Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
On Sep 2018

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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : LC01 - LC08 Full Version

A Cross-sectional Study on Adherence to Personal Protective Equipment among Healthcare Workers during COVID-19 Pandemic in a Tertiary Care Centre, Tamil Nadu, India

Published: May 1, 2022 | DOI:
R Purushotham, Veena Raja, SPJ Salim Javeedh, Balaji Ramraj Ramamurthy, Bhuvanamha Devi Ramamurthy

1. Assistant Professor, Department of Anaesthesiology, Sree Balaji Medical College and Hospital, BIHER, Chennai, Tamil Nadu, India. 2. Associate Professor, Department of Pathology, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India. 3. Assistant Professor, Department of General Medicine, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India. 4. Scientist E Medical, ICMR National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India. 5. Associate Professor, Department of Pathology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Bhuvanamha Devi Ramamurthy,
63, Luxmi Nagar, Naidu Shop Street, Chrompet, Chennai, Tamil Nadu, India.


Introduction: Personal Protective Equipment (PPE) provides physical barrier against hazardous injury or infectious agents. With the outbreak of COVID-19 pandemic, PPE plays a vital role with face mask and gloves are being most essential. The frontline Healthcare Workers (HCW) utilises them to minimise the risk of contaminated contact or infected droplet exposure.

Aim: To evaluate the appropriate use of PPE among healthcare workers in tertiary care hospital.

Materials and Methods: This cross-sectional study was conducted in SRM Medical College Hospital and Research Centre, Potheri, Chengalpet district, Chennai, Tamil Nadu, India, from February 2021 to May 2021, on utility of PPE among the healthcare workers. There were a total of 273 participants including doctors, residents (postgraduate)/interns, nurses and laboratory technicians. A predesigned questionnaire was utilised to collect information, apart from observation of their PPE practice and 360 degree observation from peers were also used to evaluate. Statistical analysis was done using Chi-square test, Fisher’s-exact test and logistic regression model.

Results: Among 273 HCWs, there were 58 (21.24%) doctors, 163 (59.71%) residents and interns, 19 (6.96%) nurses and 33 (12.09%) technicians. There was no association in the frequency of mask with the type of HCW (p-value=0.217). However, the usage frequency of gloves (p-value=0.003), face shield/goggles (p-value=0.004), disposable gown (p-value=0.001) and doffing according to protocol (p-value=0.001) showed statistically significant difference between the category of HCWs.

Conclusion: In this study, PPE adherence was high among HCW; however, there was a subtle difference in compliance across the varied groups of healthcare professional and type of PPE used. The PPE compliance among HCW cannot be assumed to be good blindly; frequent official training programs, availability of PPE logistics along with scrutinisation regarding its appropriate usage and discarding at regular intervals minimises the non compliance and also helps in curtaining the COVID-19 transmission.


Compliance, Coronavirus 2019 infection, Severe acute respiratory syndrome coronavirus-2, Transmission

The novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the cause of Coronavirus Disease 2019 (COVID-19), could spread through aerosol, droplet and fomite (1). The disease was transmissible from not only symptomatic but also through asymptomatic individuals, a significant contributor of pandemic, had affected the whole world, among which the healthcare population are at high risk of transmission due to their direct contact with COVID-19 patients (2),(3). Depending on the specific role of Healthcare Workers (HCW), the level of exposure varies. The healthcare professionals working in emergency department or operation room are at higher risk during surgical procedures, intubation or resuscitation as there would be an integral threat of close and long contact period with the patients (4).

In early 2000, during the SARS epidemic, studies showed that the rate of infection was less in HCW who defended with adequate Personal Protective Equipment (PPE) (5),(6). The PPE are to protect HCW from serious workplace biological accidents or illness by providing a physical barrier between microorganism and wearer (7),(8). The guidelines for PPE use, had been issued by the World Health Organisation (WHO) in February 2020, which includes gloves, medical masks, goggles or a face shield, and gown, as well as N95/Filtering Facepiece Respirators (FFR) or equivalent respirators, for those performing aerosol-generating procedure (9). Though there were established evidence on advantages, the utility of PPE is disorganised due to discomfort, handiness and individual’s acumen (10),(11). Ineffectiveness in PPE adherence may facilitate nosocomial transmission of COVID-19 (12),(13). In China, it has been reported that 2055 HCW working in 476 different hospitals, mainly from Hubei (88%), have been infected with COVID-19 from December 18, 2019 to February 20, 2020. The reason for this high rate of infection among HCW was mentioned to be due to extended hours of duty (>10 hours) as there were large number of patients and serious shortages of staff (14),(15). Hence it is an irrefutable fact that the healthcare professionals play critical role during outbreaks despite of the fact that their life’s are at increased risk. Therefore, it is needless to mention that personal protective equipment is the only effective armour against repeatedly mutating virus, wherein the effectiveness of vaccine is still repudiated.

Prevention of COVID-19 infection is a herculean task, where , there is shortage of PPE on one hand and on the other hand in spite of availability there is low compliance to PPE due to various reasons like cost, comfort, lack of awareness, lack of training. Moreover, there are very few studies available addressing the knowledge and compliance to PPE measures from Southern India (11),(16). This information provides an opportunity to the administrators and decision makers to identify the deficiencies and bridge the gap. Therefore, this study was conducted to determine the adherence of PPE among healthcare workers in the tertiary care hospital during the COVID-19 outbreak and to find the association between utility of PPE and incidence of COVID-19.

Material and Methods

This cross-sectional study was conducted in SRM Medical College Hospital and Research Centre (tertiary care hospital), Potheri, Chengalpet district, Chennai, Tamil Nadu, India, from February 2021 to May 2021, on utility of PPE among the healthcare workers. The Institutional Ethics Committee approval was obtained (IEC No.:2166/IEC/2020).

Inclusion criteria: All healthcare professionals i.e, doctors (including residents and interns), nurses and technicians (N=1100), those providing complete information to the questionnaire and those given consent for participation were included in the study.

Exclusion criteria: All the non healthcare professionals, those providing questionnaires with incomplete information and those not willing to participate were excluded from the study.

Sample size calculation: In the pilot study conducted (n=50) there were about 65% of healthcare workers appropriately using the PPE. Minimum sample size (n) required to conduct the study was calculated by the following formula:

n= (Z1-α)2×PQ / E2

Z(1-α) at 95% confidence level=1.96;
Q=1-P=0.35 and
E=Margin of Error=6%=0.06.

In addition, 10% of attrition rate expected when collecting the data. Therefore, n=243+10% of 243 (attrition rate). Hence, the minimum number of samples required to conduct the study was 267.


The questionnaire was prepared in English, based on World Health Organisation and Government of India, Ministry of Health and Family Welfare guidelines [17-20]. It was scrutinized, validated and approved by multidisciplinary experts (r=0.652). Another pilot study was conducted with 30 HCWs of different designations and professions (Doctor/Nurses). Their feedback was also obtained, evaluated and modified accordingly for precise addressing of the objectives and clear understanding of questions. The questionnaire was distributed by E-mail and mobile based application (WhatsApp) to the HCW.

The questionnaire had three parts,

• Part 1 comprised of basic demographic characteristics of the professional and knowledge regarding use of PPE. On the basis of factor analysis, two latent variables such as utility of PPE and contact history of COVID-19 were extracted from the questionnaire items. The Cronbach’s alpha values of the utility of PPE and contact history of COVID-19 were 0.873 and 0.655 respectively, which revealed that there was a good reliability within the items of these latent variables.
• Part 2 was pertaining to contact history of HCWs with COVID-19 patients
• In Part 3 evaluated the use of PPE that was prepared with guidelines on safety checklist issued by WHO, with Likert responses: “always, as recommended”, “most of the time”, “occasionally” “rarely” and not applicable (14),(15).

The questionnaire was sent by E-mail and mobile based application (WhatsApp) to the HCW. The HCW with responses of “Always” and “Most of time” was considered as compliant and those who responded as occasionally, rarely and not applicable were considered as noncompliant with PPE adherence. Their responses once collected were statistically analysed [Annexure-1].

A total of 310 HCW responded to the questionnaire, however 37 were not considered due to incomplete information. So, the final sample considered for analysis was 273. The willingness of the participants to participate in the study was obtained through informed consent. The 273 participants, apart from the questionnaire, were assessed by 360 degree feedback (multisource evaluation technique) (21), (22) from peers - senior doctors, colleagues, staff nurse/laboratory technician to avoid ambiguous bias of respondents. The HCW was unaware, that he or she is been assessed during their work. All the responses once collected were statistically analysed.

Statistical Analysis

Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 23.0 and Microsoft Excel software. The categorical variables were presented by frequency and percentage whereas the continuous variables were presented by mean and standard deviation. The association between two categorical variables was assessed either by Chi-square test (χ2) or Fisher’s-exact test. Interobserver reliability of 360 degree feedback and correlation with questionnaire responses was analysed with kappa statistics. The kappa statistics >0.7 is acceptable level of agreement (reliability 50-60%) and >0.8 is perfect level of agreement (reliability 65-80%) (23). Multivariable statistical model like logistic regression model was used to extract the most predominant factors that need to be considered for avoiding COVID-19 infections among healthcare professionals. The statistical significance was considered when p-value <0.05.


Among 273 HCW, there were 58 (21.24%) doctors, 163 (59.71%) residents and interns, 19 (6.9%) nurses and 33 (12.09)% laboratory technicians. The average age of doctors were 32.25±7.58 years followed by technicians were 26.61±5.45 years, residents and interns were 24.90±3.79 years and nurses were 24.89±7.42 years old. Overall, there were 110 male and 163 female HCW participated in the study. The demographic characteristics and knowledge pertaining to PPE among HCWs are presented in (Table/Fig 1). The awareness of PPE and its indication was 100% across HCWs. The correct response for list of PPE was given by 100% of HCWs and correct response for levels of PPE was 80.95%. There was only 68.49% correct response for opting Level A as highest level of skin, eye and respiratory protection.

The mode of contact with COVID-19 patient among the heathcare professionals, showed that the direct care to confirmed COVID-19 patients provided by 140 (51.28%) HCW, face to face (within 1 metre) by 132 (48.35%), direct contact with the environment where the confirmed COVID-19 patient were cared by 128 (46.89%) and aerosol generating procedures were performed by 88 (32.23%) (Table/Fig 2). The association between the type of HCW and utility of PPE showed that there was no significant difference in the usage frequency of mask (p-value=0.217). It infers that majority of healthcare professionals always wear masks. However, there was a significant difference among the HCW with respect to usage frequency of gloves (p-value=0.003), face shield/goggles (p-value=0.004), disposable gown (0.001) and doffing according to protocol (p-value=0.001) (Table/Fig 2).

There was no statistically significant difference (p-value=0.854) noted in the occurrence of COVID-19 infection 37 (13.55%) across HCW (Table/Fig 3) because of all HCW (100%) “Always /Mostly” wearing face mask. COVID-19 illness among healthcare workers is presented in (Table/Fig 4).

The 360 degree observation by peers was assessed for interobserver reliability and correlated with response to questionnaire from HCW using Kappa statistics (Table/Fig 5) (23). There was a perfect agreement among the peers observations and respondents’ scores (Kappa Statistic >0.8) pertaining to the frequency of usage of mask, single-use gloves, disposable gown and removing and replacing PPE according to protocol whereas acceptable level of agreement exists pertaining to the question “Face shield or goggles/protective glasses” (Kappa Statistic >0.7).

In the logistic model, usage of mask, single use gloves, face shield or goggles and disposable gown were included as independent variables and COVID-19 infection was included as dependent variable (Table/Fig 6). The following factors such as usage of mask face shield and goggles were significantly associated with lower risk of developing COVID-19 infections among HCW (Table/Fig 7). Though HCW who followed single use gloves had lesser risk of getting COVID-19 infections, it was statistically not significant (p-value=0.057). The adjusted odd ratios revealed that the odds of those who always wear a mask, gloves and face shield/goggles (OR <1) was less among COVID-19 infected persons compared with those who not always wear (Table/Fig 7).


Personal protective equipment (PPE), is a protective clothing prevents the physical chemical and microbial hazards at work place. It is not only helpful in assuring the safety and but also indirectly ensures their availability of HCWs to work throughout this pandemic, by protecting them from COVID-19 illness (24). Infection prevention and control measures plays critical role in reducing HCW exposure to COVID-19 infection. Few studies had observed that inspite of availability of PPE, there was noncompliance, either it was not worn or incorrectly worn by HCWs (25). Authors did the analysis of appropriate use of PPE among healthcare workers in tertiary care hospitals during the COVID19 outbreak.

In this study, the mean age of the participants is 27.16. The participants age less than 30 years were 211 (77.29%) and 62 (22.71%) were between 30-60 years. In a study conducted by Ashinyo ME et al., had 124 (37.80%) study participants in the age group of less than 30 years and 204 (62.20%) between 30-50 years. The difference is due to the elderly HCWs, with co-morbidities were exempted and younger age HCWs were deployed for the COVID-19 duty. There were slightly higher enthusiastic participants of female gender 163 (59.71%) than males 110 (40.29%) (26).

In the present study, 100% (n=273) HCWs were aware of PPE, its indication and knew what it constituted. However, correct response regarding the details of classification of PPE levels were given only by 80.95% which is comparable with studies of Hossain MA et al., (27) and Tien TQ et al., (28) (Table/Fig 8) (27),(28),(29). The studies by Alao MA et al., had observed only 14% of respondents knew about standard PPE (29). Similarly, Wang J et al., had also reported low knowledge about PPE, in Hubei province of China (30) and by Aguwa EN et al., in Southeast Nigeria during Ebola infection (7). The possible reasons for poor knowledge was mentioned to be due to less expertise to conduct training, less training, further repeated trainings and negligence or lack of involvement in acquiring knowledge about rare disease (29).

The PPE adherence was high among residents/interns (76.84%) and doctors (77.15%) followed by nurses (97.36%) and technicians (89.37%). High compliance of PPE usage (90.33%) was noted while performing aerosol generating procedures which was similar to previous studies (31),(32).

The overall compliance among HCW in the present study is 85.17%, which is slightly higher than study by Mulkalwar S et al., (84.4%), Gulilat K et al., (84%) (33) and Desta M et al., (84.7%) (32),(33),(34). However, the compliance was slightly less than the study conducted by Ashinyo ME et al., (90.6%) (26) and Russell D et al., (35). Among HCW in a Tanzanian outpatient facilities, Powell-Jackson T et al., had observed a low compliance (36). The difference is due to the reason that the study was conducted by observation during non COVID-19 times as against, in the present study and also study by Ashinyo ME et al., the research was conducted during the COVID-19 outbreak and by self reporting by HCW (26).

Lai X et al, observed that the improvement in infection prevention and control behaviours of healthcare workers during the COVID-19 outbreak (37). On an average 100% compliance for mask was observed among doctors and nurses followed by residents/interns and laboratory personnel. Compliance for gloves, face shield and disposable gown were high among nurses and lab personnel. This is in contrast with previous study wherein the compliance among ancillary staff was low (26).

Low compliance among subpopulation (always use face shield=74.35%) was noted with faceshield in the present study. Inspite of studies had shown that faceshield prevent transmission by reducing the ocular exposure or contamination of masks or hands or by divertion of movement of air around the face, there is limited utility because of poor visibility due to glaring and fogging (38),(39).

In this study, low compliance (always use disposable gown=58.97%) was noted with use of disposable gown which is comparable with study conducted in Ghana (26). Manian FA and Ponzillo JJ, also observed low compliance (73%) during non covid times, especially among male HCWs has mentioned, to improve the compliance with gown use, more intensive educational efforts have to be made (40).

The mean age of COVID-19 positive HCW was 24.21±2.32 years in the present study. Study conducted in Bangladesh observed 32.7±5.4 years and 42 years in a United States of America based study. During the study period, there were small proportions of HCWs (doctors (n=8/58,13.79%), Interns/postgraduates (n=21/163,12.88%), nurses (n=2/19, 10.52%) and technicians (n=6/33, 18.18%)) affected by COVID-19 in each group which could be reduced by stringent PPE measures and repeated training at monthly intervals (41),(42).

Overall compliance with PPE was high among nurses (97.36%) followed by the rest of HCW. Similar findings were shown by earlier studies that nurses generally tend adhere to the universal precautions than the other HCW (43),(44),(46).Though the reasons are not very clear, it was possible that a relatively experienced well trained staff nurse and specialist nurses who work in the theatre and intensive care unit participated in the survey.


The limitations of the study include recall bias could have occurred while responding the questionnaire. Also the increased work load/stress level on HCW, overt lack of interest, or multiple survey fatigue at the time of the study which could have excluded some of the HCWs from participating. The sample size was small and factors affecting compliance was not evaluated.


In the present study, high PPE compliance was observed but varied with healthcare personnel characteristic. There was no statistically significant difference noted in the occurrence of COVID-19 infection across HCW because of all HCW “Always/Mostly” wearing face mask. There was a perfect agreement among the peers observations and respondent’s scores (Kappa Statistic >0.8) for frequency of usage of mask, single-use gloves, disposable gown and removing and replacing PPE. The protective measures are to be practised universal, assuming that everyone is potentially infected or is colonised with a pathogen that can be transmitted in a healthcare environment. Strong PPE compliance can be achieved with repeated training programme, frequent supervision, effective communication of its importance, mock drill, support from management and administration for uninterrupted supply of PPE. Furthermore, large scale, multicentric study with proportionate sampling in each group would exploit ways to increase the PPE adherence.


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DOI and Others

DOI: 10.7860/JCDR/2022/53717.16302

Date of Submission: Jan 12, 2022
Date of Peer Review: Jan 29, 2022
Date of Acceptance: Apr 09, 2022
Date of Publishing: May 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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