workers (HCWs) are already infected and still being affected, and hundreds have lost their lives. The risk of COVID-19 infection among HCWs is higher than in the general population.
A study among Indian residents showed that 74% showed inadequate awareness, 75% followed hand hygiene guidelines and 5% did not follow lockdown restrictions. Another study reported around 76% of female HCWs showed adequate knowledge regarding COVID-19, which was relatively higher than that reported in Uganda.,
There is a dearth of studies evaluating knowledge, attitude and practices among sanitation workers regarding the SARS-CoV-2 prevention protocol during hospital waste management. Hence, this study aimed to evaluate knowledge, attitude and practices amongst sanitation workers regarding SARS-CoV-2 prevention during hospital waste management.
| Material and Methods|| |
A cross-sectional study evaluated knowledge, attitude and practices among sanitation workers regarding SARS-CoV-2 prevention. Ethical clearance was obtained from the institutional ethical committee and review board (PGIDS/IEC/41). Necessary permission was taken from authorities of the Pt. B. D Sharma University of Health Sciences, Haryana, India. Informed consent was obtained from the sanitation workers after explaining the purpose and procedure of the study. The principal investigator was trained and calibrated in the Department of Public Health Dentistry, PGIDS, Rohtak.
A pilot study was conducted among 25 sanitation workers to check the feasibility of the study. As the situation of COVID-19 was of prime concern and the health and life of all health workers were at stake, it was important to assess the knowledge, attitude and practices regarding preventive measures among sanitation workers. Hence, all 426 sanitation workers were included in the study.
About the tool
The domains of the questionnaire included demographic data, knowledge aspect, attitude aspect and practice aspect.
The sociodemographic profile was recorded, which included information pertaining to name, age, gender, level of education, work experience, source of knowledge regarding infection control related to care of COVID-19 patients, and spread and prevention of COVID-19.
The knowledge domain comprised 11 questions. The first 4 questions were related to the nature of COVID-19, whom it affects and its mode of transmission. The next 4 questions were regarding the symptoms and sources of COVID-19 infection. The first 8 questions were in the form of a multiple-choice answer. The response to the last three questions regarding the level of knowledge about the usage, decontamination and disposal of personal protective equipment (PPE) were recorded in the form of yes or no. Nine questions were asked to evaluate the attitude of the sanitation workers towards SARS-CoV-2 prevention. The responses were recorded on the Likert scale. The practice domain included 10 questions on practice towards SARS-CoV-2 prevention.
Cross-cultural validation of the interviewer-administered questionnaire was performed by means of the back-translation method. Readability and comprehension were assessed during the pilot study. Necessary corrections and modifications were made. Internal consistency of the questionnaire was found to be good (Cronbach alpha = 0.89).
Statistical considerations and data analysis
The data collected was entered into a MS Excel spreadsheet. Responses were coded, and weights were assigned. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 22. The Chi-square test was used to find out the differences between proportions. The unpaired t-test was used to find the difference in mean knowledge, attitude, and practice scores among males and females. Correlation among different study variables was assessed using Spearman's correlation analysis. Binary logistic regression was done to check the gender-wise likelihood of favourable knowledge, attitude and practices. The statistical significance was set at 5% (confidence interval 95%).
| Results|| |
The present study comprised 426 sanitation workers, where the majority (62.9%) were males. Most of the participants (42%) belonged to the 30–39 year age group followed by 40–49 (31.5%), 18–29 (20%), and above 50 (6.5%) year age groups. The mean age of the participants was found to be 36.35 ± 8.2 years. The majority of the participants had qualifications up to matriculation (90%).
Discussion within the department by faculty members (83.3%) was found to be the main source of information regarding COVID-19. The majority of study participants reported that close contact with an infected person (93.4%) is the main reason, followed by coughing (91.8%). For prevention of COVID-19, maintaining social distance was the most favoured response (99.1%). The mean knowledge score of the participants was found to be 7.15 ± 2.02. About 93.7% of participants had good knowledge about COVID-19, whereas a majority (73.7%) did not know about its overall effects, but most of them were aware of the main symptoms. The majority of the participants strongly agreed that COVID-19 is a life-threatening disease (64.3%) and believed that the risk of COVID-19 increases if we do not wear mouth masks and gloves (72.5%). Only a few (47.9%) agreed that self-medication should not be done, whereas the others thought that it is necessary to consult a healthcare specialist (66.2%). Regarding practices, the majority reported washing hands frequently using water and soap (69.7%) and avoided touching their faces and eyes (63.4%).
The majority of the participants (69.7%) had a work experience of more than 5 years [Table 1].
|Table 1: Distribution of the study population based on work experience and gender|
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The mean knowledge (7.3 ± 1.8) and practice (4.20 ± 0.45) score was found to be higher among male sanitation workers compared to females (knowledge = 6.9 ± 2.24; practice = 4.1 ± 0.46), whereas the mean attitude score was found to be almost the same for both groups, but the difference was statistically not significant [Table 2].
|Table 2: Gender-wise distribution of mean knowledge, attitude and practice scores|
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Male sanitation workers were found to have higher odds of satisfactory knowledge (OR = 1.491, CI − 0.006–0.788, P = 0.05) and practices (OR = 1.313, CI − 0.198–1.612, P = 0.12) compared to females while lesser odds of favourable attitude (OR = 0.958, CI − 0.991–0.690, P = 0.72), but the results were not statistically significant [Table 3].
|Table 3: Logistic regression analysis of knowledge, attitude and practices|
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Overall, there was a statistically significant positive correlation between knowledge, attitude, practices and education [Table 4].
|Table 4: Correlation between knowledge, attitude, practices and education|
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| Discussion|| |
Since the announcement of COVID-19 as a pandemic by the WHO, the knowledge, attitude and practices (KAP) towards this disease have been growing gradually. This cross-sectional study was an attempt to understand the insight into their KAP regarding COVID-19, and to the best of our knowledge, this is one of the earliest carried out among sanitation workers of a tertiary-care centre.
A study in Nepal reported that F-HCWs exhibited acceptable expertise and a favourable attitude. Overall, experienced F-HCWs with greater education and infection prevention control (IPC) training had improved KAP. Another KAP study found that most of the (79.42%) healthcare personnel knew enough about COVID-19 symptoms, transmission, management, and prevention. Whereas 35.32% of people dread working in a hospital; 80.85% saw it as a duty. The KAP showed a substantial correlation between age and education.
During the COVID-19 outbreak in China, a study reported that elder respondents had less understanding and experience of COVID-19. Given the high awareness of COVID-19 among Chinese workers, health authorities must continue to educate and develop COVID-19 prevention programmes, especially for older and less-educated workers.
The source of knowledge regarding infection control related to the care of COVID-19 patients was found to be discussion among faculty (83.3%), followed by television, co-workers, social media, training, posters and pamphlets in the descending order. This is in contrast to another study carried out on the general population, where a majority of the population stated traditional media sources as the source of information. This might be because the COVID-19 information source was significantly determined by the participant's workplace and residence. Discussion among the faculty members was found to be the leading source of knowledge in our study as the study setting was frontline HWs' workplace, the ones taking care of the rest of the population, so they guided the sanitary workers in a great way to be safe in the workplace regarding the spread of COVID-19 and the responses of the participants were found to be close contact with an infected person (93.4%) and direct transmission during coughing (91.8%), which is in contrast to a study done on primary healthcare providers, in Pakistan, where only 74.3% of the participants agreed that coughing leads to transmission. The variation in responses might be because of the time gap between the conduction of the studies.
In the present study, two-thirds of the study population had adequate knowledge about COVID-19, which was in line with studies done among Oyo State healthcare workers, housekeeping staff, hospital staff and Indian residents.,, However, it was far lower than the study done in Wuhan amongst Chinese residents (90%). The results were in contrast with the study done in Malaysia among the general public (80.5%).
Overall, all correct symptoms were reported by less than one-quarter of our study population, whereas it was more than three quarters in the study by Azlan et al., 93.1% by Ayinde et al., and 79.8% of the general population in the UK. A majority of the participants knew the correct modes of transmission (via respiratory droplets and personal contact) in our study. However, it was higher than in the study done in Malaysia among the general public 82%, 74.8% in the study done by Ayinde et al., in the UK, and 89% in a study done by Dkhar et al., in social media users of Jammu and Kashmir. This might be because the participants were sanitation workers and while educating them, they could not grasp the information regarding symptoms, but information regarding mode of transmission was well grasped due to the mode of work they do.
In our study, most of the study population regarded frequent hand washing as a method of prevention, which was corroborative with the findings by Roy et al. (97%), Ayinde et al. (93.4%) and Dkhar et al. (76%). This may be because of effective awareness campaigns conducted within the institute, state, and country. On the contrary, this finding was only 23.3% in the study by Pandey et al.
Regarding the knowledge of social distancing, we found that it was 99.1%, which was in line with the study done in Malaysia among the general public (96.7%), and far higher than another study in the Indian population (16.9%); this might be because of workplace training and the time lap between the studies.
A majority of the participants in our study knew about donning and doffing of PPE and about 66% had the knowledge of decontamination and or disposal of PPE, which is in contrast to the study in Brazil where about half of the participants reported a lack of sufficient knowledge regarding the same.
All participants practised frequent hand washing in our study, which was higher than the findings observed by a study in Malaysia among the general public, and among social media users of Jammu and Kashmir;, this might be due to increased awareness regarding the modes of prevention. Half of the participants strongly agreed that self-medication for COVID-19 symptoms should not be done, which is in contrast to a study where most of the participants took self-medication according to the symptoms present. This might be due to the fear of visiting the hospital.
The limitation of our study is that it was conducted in one institute only, but the institute is a centre of excellence in North India, and all sanitation workers were included in the study, who can be considered as representatives of all such workers. Also, the social desirability bias inherited in the cross-sectional study design may have affected the responses, but anonymity of the participants was ensured to overcome this limitation.
The strengths are as follows: (1) There is a dearth of studies about COVID-19 prevention among sanitation workers, and this is one of the earliest studies carried out in India among sanitation workers and housekeeping staff. (2) Our findings provide valuable information about the KAP of an important group of frontline workers during this period of pandemic and lay the foundation for further research.
| Conclusion|| |
Sanitation workers and housekeeping staff had adequate knowledge about the prevention protocol of COVID-19, and their attitudes were overwhelmingly positive. They also had satisfactory practice, which may be a result of the efforts made by local authorities to sensitise all hospital staff about COVID-19 and its requirements. Nonetheless, as the global threat posed by COVID-19 continues to grow, greater efforts, including campaigns that target frontline workers as well as the general public, are extremely important.
Declaration of patient consent
The authors certify that they have obtained all appropriate consent forms. In the form, the sanitary workers understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chan JF, Kok KH, Zhu Z, Chu H, To KK, Yuan S, et al
. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect 2020;9:221-36.
World Health Organization. Coronavirus Disease 2019 (COVID-19): Situation Report. Geneva, Switzerland: World Health Organization; 2020.
Sohrabi C, Alsafi Z, O'neill N, Khan M, Kerwan A, Al-Jabir A, et al
. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71-6.
Nguyen LH, Drew DA, Joshi AD, Guo CG, Ma W, Mehta RS, et al
. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. medRxiv: the preprint server for health sciences. 2020 May.
Kartheek AS, Gara KH, Vanamali DR. Knowledge, attitude and practices towards COVID-19 among Indian residents during the pandemic: A cross-sectional online survey. J NTR Univ Health Sci2020;9:107-15. [Full text]
Olum R, Chekwech G, Wekha G, Nassozi DR, Bongomin F. Coronavirus disease-2019: Knowledge, attitude, and practices of health care workers at Makerere University Teaching Hospitals, Uganda. Front Public Health 2020;8:181.
Tamang N, Rai P, Dhungana S, Sherchan B, Shah B, Pyakurel P, et al
. COVID-19: A national survey on perceived level of knowledge, attitude and practice among frontline healthcare workers in Nepal. BMC Public Health 2020;20:1905.
Mahato C, Suryavanshi S. Knowledge, attitude, and practices towards COVID-19 among nurses, ward attendants, and housekeeping staff at a tertiary psychiatric institute in India. Int J Community Med Public Health 2020;7:5035-43.
Li ZH, Zhang XR, Zhong WF, Song WQ, Wang ZH, Chen Q, et al
. Knowledge, attitudes, and practices related to coronavirus disease 2019 during the outbreak among workers in China: A large cross-sectional study. PLoS Negl Trop Dis 2020;14:e0008584. doi: 10.1371/journal.pntd. 0008584.
Ganie MA, Habib A, Ali SA, Rashid A, Rashid R, Fazili A. Cross sectional study on Kashmiri tribal population: Their demo-economic status and behavioural risk factors. J Family Med Prim Care 2020;9:4929-35. [Full text]
Hussain I, Majeed A, Imran I, Ullah M, Hashmi FK, Saeed H, et al
. Knowledge, attitude, and practices toward COVID-19 in primary healthcare providers: A cross-sectional study from three tertiary care hospitals of Peshawar, Pakistan. J Community Health 2021;46:441-9.
Ayinde O, Usman AB, Posi A, Gbolahan A. A cross-sectional study on Oyo state health care workers knowledge, attitude and practice regarding corona virus disease 2019 (COVID-19). Adv Infect Dis 2020;10:6-15.
Acharyya A, Ghosh S, Ghosh M, Sarkar K, Ghosh S, Bhattacharya A, et al
. Knowledge, attitudes, and practices towards COVID-19 among hospital staff of West Bengal during COVID-19 outbreak: A hospital based cross sectional study. Asian J Med Sci2020;11:1-8.
Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al
. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci 2020;16:1745-52.
Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E. Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PloS One 2020;15:e0233668. doi: 10.1371/journal.pone. 0233668.
Dkhar SA, Quansar R, Saleem SM, Khan SM. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020;64:S205-10.
Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr 2020;51:102083.
Pandey S. Gupta A. Bhansali R, Balhara S, Katira P and Fernandes G. Corona virus (COVID-19) awareness assessment-a survey study amongst the Indian population. J Clin Med Res. 2020;2(4):1-0.
Martin-Delgado J, Viteri E, Mula A, Serpa P, Pacheco G, Prada D, et al
. Availability of personal protective equipment and diagnostic and treatment facilities for healthcare workers involved in COVID-19 care: A cross-sectional study in Brazil, Colombia, and Ecuador. PLoS One 2020;15:e0242185. doi: 10.1371/journal.pone. 0242185.
Manik MIN, Khan A, Ali MH, Zobayed A, Islam MM. Survey on common trends for non-prescribed medication use among the young generation in Dhaka, Bangladesh: A cross sectional study. Int J Community Med Public Health 2021;8:1104.
Dr. Jadhav S Kumar
Post Graduate Institute of Dental Sciences, Rohtak, Haryana - 124 001
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]