Assessment of Knowledge, Attitude, and Practice Regarding Usage of Masks and Medical Gowns among Postgraduate Students

Introduction

Severe acute respiratory syndrome coronavirus (SARSCoV-2), the cause of Coronavirus disease-2019 (COVID-19), the largest pandemic of this century, is a member of the family Coronaviridae of the order Nidovirales. The infection first appeared in the Chinese city of Wuhan in December 2019, and it quickly spread throughout the world. The World Health Organization (WHO) proclaimed pneumonia caused by SARS-CoV-2 a public health emergency of international concern on January 30, 2020 after it was discovered that it could be transmitted between people. The WHO formally called it COVID-19 on February 11, 2020. The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-1) in 2002–2003 in China and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012 in China and Saudi Arabia are two more coronavirus strains.¹

Coronaviruses are zoonotic pathogens, spherically shaped with an outer lipid layer, a crown of club like spikes or peplomers containing single-stranded RNA (ssRNA) as their genetic material. SARS-CoV-2 and SARSCoV are structurally very similar, but the essential spike protein is different (s). Coronaviruses affect respiratory, gastrointestinal, and central neurological systems of the host to cause symptoms. Coronaviruses are widespread and can be found in a variety of mammalian and avian species.¹

While SARS-CoV-2, SARS-CoV, and MERS-CoV are linked to deadly respiratory illnesses, six coronaviruses— HCoV-229E, HCoV-NL63, HCoV-HKU1, and HCoVOC43—cause moderate respiratory symptoms similar to common cold. SARS-CoV-2 uses the angiotensinconverting enzyme 2 (ACE-2) receptor and invades the lower respiratory tract cells.^2-4

Coronavirus disease-2019 (COVID-19) is transmitted thorough respiratory droplets expelled by infected people while coughing, sneezing, or speaking.⁵ During COVID-19 outbreak, dentistry was classified as a very-high-risk category of occupations involved with infections due to aerosol production. Protecting clinicians and other healthcare workers from severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection by respiratory aerosol and contact transmission has been the main concern.

Dental health care professionals (DHCPs) are more vulnerable to contacting pathogens during oro-dental examinations or treatments that include contact with infected patients and no protective medium. Therefore, while using high-speed and low-speed rotary instruments, DHCPs must employ all precautionary measures, including donning gloves, face mask, and eye protection, as well as using a suitable high-speed suction.^6-8

Gowns are an example of personal protective equipment that is frequently used in medical settings to shield the user from the spread of disease if they come in contact with potentially contagious liquid and solid materials. They could also be used to prevent the person wearing the robe from spreading germs that might damage more susceptible patients, like those with compromised immune systems. Gowns are one part of an overall infection-control strategy. Gowns including surgical gowns, isolation gowns, surgical isolation gowns, nonsurgical gowns, procedural gowns, and operating room gowns are used in health care settings.⁹

The spread of disease can be stopped and controlled by taking precautions including routine hand washing, physical separation, and wearing a face mask over the mouth and nose. The usage of a facemask is regarded as an affordable, reliable, and secure solution that causes least amount of disruption to daily life.¹⁰

The purpose of this survey was to determine how well postgraduate students are aware of masks and medical gowns.

Materials and Methods

A cross-sectional study was conducted among 400 postgraduate students. The data was obtained using a self-administrated questionnaire comprising of 15 multiple choice questions, based on Likert scale (five point) that included questions on knowledge, attitude & practice towards awareness of masks and medical gowns. The questionnaire was personally administered to the students after explaining the motive of the study and instructions to complete the questionnaire. The questionnaire comprised of three sections - knowledge -5, attitude -5, and practice-5.

Questionnaire: (5 point Likert scale: 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree)

Knowledge

1. Dental profession/dentistry is one of the high-risk professions?

2. Wearing a mask and medical gown helps to reduce the spread of the coronavirus?

3. Using an ear loop mask leads to discomfort in your ears?

4. N95 respiratory masks help in preventing the spread of COVID-19?

5. Polyester fabric medical gown is reusable.

Attitude

1. Wearing a mask and medical gown doesn’t work- it just gives people a false sense of security.

2. Face masks disrupt my breathing.

3. Face masks and medical gowns cause me to overheat.

4. Coronavirus isn’t as big a threat as “they” make it to be.

5. Face masks are unsafe because they force you to touch your face.

Practice

1. Respiratory masks are ideal for patient management during the aerosol procedure?

2. N95 mouth masks can be reused?

3. After 2-3 times of reuse cycles, the mask will be disposed of.

4. Medical gown covering the toe is recommended?

5. 3-ply surgical masks are ideal for patient management for non-aerosol procedures?

Statistical analyses

Chi square test was used to compare the distribution of responses to knowledge, attitude & practice based questions among postgraduates. The significance was set at p≤0.05.

Results

A total of 400 postgraduate students participated in the study and completed the questionnaire. The mean age of the participants was 26.228±1.92 years. The mean value of knowledge was 4.178±0.6513, mean value of attitude was 3.303±1.0624 and mean value of practice was 4.016±0.6855.See table 1 With the Pearson correlation coefficient, it can be understood that a positive relationship exists between the knowledge (0.363) the postgraduate students possess, their attitude (0.561) and practice (0.489) towards masks and medical gowns. See table 2

Discussion

After the Spanish flu pandemic (1918-1919), COVID-19 impacted India’s health care system, economy and psychology.¹¹

High fever, cough, sore throat, shortness of breath, fatigue, and malaise are commonly observed in patients infected with COVID-19 virus. The weakened immune systems of chronically ill patients and the elderly make the impact of COVID-19 more severe and potentially fatal for those suffering from these comorbidities. The disease had spread to 219 countries around the world and World Health Organization (WHO) has declared it a pandemic. It infects people of all ages and occupations. This infection can strike healthy adults and those with health problems, and kills indiscriminately, spreading exponentially. During the mid-stage of COVID-19, students were intended to focus on the use of masks and gowns. At the same time, demand for masks and doctor coats was high.¹²

Since the declaration of COVID-19 as a pandemic, face masks became a very important part of everyday life (Eberhart et al., 2021). Wearing a mask prevents hand-to-mouth or hand-to-nose contact, transmission of respiratory droplets from an infected person, and filters airborne particles. Therefore, usage of face mask has been proposed as an important risk reduction strategy against viral infections.¹³

The N95 is an ideal mask for medical staff and dentists as it fits snugly on the face and efficiently filters airborne particles. The ends of the respirator form a seal around the nose and mouth. A surgical mask is a loose, disposable device. It forms a physical barrier between the wearer’s mouth and nose and adjacent potential contaminants and is not designed to form a seal around the nose and mouth.¹⁴

To extend the life of N95 mask, it can be covered with a surgical mask that is discarded after the use. N95 does not offer full protection. Masks with breathing valves are beneficial as they make breathing more efficient and reduce heat build-up. A breathing valve mask is not recommended if sterility is required. If the respirator becomes damaged, soiled, or if the wearer has difficulty in breathing, it should be removed, disposed properly, and replaced with a new one. To safely dispose the N95 respirator, put it in a plastic bag and throw it in the trash.

According to CDC guidelines, N95 can be reused five times, rotated daily for use, and allowed to dry long enough (72 hours or more) for the virus to become non-viable. Medical gown act as a barrier between the patient and the doctor, protecting the doctor from microorganisms, bodily fluids, and other particles. The gown should cover the body from shoulder to knee and the arm from wrist to top of elbow.^15,16

A study conducted by Anusha Arvind Math et al. included a total of 44 students. Among them, 26 (59.09%) were female students and 18 (40.91%) were male students. In the present study, a total of 400 students were included, of which 54% were males and 46% were females.⁹

Most of the students were in 1st grade (38.64%), 2^nd grade (27.27%) and 3^rd grade (34.09%), and while in the present survey, majority were in 1st grade (52%), followed by 2nd grade (29%) and third year (19%).

According to Anusha Mas et al., 2% students reused N95 ventilator, while 35% of the students in this study agreed that N95 could be reused. 42% discarded after 2-3 reuses, while 81.6% of them in the current survey discarded after 2-3 reuses and 11% of students used recycled polyester medical use gowns, and the current survey showed that 33% of students agree that medical gowns made of polyester material can be reused.

Ear loop mask caused discomfort as per 24 respondents as per the study by Mas et al. ⁹ , but in this study she agreed that 39.7% of ear loop masks caused ear discomfort.

For patient management under aerosols, 5% of students considered ventilator as ideal, compared to 38.7% students in the current study.

For patient management during non-aerosol procedures, 32% of students judged 3-layer mask to be ideal, whereas in this study, 36.9% of students judged the mask to be ideal. 19% of the students agreed that medical gowns should cover the toes, and in the current study, 82% of students agreed for the same.

Therefore, the present study indicated that knowledge and practice regarding hygiene masks and gowns was good and their attitude was appropriate.

Conclusion

Post graduate students demonstrated good knowledge and practice towards the masks and medical gowns, whereas the attitude was still truncated. Hence, the perception of postgraduate students towards the mask and medical gowns needs to be gauged for the betterment of their service.

Conflict of Interest

None