ISSN: 2320-5407 Int. J. Adv. Res.

12(10), 701-715

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/19688
DOI URL: http://dx.doi.org/10.21474/IJAR01/19688

RESEARCH ARTICLE
KNOWLEDGEANDBEHAVIOROF
HATTAHOSPITALHEALTHCAREPROFESSIONALSREGARDINGCOVID-
19INFECTIONPREVENTIONANDCONTROL

Naglaa Mohamed Abdelhamied, MD, Eric S. Weinstein, MDMScDM, AfzalhusseinYusufali, MD;

MMed; FRCPand Rasha M. Farghaly, MD.

Emergency Medicine Departement, Hatta Hospital, Dubai health.

……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Healthcare-associated infection represents a public health problem in
Received: 19 August 2024 all countries. COVID-19 patients can rapidly overwhelm the capacities
Final Accepted: 22 September 2024 of healthcare systems. As more patients are hospitalized, healthcare
Published: October 2024 workers (HCW) at the frontline of care are at the greatest risk of
Key words:-
infection. This study aimed to assess the knowledge and self-reported
Knowledge, Behavior, COVID-19, behavior of healthcare professionals in Hatta Hospital regarding
Infection, Prevention, Control COVID-19 infection prevention and control (IPC) during this emerging
infectious disease pandemic. A descriptive cross-sectional study was
conducted in Hatta hospital, United Arab Emirates (UAE) among one
hundred HCWs using a self-administered questionnaire based on UAE
National and World Health Organization (WHO) IPC guidelines. Of
the study participants, 66% received COVID-19 IPC training inside
Hatta hospital. The mean knowledge and behavior scores were 75.7% ±
9.4 and 87.6% ± 5.9, respectively. Knowledge score and behavior score
were not related to gender (p= 0.232, 0.091, respectively ) and to work
position (p= 0.882, 0.994, respectively), however, they were related to
the previous contact with COVID -19 patients (p= 001, 0.011,
respectively ). Nonetheless, gaps in IPC knowledge and behavior have
been identified and need improvement. This includes donning and
doffing of PPE and optimal use of protective measures especially
respirators (N95 or FFP2).

Copyright, IJAR, 2024,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
On 30 January 2020, the World Health Organization (WHO) declared Coronavirus disease2019 (COVID-19)
outbreak a PublicHealth Emergency ofInternationalConcern[1]. The COVID-
19pandemic,causedbythesevereacuterespiratorysyndromecoronavirus2(SARS-CoV-2),hadbecome a global
challenge [2]. COVID-19 had spread worldwide especially with the aid ofcommercial air travel [3]. The spread
of COVID-19 was explained by the phenomenon of ‘superspreading’, whereby a COVID-19 patient may have
transmitted the disease to up to eightcontacts [4]. Any delay in the recognition of the disease and the application
of effective controlmeasure areas increased the probability of the spread of the virus. The increasing numbers
ofCOVID-19 patients could rapidly overwhelm the capacities of healthcare systems. As

Corresponding Author:- Naglaa Mohamed Abdelhamied 701

Hatta Hospital, Emergency Department
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morepatientswerehospitalized,healthcareworkersatthefrontlineofcarewereatthegreatestriskofinfection [5].
Infection control encompassed all the policies, procedures, and measures used toprevent or minimize the risk of
transmission of infectious disease in healthcare facilities
[6].Appropriatehospitalinfectioncontrolmeasureshavebeenrecentlyshowntopreventnosocomial transmission of
SARS-CoV-2 [5]. If infection control measures were not widelyfollowed, healthcare facilities may dramatically
speed up the spread of the virus amongst staff[7]. In Italy, 2020 infection rates of healthcare workers were five
times that of the generalpopulation [7]. BytheendofthelastEbolaepidemicin WestAfricain2016,the
rateofinfectionamonghealthcareworkerswas21to32timesthatofthegeneralpopulation[7].Leftunchecked,the current
pandemic could attain comparable levels and lead to the failure of healthcare systems[7].

A positive, correlation was found between knowledge regarding COVID-19 among HCWsand appropriate
clinical practices [8]. The contact with confirmed and suspected COVID-19patientsdidnotpromoteself-
reportedIPCbehaviorsinlow-riskareas,butinhigh-riskdepartments,IPC behaviorshave significantlyimprovedafter
theCOVID-19 outbreak[9].

Very few studies report on the Knowledge and behavior of COVID 19 IPC. A nationalsurvey of UK medical
students and interim foundation doctors in 2020 during the COVID-19pandemicshowedthatthelevelsofself-
reportedPPEandIPCtrainingweresub-optimal[10].InUAE a study in Al Ain, (2020) indicated that there was a
significant gap in knowledge andperception about COVID-19 [11]. However, in UAE and the Middle East, no study
has been doneregardingCOVID19IPCknowledge andbehaviorintheHCW.

International health regulations have dictated five public health measures to manage anoutbreak: prevention,
detection, response, enabling function, and operational readiness [2]. Thebest approach to control a pandemic
was through the simultaneous application of
preventivemeasuresandsensitivediagnoses[12].Therefore,thisstudyaimedtoassesstheknowledgeandself-reported
behavior of healthcare professionals in Hatta Hospital regarding COVID-19 IPCand toidentifyany gapsthat
mightincrease theriskofinfection.

MaterialsandMethods:-
Researchquestions
1. Didhealthcareprofessionals(HCP)inHattaHospitalhaveup-to-dateknowledgeaboutCOVID-19IPC?
2. DidthisknowledgeaffecttheirbehaviorregardingCOVID-19IPCmeasures?

ResearchMethods:-
This is a cross-sectional descriptive study. Comprised of a convenient sample of
healthcareprofessionalsworkingatHattaHospitalwho werewillingtoparticipate inthestudy.

Questionnaire
A semi-structured paper-based questionnaire was created by the author after reviewing theUnited Arab Emirates
(UAE) national guidelines course materials on emerging respiratoryviruses,includingCOVID-
19[13]andWHOIPCguidelines[14,15,16,17]aswellasWHOcommonlyaskedquestionsthat coverall
partsrelatedtoCOVID-19IPC[18].

Two infection control experts (qualified infection control consultants at Suez Canal University)who also have
access to the materials used for developing the questionnaire have validated thequestionnaire.

Following the validation process, five physicians and ten nurses from Hatta Hospital tested
thepilotquestionnairethroughoutthe3rdweekofMay2021toinstituteclarity,easeofcomprehension,andcontentoftheq
uestionnaire.Thequestionnairewasthenrevisedaccordingto theraisedconcernsthroughoutthe 4th week ofMay
2021.

The first page of the questionnaire (appendix 1) encompassed a consent form along with
anexplanationofthequestionnaire.

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Thequestionnairewascomprised ofthreesections:
First:Demographicdata (e.g.,age, gender,yearsofexperience).
Second: Knowledge regarding COVID-19 IPC (e.g., routes of transmission, incubation period,fatality rate, and
types of protective measures in different situations). There were thirteenmultiple-choice and rearrangement
questions with 1 point to correct answer and zero point toincorrectanswerwithatotalscore of31
Third: Behavior about COVID-19 IPC practice (e.g., frequency of following respiratory hygienepractices,
educating patient and relatives about cough and sneeze etiquette, designating staffwho will be responsible for
caring for suspected or known COVID-19 patients). It included 31questions withanswers ranging from(never,
notatall) to (always, excellent).

Response to each item recorded on the 4-point Likert scale as follows: always or excellent (4-points), most of
the time or above average (3-points), average or occasionally (2-points), belowaverage or rarely (1-points), and
not at all or never with a total score of 124. A score above 80%wasconsideredasgoodbehavior [19,20].

The definition according to the WHO checklist and adapted by us was that: Always orexcellent means more
than 95% of the time. Most of the time or above-average means 50% tounder 95%of the time. Occasionally or
average means 20% to less than 50% of the time and rarelyorbelow-averagemeansless than20% ofthetime[14].

Datacollection;
The final paper-based questionnaire was given to the participants in person and administeredbythe
respondentsthemselves(self-administered throughoutthe 1stweekofJune2021.

Participants’ inclusion criteria: Health care professionals at Hatta Hospital, including doctors,nurses, technicians,
and pharmacists. Hatta Hospital staffing at the time of the study: 112 doctors,239 nurses, 99 technicians, and 10
pharmacists. The sample size was at least 80 participantsaccording to thefollowingequation[21].

Where
n= samplesize
Zα/2= 1.96(Thecritical valuethatdividesthecentral95%of theZdistributionfromthe5%inthe tail)
σ=theestimateofthestandarddeviation=1.3
E =the marginoferror(=widthof confidenceinterval)=0.5

Exclusioncriteria:
Otherhospitalstaffanduncompletedquestionnaire.

Ethicalconsiderations
The first page of the questionnaire consisted of an explanation of the aim, objectives,
andmethodsofthestudyaswellasaninformedconsenttobeagreedbytheparticipantsbeforetheycanadvance
tothequestionnaire.

The participants’ identities were kept anonymous, and the collected data was saved in a securefile, and was
strictly confidential and used for this research purpose only. Participants wereaware that this study required
voluntary participation, and their participation had no bearing ontheirprimary work position.

Theparticipantshadtherighttowithdrawfromthestudyat anytime.

Ethics approval:
The study was performed following the deliberation of the Dubai ScientificResearch Ethics Committee
(DSREC) and ethical approval reference number: USRRC-GL-2021-04-03.

DataAnalysis:-
Analysiswasbyfrequenciesandpercentforqualitativedataandmean±standarddeviationforquantitative data (such as
age and years of experience). The significance of the relationshipbetween quantitative variables would be tested
by one-way analysis of variance (ANOVA) andindependent sample t-test for parametric quantitative data.

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Correlation Coefficient was used toassess the strength and direction of the relationships between variables as
years of experienceandknowledgescores.Ap-
value<0.05wasconsideredstatisticalsignificance.Allanalyseswereconductedusingthe
SPSSforWindowsstatisticalpackage 9(version22).

Results:-
One hundred sixty-three health care professionals from Hatta hospital participated in thisstudy. However, only
one hundred submitted complete questionnaires and were included inthis study. The description of their
demographic profile is shown in Table 1. The mean age was37.9±6.12yearsand57%werefemale.Twenty-
eightpercentwerefromtheEmergencyMedicinedepartment, 13% from Family Medicine, 11% from ICU, 9% from
Radiology department 7%Surgery and 6% Obstetrics and Gynecology departments, and (2%) ware from the
Anesthesiadepartment.Themajority(58%)wereNursesand27%weredoctors.Regardingthemainsourceinformation,
42% use social mdmediacircular hospital announcements, and scientific journals asmain
sourcesofinformationTable1 alsocontainstrainingand COVID 19contact.

Table1:-Descriptionofthedemographicprofileofstudyparticipants(n=100).

Characteristics Values
Mean±SD 37.9± 6.12
Age(years) Range 30–59
Male 43%
Gender Female 57%
Doctor 27%
Nurse 58%
Workposition Pharmacist 4%
Technician 11%
Mean±SD 13.5± 5.1
Yearsofexperience Range 6– 35
Socialmedia
SourcesofinformationregardingCOVID-19infection 68%
Circularhospital 66%
announcement
Scientificjournal 55%

Table2:-Shows thepercent ofcorrectknowledgeofallparticipants.Themeanpercentageofcorrectknowledgewas

75.7± 9.4.
Workshop 27%
Other 13%
PreviousdirectcarecontactwithCOVID-19patient No 9%
Yes 91%
Hattahospitaltraining 65%
Self-study 44%
Nationaltraining 10%
TrainingforCOVID-19infectionpreventionandcontrol Traininginanother hospital 6%
Other 4%
None 10%

Regard the incubation period and fatality rate of COVID-19, 89 (89%) of participants knewthat the incubation
period was 1-14 days; and 53 (53%) knew that the fatality rate of COVID-19was 3%. Only 45 (45%) knew
about the three most common routes of COVID-19
transmission,whichwerethroughthedroplet,directcontacttransmission,andaerosoltransmission,while51(51%)ofthe
participantshadmisunderstandingsregardingwatertransmission.

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As regards the aerosol-generating procedure, 54 participants (54%) had known the threemost aerosol-generating
procedures i.e the tracheal intubation procedure, nebulizer treatment,and open airway suctiofiftysixty six (56%)
of participants had misconception regarding thecollectionofsputum as aerosol-generating procedure.

Assessing the knowledge about protective measures required during triage of suspectedCOVID-19 patients
revealed that 59 participants (59%) knew that medical masks should use.Besides,80 participants(80%) have
amisconceptionaboutusingrespirators (N95orFFP2).

Regarding the knowledge about protective measures required during transporting of

asuspected/confirmedcaseofCOVID-
19includingdirectpatientcare,48%knewthefourrecommendedprotectivemeasures,single-
usegloves,goggles,andmedicalmasks.Nevertheless,84participants(84%)hadamisunderstandingoftheutilizationof
respiratorsasaprotectivemeasure. (Table2)

Table2alsopresentsparticipants’knowledgeabouttypesofPPEsrequiredduringcollectingarespiratoryspecimen.Only
forty-oneparticipants(41%)knewthefourrecommended protective measures, the gowns, goggles single-use
gloves and medical masksEighty-seven of the participants (87%) misunderstood the utilization of respirators as
beingrequired during collecting the respiratory specimen. Among the total participants, 89 (89%)knew about the
four most protective measures required during aerosol-generating procedures,which include single-
usegloves,respirators, gowns, andgoggles

Regarding knowledge about the approaches that help to prevent transmission of COVID-
19,66(66%)knewallfourapproachesthathelptopreventtransmissionofCOVID-
19,handhygiene,stayinghome,coveringnoseandmouthwhilecoughing,andrapidassessment.All100participants
(100%) believed that hand hygiene was the very essential approach that could helppreventtransmission
ofCOVID-19.(Table2)

Regarding correct steps of donning and doffing PPEs, fifty-nine participants (59%) knewand followed the
correct donning steps of PPEs. In addition, 58 participants (58%) knew thecorrect doffing steps of PPEs.
Concerning knowledge about actions needed in case of concernsregardingabreachofPPE
duringpatientcare,only37participants(37%)knewthethreeactionsthat should be taken. These actions include
removing and changing PPE away from the
patientin71participants(71%),leavingthepatientcareareawhensafetodosoin64participants(64%),reporting it to the
direct line manager and infection control unit in 56 participants (56%). (Table2)

Table2:-KnowledgeaboutCOVID-19IPCinstudyparticipants(n=100).
Description Correctresults
Incubationperiod 89%
Fatalityrate 53%
KnowledgeaboutmostlikelyroutesofCOVID-19transmission 43%
Typesofaerosolsgeneratingprocedures 54%
Typesofprotective measuresrequiredduringtriageofanon-suspectedCOVID-19patient 56%
Typesofprotective measuresrequiredduringtriageofasuspectedCOVID-19Patient
59%
Typesofprotective
measuresrequiredduringtransportingofasuspected/confirmedcaseofCOVID- 48%
19includingdirectpatientcare
Typesofprotective measuresrequiredduringcollectingarespiratoryspecimen 41%
Typesofprotective measuresrequiredduringaerosol-generatingproceduresonCOVID-
19patient 89%
KnowledgeaboutapproachesthathelptopreventtransmissionofCOVID-19 66%
KnowingthecorrectstepsofPPEsdonningtechniques. 59%
KnowingthecorrectstepsofPPEsdoffingtechniques. 58%
Participants’knowledgeaboutactionsthatshould betakenincaseofconcernsregardingabreach
ofPPE duringpatientcare. 37%

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Mean±SDofKnowledgescore 75.7±9.4

Table3showsself-reportedbehaviorsonthefrequencyofusingPPEsinstudyparticipantsduring a healthcare
interaction with a COVID-19 patient. Ninety-two participants (92%) statedthat they always use single-use
gloves. About the utilization of surgical masks, the majority ofthe participants always have good behavior in using
the surgical mask, which is equivalent to
90participants(90%),while53(53%)hadgoodbehaviorbehusingorregardingusegoggles.seventy-
threeparticipants(73%)hadalwaysutilizedgowns.Generally,theseresultsshowedthatthemajorityoftheparticipantshaveg
oodbehaviorinusingthementionedPPEsduringtheirinteraction with aCOVID-19patient.

Table 4 presented self-reported participants’ behavior on the frequency of using PPEsduring an aerosol-
generating procedure on a COVID. For single-use gloves, 87 participants
(87%)reportedthattheyalwaysusegloves.While76participants(76%)alwaysutilizedtheN95mask.
69participants(69%)alwaysusedgoggles.60participants(60%)alwaysutilizedgowns,whereas, 59 participants
(59%) used the apron always. Overall, the majority of the
participantshavegoodbehaviortowardstheuseofPPEsduringanaerosol-generatingprocedureonCOVID-19patients.

During a health care interaction with the COVID-19 patient, the self-reported behavior
onthefrequencyofperforminghandhygienebeforetouchingthepatientwasperformedalwaysin74participants(74%).S
eventy-eightofthem(78%)respondedthattheyalwaysperformedhandhygiene after touching the patient. While,
hand hygiene was being performed always before
orafteranycleaningorasepticprocedureasperceivedby83participants(83%),handhygieneafterbody fluid exposure
was always performed by 75 participants (75%). on the other hand, handhygiene after touching the patient’s
surroundings was always performed in 71 participants(71%). These results showed good behavior among the
studied participants were in a majorityoftenperformedhandhygiene duringtheirinteractionwithCOVI-
19patients(Table5)

Regardingtheself-reportedrateoftrainingaboutinfectionpreventionandcontrolregarding the COVID-19 outbreak

during the previous 6 months. As regards infection controlpoliciesand procedures
training,41participants(41%)ratedaboveaverageandexcellenttrainingfor38participants(38%).Forhandwashtechniq
ues,forty-twoparticipants(42%)rateditbothexcellentandabove-arespectively.AboutN95mask-
wearingtechniques,46participants(46%) rated it excellent and above average for 33 participants (33%). On
wearing gloves, 46participants (46%) rated it excellent and above average for 43 participants (43%).
Concerningwearinggogglesorfaceshieldsratedexcellentby47participants(47%)andaboveaverage in40participants
(40%). Regarding the removal and disposal of PPEs, 40 participants (40%) rated itexcellent and above average
for 44 participants (44%). The results show that the majority of theparticipants have good behavior regarding
training about the COVID-19 outbreak during thelast6months.(Table6)

Table 7 shows the rate of different preventive actions performed to prevent COVID-19.Removing and replacing
PPEs according to protocols was always performed in 62 participants(62%). 57 participants (57%) always
observed following respiratory hygiene. While on triagepatients for respiratory symptoms, fifty-five participants
(55%) always performed it. Keeping aone-meterdistancebetweenthepatients
wasalwaysfollowedby58participants(58%).Besides,offeringamedicalmaskforasuspectedCOVID-
19patientwasalwaysperformedby67participants (67%). Educating patients and relatives about cough and sneeze
etiquette
wasalwaysperformedby65participants(65%).Avoidingtouchingeyes,mouth,ornosewasalwaysperformedby76parti
cipants(76%).56participants(56%)alwaysreportlimitmovementsuspected/confirmedpatientswithCOVID-
19patientsinsideofthefacility.Placingsuspected/confirmed patients with COVID-19 in an isolation room was
always followed in
71participants(71%).Furthermore,67participants(67%)alwaysperformedenvironmentaldisinfection after each
patient. Reporting to a superior/higher up was always applied in 68participants(68%).

Table 3:- Self-reported behaviors on the frequency of using PPEs during a healthcare interactionwithaCOVID-
19patient.
Description Values
Mostoftime 8%

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Single-usegloves Always 92%

Mostoftime 7%
Surgicalmask Always 90%
Mostoftime 28%
Goggles Always 53%
Mostoftime 15%
Gowns Always 73%

Table4:-Self-reported behaviorsonthefrequencyofusingPPEsduringanaerosol-generatingprocedureonaCOVID-19
patient.
Description
Mostoftime 6%
Single-usegloves Always 87%
Mostoftime 11%
N95mask Always 76%
Mostoftime 13%
Goggles Always 69%
Mostoftime 26%
Gowns Always 60%
Mostoftime 22%
Apron Always 59%

Table5:-Self-reportedbehaviorsonthefrequencyofperforminghandhygieneduringahealthcareinteractionwithaCOVID-
19patient.
Description Values
Mostoftime 24%
Performhandhygienebeforetouchingthepatient Always 74%
Mostoftime 17%
Performhandhygieneaftertouchingthepatient Always 78%
Performhandhygienebeforeorafteranycleaningorasepticprocedure Mostoftime 13%
Always 83%
Mostoftime 20%
Performhandhygieneafterbodyfluidexposure Always 75%
Performhandhygieneaftertouchingthepatient’ssurroundings Mostoftime 18%
Always 71%

Table6:-Self-reported rateofparticipants’trainingregardingtheCOVID-19outbreakduringtheprevious6months.
Description Values
Aboveaverage 41%
Infectioncontrolpoliciesand procedures Excellent 38%
Aboveaverage 42%
Handwashingtechniques Excellent 42%
Aboveaverage 33%
N95mask-wearingtechniques Excellent 46%
Aboveaverage 43%
Wearinggloves Excellent 46%
Aboveaverage 40%
Wearinggogglesorafaceshield Excellent 47%
Aboveaverage 40%
Removaland disposaloffPPEs Excellent 44%

Table7:-Self-reported Participants’rateofperformingpreventiveactionsrelatedtoCOVID-19.
Description Mostoftime Always
Removeand replacePPEsaccordingtoprotocol 35% 62%

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Followrespiratoryhygienepractice 35% 57%

Triage patientsforrespiratorysymptoms 27% 55%
Keepa one-meterdistancebetweenthepatients 36% 58%
Offer medicalmaskforasuspectedCOVID-19patient 23% 67%
Educatepatientandrelatives aboutcoughandsneezeetiquette 30% 65%
Avoidtouchingyoureyes, mouth,ornose 18% 76%
Limitsuspected/confirmedpatientswithCOVID-19patientsinsideofthefacility 40% 56%
Placesuspected/confirmedpatientswithCOVID-19inanisolationroom 21% 71%
Ensureenvironmentaldisinfectionaftereachpatient 25% 67%
Reporttoasuperior/higherup 27% 68%

Table 8 shows the Knowledge and Behavior scores. The mean knowledge score was 23.5
±2.9(75.7±9.4%),andthemeanBehaviorscorewas108.6±7.3(87.6±5.9%).ThehighestachievableKnowledgescore
possibleis31 andthe Behavior score is 123

Table8:-Knowledgeandbehaviorscoresinstudyparticipants(n=100).
Highest Percentageachieved
Description AchievedValue possiblevalue
Mean±SD 23.5±2.9 75.7±9.4
Range 16 – 31 31 51.6–100
Knowledgescore Median 23 74.2
Mean±SD 108.6± 7.3 87.6±5.9
Range 89–123 124 71.8–99.2
Behaviorscore Median 110 88.7

Table9showstherelationshipbetweendifferentcategoriesofhealthcareprofessionalsandtheir Knowledge and

Behavior regarding COVID-19 Infection Prevention and Control.
Therewasnostatisticalsignificancedifferencebetweendifferentwork positionsregardingtheirknowledge and
behavior about the COVID-19 pandemic. Based on the knowledge mean scoreand percentage of the total score
achieved, it was 23.6 ± 2.2(76.0±7.1%) for doctors, 23.3 ±2.9(75.5±9.5%) for nurses, 24.3 ± 3.5 (78.3±11.3%)
for pharmacists, and 23.3 ± 4.1(75.1±13.4%) fortechnician; where (p= 0.882). Similarly, for behavior, it was
108.9 ± 5.7 (87.8±4.6%) for
doctors,109.1±9.3(87.6±6.5%)fornurse,106.5±9.1(85.9±7.4%)inpharmacist,and108.8±6.6(87.7±5.3%)fortechnic
ian(p-value=0.938).

Table9:-Relationbetweenworkpositionandknowledgeandbehaviorscores.
Workposition Kruskal-
Description Doctor Nurse Pharmacist Technician Wallis p-value
(N=27) (N=58) (N=4) (N =11)
23.6±2.2 23.3±2.9 24.3±3.5 23.3±4.1 0.66 0.882NS
Knowledgescore 76.0±7.1% 75.5±9.5% 78.3±11.3% 75.1±13.4% 0.66 0.362NS
108.9±5.7 109.1±9.3 106.5±9.1 108.8±6.6 0.41 0.938NS
Behavior
scoreMean±SD 87.8±4.6% 87.6±6.5% 85.9±7.4% 87.7±5.3% 0.362 0.948NS

As shown in Table 10, the knowledge and behavior scores compared to each other andexperience and age.
There was no statistical significance (p = 0.331) and correlation (r =
0.098)betweenknowledgeandbehaviorscore,nostatisticalsignificance(p=0.283)andcorrelation(r=- 0.1) between
knowledge score and years of experience. In addition, between behavior scoresand years of experience, there was
no statistical significance (p = 0.925) and correlation (r = -0.01).Atsametime,therewasno statistical significance(p
=0.921)andcorrelation(r=-0.01)betweenknowledge score and age, and similarly, there was no statistical
significance (p = 0.590) andcorrelation (r =- 0.05)between behaviorscorevs age.

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Table10:-Correlationbetweenyearsofexperience, ageandknowledge,andbehaviorscores.

Variables (r) p-value

KnowledgescorevsBehaviorscore 0.098 0.331NS
KnowledgescorevsyearsofExperience -0.1 0.283NS
Behaviorscorevsyears ofExperience -0.01 0.925NS
Knowledgescorevs.age -0.01 0.921NS
Behaviorscorevs.age -0.05 0.590NS
(r): Pearsoncorrelationcoefficient.NS:statisticallyinsignificant

Table 11 presents the relation between the percent of correct knowledge and thedifferent basic data of the study
participants. There was no statistical significant relationshipbetween knowledge and gender or work position.
On the other hand, there was a statisticalsignificant difference (p = 0.001), between knowledge and contact with
COVID-19 cases., Thepercent ofcorrect knowledgewashigherinindividualsincontactwithCOVID-
19cases(76.6±9.01%)thanindividualswithoutcontact withCOVID-19cases(65.9±7.4%)

Table 11:- Relationship between knowledge score and gender, work position, and COVID-19contact.

Description Variables No correctknowledge CorrectKnowledg Test P-value

score e%
Male 43% 23.9± 2.9 77±9.5
Gender Female 57% 23.2±2.8 74.7±9.2 T=1.2 0.232NS
Doctor 27% 23.6±2.2 75.9±7.1
Nurse 58% 23.3±2.9 75.5±9.5
Pharmacist 4% 24.3±3.5 78.3±11.3
WorkPosition Technician 11% 23.3±4.1 75.1± 13.4 KW=0.66 0.882NS
No 9% 20.4±2.3 65.9±7.4
COVIDcontact Yes 91% 23.8±2.8 76.6±9.01 MW =141 0.001S
T:IndependentsampleTtest. NS: p-value > 0.05 is considered non-significant.KW:Kruskal–Wallistest
NS: p-value > 0.05 is considered non-significant.MW:Mann-Whitneytest
S:p-value<0.05isconsideredsignificant.

In table 12, the relationship between the percent of good behavior and different basic dataof the study
participants. The results showed that there was no statistical significant
difference(p=0.091),betweenthepercentofgoodbehaviorandthegenderoftheparticipants(where;male=88.7±5.01andfe
male=86.7±6.3).Therewasalsonostatisticalsignificance(p=0.944),betweenpercentofgoodbehaviorsandworkposition
oftheparticipants(where;doctor=87.8±4.6,nurse= 87.6 ± 6.4, pharmacist = 85.9 ± 7.3, and technician = 87.7 ± 5.2).
While there is a statisticalsignificance (p = 0.011) in the percent of good behavior in that HCP in contact with
COVID-19casescomparedto those notincontact (88.04±5.4% vs82.8± 8.5respectively).

Table12:-Relationshipbetweenbehaviorscore andgender,work position,andCOVID-19contact.

Description Variables P Behaviorscore Behaviorscore% Test P-

value

Male 43% 110.7±8.2 88.7±5.01

Gender T =1.7 0.091
Female 57% 107.5±7.8 86.7±6.3 NS

Doctor 27% 108.9±5.7 87.8±4.6

WorkPosition Nurse 58% 109.1±9.3 87.6±6.4 F =0.12 0.944

NS

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Pharmacist 4% 106.5±9.2 85.9±7.3

Technician 11% 108.8± 6.6 87.7±5.2

No 9% 102.8±10.6 82.8±8.5
COVIDcontact T=2.6 0.011 S
Yes 91% 109.5± 7.6 88.04±5.4

T:IndependentsampleTtest. NS: p-value >0.05isconsiderednon-significant.

F:FvalueofANOVAtest. S:p-value<0.05isconsideredsignificant.

Discussion:-
Health care workers, in particular those in contact with COVID-19 patients, are athigher risk of being infected
with COVID-19 than the general population. Despite the healthworkers representing less than 3% of the
population in the large majority of countries and lessthan2%inalmostalllow-andmiddle-
incomecountries,about14%ofCOVID-
19casesreportedtoWHOareamonghealthworkers[22].Theproportioncanbeas
highas35%insomecountries[23].WHO estimates that in the period between January 2020 to May 2021, between
80000 and180000 health andcareworkers couldhavediedfromCOVID-19[24].

ThefirstconfirmedcaseintheUnitedArabEmirateswasannouncedon29January2020.Itwas
thefirstcountryintheMiddleEasttoreport
aconfirmedcase[25].AccordingtotheUAENationalEmergencyCrisisandDisasterManagementAuthority’slatestrep
ortaboutcoronavirusdisease(COVID-19)inNovember2021,thetotalnumberofCOVID-19patientswas741433, and
the death rate was 21.678 per million [26]. No published statistics regarding theinfection rate among HCW in
UAE are available An early survey on HCWs in Al Ain, UAE in2020 indicated that there was a significant gap
in knowledge and perception about the COVID-19virus [11].

Available scientific evidence suggests that appropriate personal protective equipment

use,handhygienebestpractices,implementationofuniversalmaskingpoliciesinhealthcarefacilities,andadequateinfec
tionpreventionandcontrol(IPC)trainingandeducationareassociatedwith decreasedrisk of COVID-19amonghealth
care workers [22].

Mitigating and reducing the risk of infection in the HCW is essential to protecting their well-being and reducing the
spread of COVID-19[22]. Therefore, this study aimed to assess theknowledge and self-reported behavior of
healthcare professionals in Hatta Hospital regardingCOVID-19 IPCmaiandtoidentifyanygaps that
mightincreasethe riskofinfection.

This is a cross-sectional descriptive study that used a semi-structured self-administratedpaper-based

questionnaire involving a convenient sample of healthcare professionals (HCP)working at Hatta Hospital who
were willing to participate in the study during the first week ofJune2021.

HattahospitalHCPdependsondifferentsourcesofinformationtobuilduptheirknowledgeregardingCOVID-
19infectionandpreventioncontrol.Themajority(68%)wasfromsocial media, hospital circular announcements (66%),
and scientific journals (55%). There was theuse of multiple sources of information (42%) not relying on social
media only most
probablyreflectedontheirknowledgescore.Asimilarstudyshowedthatthemostoftenmentionedsourceofinformationabout
COVID-
19wastheministryofhealthwebsiteorWHOofficialwebsitesandsocialmediawithonlyasmallpercentreportingcourseortrain
ingastheirsourceofinformation[20]. This was unlikeotherstudieswheresocial mediawasthemainsource [27, 28].

RegardingCOVID-19IPCtraining,ninetypercentofparticipantswereinvolvedinvarioustraining approaches, sixty-

five percent acquired most of their training inside Hatta hospital,(44%) reported self-study, and (10%) received

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national training, and (4%) learned from anothertraining facility program and all these approaches affected their
knowledge and behavior. Thiswas unlike the national survey conducted on the United Kingdom (UK) medical
students andinterim foundation doctors during the COVID-19 pandemic, which showed sub-optimal self-
reported PPE (43%)and IPC training (56%) in medical students from 33 medical schools in theUKduringthe
COVID-19pandemicduringMarch2020[10].

Inthecurrentstudy,theknowledgelevelofHCPaboutCOVID-19IPCwashigh.Themeancorrect answer rate was 75.7 ±

9.4. %. However, the knowledge level of still less than other studiesconducted in Egypt(80.4%), China(90%), and
Pakistan(93.2%) [20, 27, 28]. On the other hand, ina study from the United Arab Emirates, poor knowledge
about the disease transmission (61%),and the symptom (63.6%) was found in a significant proportion of HCWs
[11], this may be
duetothecurrentstudy,concentratedonCovid19IPCmeasureswhilethepreviousstudydiscussedcovid 19asadiseasein
general.

This study showed that 89% of participants knew about the COVID-19 incubation period(1-14 days). A similar
study showed that approximately 96.19% of HCWs indicated that theincubation period of the virus is 1-14 days.
This time was very important in preventing diseasespread, and suspected individuals must quarantine for 14
days until symptom appearance orarrivaloflaboratoryreports [29].

Based on the responses of the participants, only 45% knew about the three most commonroutes of COVID-19
transmission. Individually, however, 85% chose droplet transmission, 69%direct contact transmission, and 51%
aerosol transmission as routes of transmission. However,51% had a misconception that it was transmissible
through the water. In a study from
Jeddahcity,SaudiArabia(2020),themajorityofHCWsdisplayedsufficientawarenessofvirustransmission mode,
droplets emitted during coughing (97.46%), physical contact with infectedindividuals (96.38%), and sharing
clothing/towels (84.07%). However, 54.25% thought of waterasasourceof COVID-19 transmission[29].

Only 54% in the study knew all the three most aerosol-generating procedures, the
trachealintubationprocedure,nebulizertreatment,andopenairwaysuctioning.Thisisalargeknowledgegap,asaerosol-
generatingprocedureshavebeenassociatedwithanincreasedriskoftransmission of COVID-19 [17]. Moreover,
additional airborne precautions are needed whenperforming aerosol-generating procedures other than contact
and Droplet precautions [17].However, 56% of participants had misconceptions regarding the collection of
sputum as anaerosol-generating procedure.This may explaintheoveruse of respirators during sputumcollection.

The current study showed above-average knowledge about protective measures requiredduring dealing with
suspected COVID-19 patients in different situations especially using themedical mask. These results support the
previous literature that facemasks are the most
essentialpreventivemeasuresinPPEforhealthcareprofessionals[30].Incontrast,Kumaretal.[31]foundHCWs’ knowledge
regarding the role of facemasks in the prevention of the disease to bemoderate to poor. On the other hand, Olum
et al., [32] found about 17% of HCWs believed thatwearinggeneralmedicalmaskswasnotprotective against
COVID-19.

One of the findings in the study was the overuse of respirators (N95 or FFP2) that wererecorded and reported
from 80 to 87% in different situations. This may be due to fear of beinginfected or transmitting the infection to
their families followed by their belief that the disease ishighly transmissible[20].

ThisstudyshowedgoodknowledgeaboutapproachesthathelptopreventtransmissionofCOVID-19 score. Sixty-six

percent of study participants knew all four approaches that help toprevent transmission of COVID-19, hand
hygiene, staying home, covering nose and mouth
whilecoughing,andrapidassessment.All100participants(100%)believedthathandhygienewasthevery essential
approach that could help prevent transmission of COVID-19.Hand hygiene isrecognizedglobally as a leading
measureof IPC, which is effective in decreasing
thetransmissionofcommonrespiratoryviruses,includinghumancoronavirusesandithadbeenusedinrespondingto
SARS,and,Ebola[9].

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Another area ofknowledgegap which needs improvement,was the correct steps

ofdonninganddoffingPPEsasonly59%knewandfollowedthecorrectdonningstepsofPPEs.Inaddition, only 58%
knew the correct doffing steps of PPEs. A similar finding showed from anational survey of UK medical
students, as the sufficiency of PPE information was
significantlyworsethanthatofIPCtraining.Furthermore,thesameUKstudystatedthatitmightbedesirabletoexaminethepro
ficiencyofIPCmeasuresandinclude‘donninganddoffing’asaskillrequiredfor medicalgraduation[10].

As regards to self-reported behavior of the participants on COVID-19 IPC measures in thecurrent study, the
participants have shown a good overall behavior score of 87.6%
(SD=5.9).similartoSuleimanetal.studyshowedthat:adherencetosafetymeasureswas80.4%[19].Also,Al-Hanawi
etal reportedthatoptimistic attitudesof(94.1%)amongstudyparticipants[33].

Therewas nostatistical significance difference between different work positions, age,gender, work position, and
years of experience regarding their knowledge and behavior abouttheCOVID-
19pandemic.Olumetal.inUgandareportednosignificantdifferenceinthelevelofknowledge about COVID among
HCWs irrespective of their professions or qualifications
[32].Inotherstudies,physicianshadasignificantlyhigherlevelofknowledgefollowedbypharmacistsandnurses[34,35]
.Similarly,Wahedet al.inEgyptstatedthatthelevelofknowledge about COVID-19 was significantly associated with
younger age groups especially20–30 years, and with superior education levels [20]. In this study, there was no
statisticalsignificance (p = 0.331) and negative correlation (r = 0.098) between knowledge and
behaviorscoresdespitegoodrecordingscoresinbothsections.Thiswasunlikeotherstudiesthatfoundagood knowledge
in HCW was significantly associated with this positive attitude [20, 28, 34].Even the studies that included the
general population showed that a higher knowledge level
wasassociatedwithapositiveattitude[35,36].AccordingtoWahedetal.,[20]knowledgeofHCWsis a very important
prerequisite for prevention beliefs, positive attitudes, and promoting positivepractices. It also affects their coping
strategies to some level. This may be related to the gapsshown inthecurrentstudy knowledge andhighself-
reportedbehavior.

On the other hand, there was a statistical significant difference between knowledge andcontact with COVID-19
patients, the percent of correct knowledge was higher in individuals incontact with COVID-19 cases (76.6 ±
9.01 %) than individuals without COVID-19 contact (65.9 ±7.4%).The Egyptian study similarly found being in
direct contact with COVID 19 patientssignificantly increases the knowledge level as direct dealing with patients
makes HCWs moremotivatedtoknow aboutthediseaseandto searchforscientificmaterialsandguidelines[20].

ThecurrentstudyreportedthattherewasastatisticalsignificanceinthepercentofbehaviorinthatHCPincontactwithCOVID-
19casescomparedtothosenotincontact(88.04±5.4%vs82.8 ± 8.5 respectively). Remarkably, a study on healthcare
workers in China showed the self-reported IPC behaviors of HCWs significantly improved after the COVID-19
outbreak. HCWswho were in the affected area and high-risk departments reported better IPC behavior [8].
Thiswas opposite to Lai et al., also from China who reported that the contact with confirmed andsuspected
COVID-19 patients did not promote self-reported IPC behaviors, which may resultfrom
thehigherworkloadandlack resourcessuchasgowns[9].

Limitation:-
The limitation of this study was that out of 163 participants only 100 (61%) completed thequestionnaire and were
included inour study. Thisstudy was from onehospital only and cannotbe generalized to other Dubai health
authorities (DHA) hospitals or UAE hospitals. Moreover,IPC’sself-
reportedbehaviorsscoreofHCWsmaybeoverestimated,becauseHCWsmayrespondtointerviewquestionsinawaythat
theybelieveissociallyacceptableratherthanbeingcompletelyaccurate.

Strength
This study concentrated mainly on COVID-19 IPC measures unlike other studies focusedonthevirusitself.

Conclusions:-
Thisstudyrevealedthat:HattahospitalusedvarietiesofCOVID-19IPCtrainingtechniques and approaches to prevent
and control the transmission of the virus among HCP.There was a high level of overall COVID 19 IPC

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knowledge and behavior. Nevertheless,

manygapsinknowledgeandbehaviorhavebeenidentifiedThisincludesdonninganddoffingofPPEand optimal use of
protective measures especially respirators (N95 or FFP2), which can becorrectedto
furtherenhancetheprotectionagainst COVID19among theHCP.

Recommendations:-
Basedontheresultsonknowledge andbehaviorofthestudiedparticipantsaboutCOVID-19IPC,some ofthe
commendationsthatneed to consider are:
StrengtheningtheCOVID-19IPCknowledgeawarenessthroughvarioustraining,workshop-seminar, and IPC
programs to improve the level of healthcare workers especially
intermsofPPESdonninganddoffingstepsandtypesofprotectivemeasuresindicatedindifferentpatientapproaches
andincludedinannualHCPmandatoryeducation.

FurthermoredirectobservationstudytoevaluateactualIPCbehavior.

Acknowledgments:-
Iexpressmydeepandsinceregratitudetomyresearchsupervisorsforgivingme guidance, motivation and vision that
had always set me on the right track. I am grateful to
alltheparticipantswhofilledthequestionnaire;providingtheirvaluabletimeandcontributiontothiswork.Iamgratefulto
MaithaAlmansoori,headoftheHealthInformaticsunitofHattahospital,forfacilitatingresearchconductionandethicala
pproval.

Funding:
Thisresearchreceivednoexternalfunding.

ConflictsofInterest:
Theauthorsdeclarenoconflict ofinterest.

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