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

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
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."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




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.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
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,
Bengaluru.
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
Consultant
(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)
E-mail: drrajendrak1@rediffmail.com
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.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

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
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : August | Volume : 16 | Issue : 8 | Page : DC01 - DC06 Full Version

Unmasking the Mask Issues among Healthcare Workers in COVID-19 Era


Published: August 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55258.16684
Neha Gupta, Renu Gur, Shalini Dewan Duggal, Deepak Dhamnetiya, Ravi Prakash Jha

1. Senior Resident, Department of Microbiology, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India. 2. Consultant, Department of Microbiology, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India. 3. Specialist, Department of Microbiology, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India. 4. Assistant Professor, Department of Community Medicine, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India. 5. Statistician cum Tutor, Department of Community Medicine, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India.

Correspondence Address :
Dr. Renu Gur,
Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India.
E-mail: renugur@hotmail.com

Abstract

Introduction: Recent pandemic have showed importance of adequate availability of Personal Protective Equipment (PPE) most importantly the face mask and training of Healthcare Workers (HCWs) for its proper usage for protection from various infections to maintain smooth functioning of healthcare facility.

Aim: To examine practices and barriers to compliance regarding face mask usage among HCWs.

Materials and Methods: The present study was a cross-sectional observational analytical study which was conducted at Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, India, from 30th June, 2020 to 24th July, 2020 during Coronavirus Disease-2019 (COVID-19) pandemic. Data was collected through semi-structured bilingual online questionnaire using Google form based on recommendations for mask use by World Health Organisation (WHO) and Centers for Disease Control and Prevention (CDC). Data was recorded in MS Excel and Statistical Package for the Social Sciences (SPSS) 16.0 software was used for statistical analysis. Qualitative data was expressed in percentages and continuous data was summarised in mean±Standard Deviation (SD). Chi-square test was used to check the association between the categorical variables.

Results: Total 362 HCWs submitted responses, of which 44.7% respondents wore N95 masks to protect themselves from COVID-19. Only 34.2% were satisfied with availability of masks in healthcare facility. Itching and sweating on part inside mask was major problem faced by 52.8% of respondents. Only 58% followed proper hand hygiene precautions while handling mask whereas 62.7% took proper measures while doffing.

Conclusion: There appears to be a lack of awareness about proper hand hygiene while handling mask, appropriate precautions for reuse and doffing. Availability of mask also needs to be addressed. Regular trainings are needed to increase awareness, improve behaviour and practices regarding mask usage for prevention of occupational spread of infection among HCWs.

Keywords

Barriers, Behaviour, Compliance, Practices

In a pandemic situation, human resource in hospitals is an irreplaceable one. Infection prevention and control in healthcare settings involves appropriate use of PPE which includes gloves, eye protection, gown, head and shoe covers, facemask or respirators, etc (1). It has become quite evident during the recent pandemic of COVID-19 that adequate availability of face masks and training of HCWs for its correct use play an important role as a significant number of HCWs became infected with the disease (2).

The virus is mainly transmitted through respiratory droplets or by touching mouth, nose or eyes with contaminated hands. Therefore, to reduce transmission, HCWs need to strictly adhere to infection control practices. In addition to appropriate hand hygiene practices, the most important measure for infection prevention and control of COVID-19 among HCWs was routine and correct use of face mask. Inadequate knowledge among HCWs leads to inappropriate use of face masks thus increasing the risk of transmission (3).

A study found that a significant number of HCWs who got infected with COVID-19 in their settings got exposed due to mask non compliance in non patient care areas or during meals sitting in groups when mask was removed and social distancing rules were not followed (4). In a systematic review, the compliance with face mask usage among HCWs ranged from 4-55%. The compliance with the use of face mask may vary depending upon individual factors, type of mask being used, environmental conditions and organisational policies (5).

There appears to be a gap between knowledge and practices among HCWs leading to decreased compliance about correct face mask usage, thus exposing them to infection in this pandemic situation. This study aimed at examining the knowledge, practices and barriers to compliance regarding the face mask usage among HCWs in hospital settings.

Material and Methods

A cross-sectional observational and an analytical study was conducted by the Department of Microbiology and Department of Community Medicine at Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India, from 30th June, 2020 to 24th July, 2020 during the period of COVID-19 pandemic. Ethical approval for this study was provided by the Institutional Ethical Committee (IEC) Ethics committee approval number: F.5(50)/2020/BSAH/DNB/committee/8211-8216), and the informed consent was obtained from each of the study participant.

Inclusion criteria: All HCWs including medical, paramedical, nursing and other staffs who gave consent were included and who work in a hospital and may come in direct or indirect contact with patients.

Exclusion criteria: HCWs who did not give consent to be part of the study were excluded from the study.

A pretested, semi-structured bilingual (English and Hindi languages) questionnaire was prepared based on recommendations for mask use by WHO and CDC (6),(7). The data was collected through online questionnaire made using Google form and circulating the link of the form via various media like email, WhatsApp etc. The subjects were considered to be included in the online survey if they agreed to participate and give their individual consent for the survey after which detailed questionnaire opened up. Questionnaire contained various questions regarding face mask usage with multiple choice answers of which one best answer was to be chosen for submission. The questionnaire had three sections; socio-demographic profile, mask usage practices and barriers to mask use. The “socio-demographic profile” section contains questions regarding age, gender and occupation/designation. The “mask usage practices” consist of questions like; Before COVID-19 pandemic, did you wear face mask? What type of mask do you wear for protecting yourself from COVID-19? For how long do you wear the mask every day? How frequently do you change the mask? How do you store the mask? What do you do before reuse of mask? When do you wash hands while handling the mask? When you remove your mask, what do you keep in mind? The “barriers to mask use” section consist of questions like; Have you ever felt dizzy wearing a mask? And after how long do you feel uncomfortable/ suffocated wearing the mask? Data was kept confidential by keeping the responses anonymous and was stored under secure settings.

Statistical Analysis

Data was recorded in MS Excel and Statistical Package for Social Sciences (version 16.0; SPSS Inc., Chicago, IL) software was used for statistical analysis. Qualitative data was expressed in percentages and continuous data was summarised in mean±SD. Chi-square test were used to check the association between the categorical variables. A p-value of <0.05 was considered significant.

Results

Total 362 people submitted their responses, of which 172 (47.5%) were females and 52.5% males. Demographic characteristics of the respondents is shown in (Table/Fig 1). More than half (58.3%) of the respondents were doctors. More than three fourth of the respondents are of age 20-40 years.

(Table/Fig 2)- depicts the usage, type and frequency of change of masks by the respondents to protect themselves from COVID-19.

Before COVID-19 pandemic, 32/211 (15%) doctors, 2/58 (3%) nursing staffs and 19/93 (20%) never wore a face mask. Maximum number (47%) of such respondents was from age group 31-40 years. Of 362 HCWs, 225 (62.1%) used to wear mask during aseptic procedure or while interacting with patients, 29 (8.1%) wore masks only to prevent allergy while the some used to wear mask only once in a while (53, 14.6%). More than two-fifth (44.7%) of the respondents wear N-95 mask, while more than one fourth (26.8%) of the respondents wear N-95 mask together with triple layer mask. About 182 (50.3%) respondents feel more comfortable with mask having adjustable elastic bands followed by those who prefer masks with 2 ties on each side that is 93 (25.7%) and rest of the HCWs prefer masks with elastic bands around ears.

Only 124/362 (34.2 %) respondents were satisfied with mask issuing frequency of healthcare facility while 81 (22.4%) were not satisfied. About 141(39%) respondents said that frequency for issuing mask was fine but it would be better if it was more frequent.

Maximum number of respondents that is 199 (55%) wear mask for 6-9 hours followed by 71 (19.6%) for 2-5 hours, 18.8% for 10-12 hours, 4.1% for more than 12 hours and rest wear mask for less than 2 hours/day (Table/Fig 2). When asked about the method of storage of mask, only 119/362 (32.9%) were storing it in labeled paper bags as advised, 81 (22.4%) storing it on a shelf in cupboard or drawer, 74 (20.4%) hang it in sunlight, 42 (11.6%) stores in polythene bags, 11 (3%) keep it open in their workplace while 35 (9.7%) said they store by some other methods (Table/Fig 2).

Some mask usage practices that were found to be significantly associated with demographic factors as depicted in (Table/Fig 3), (Table/Fig 4), (Table/Fig 5). (Table/Fig 3) shows behaviour of respondents before reusing the mask. Significantly higher proportion of younger age groups was less knowledgeable about proper method of reuse of mask (p<0.001).

(Table/Fig 4) shows number of HCW following hand hygiene practices at every opportunity while handling the mask. The practices don’t vary significantly between various age groups; and between males and females while it varies significantly among various job profiles (p<0.001). The highest proportion of HCWs who perform hand hygiene at every step as recommended were nurses (82.8%).

(Table/Fig 5) shows the number of HCW taking adequate precautions while removing mask. Significantly higher proportion of females 123/172 (71.5%) had knowledge about all precautions to be taken while removing mask as compared to males 104/190 (54.7%) (p=0.001).

(Table/Fig 6), (Table/Fig 7), (Table/Fig 8) depicts responses of HCWs to questions regarding barriers to mask compliances. Of total respondents, 155 (42.8%) could tolerate mask for only 2-5 hours followed by 102 (28.2%) individuals who could barely tolerate it for less than an hour whereas only 32 (8.8%) could tolerate it for duration longer than 12 hours and the rest from 6-11 hours (Table/Fig 3). Duration of tolerability of mask had no gender difference, between various job profiles but a significantly higher proportion of HCWs in the age group 41-50 were intolerant to mask for long hours as compared to others (p=0.022) (Table/Fig 6).

(Table/Fig 7) depicts the behaviour of HCWs about handling the mask and hand hygiene. When asked about the major problem faced due to mask, 191/362 (52.8%) HCW responded as sweating and itching on part inside the mask followed by inability to drink water frequently by 72 (19.9%), repeated touching of face and forgetting hand hygiene and inability to properly communicate by 31 (8.5%), pressure marks on face by 27 (7.5%) while the rest had allergic reaction as major problem.

When asked “Have you ever felt dizzy wearing a mask”, 139 (38%) respondents said that they felt dizzy in hot/ humid conditions while 101 (28%) never felt dizzy, 54 (15%) only after exertion, 42 (12%) feel dizzy many times every day and 23 (6%) feel dizzy at least once every day. Three HCWs reported that they fainted few times. Dizziness was reported in significantly higher proportion of females (p=0.008). More number of females, 27 (15.8%) reported feeling dizzy multiple number of times in a day as compared to only 15 (8%) males. While 67 (35.6%) males reported that they never felt dizzy, only 34 (19.9%) females reported the same (Table/Fig 8).

Discussion

Face mask acts as a barrier in reducing risk of transmission of microorganisms between patients, HCWs and environment. This study shows that quite a large number of HCWs were not used to wearing face mask which explains why there is a lack of knowledge and compliance in face mask usage. Moreover, since general populations are not trained in the use of face masks, they tend to copy what they observe in media and their practices may be influenced by health care professionals (8). An Indian study done during COVID-19 pandemic showed only 64% HCWs were wearing masks correctly while a study from a hospital in China in non isolated areas, 74% patients and their families were wearing masks correctly (9),(10).

As per WHO guidelines about PPE usage, use of N95 or equivalent mask is recommended while performing aerosol-generating procedures on patients suffering from COVID-19. Medical masks have been recommended for general care of COVID-19 patients (11). In this study, highest percentage (44.7%) of respondents wear N95 masks followed by surgical triple layered masks (24%). Whereas in a study done in Uttarakhand, 60% of HCWs were found to be using triple layered mask and only 12% were using N95 mask (9). Overall a low N95 usage might have resulted due to non availability or strict rational use of N95 masks. Use of appropriate type of mask as per the kind of work involved needs to be strictly advised as various studies have found that N95 respirators provide better protection over medical masks and hand-made masks in different situations (12),(13).

Adequate supply, availability of masks and training is essential to optimise compliance. Sudden increase in the costs of masks to 30-100 folds during pandemic situation due to huge supply-demand imbalance resulted in innovations, reprocessing and reusing of masks which may have hindered with their efficacy (14).

A study identified availability of medical masks and respirators as one of the major issues raised by the participants (15). In present study, only 34.2% of the respondents were satisfied with the mask’s availability.

Only 10.8% respondents in present study were changing their masks at recommended frequency of 6-8 hours. A study found outer surface of 10% of the masks worn by HCWs were contaminated with respiratory viruses and virus positivity was significantly higher among those who used the masks for >6 hours (16). Longer than recommended duration put HCWs at risk of decreased protection from infection as well spread of infection due to inadvertently touching the in-use contaminated masks. Therefore, HCWs should be cautious and change their masks frequently. If there is no alternative to prolonged use especially in acute shortage situations, they need to take additional precautions especially the hand hygiene before and after handling or touching the in-use masks.

HCWs are overburdened due to long working hours decreasing efficiency and quality. The masks further seem to worsen the situation (17). In this study also less than 30% HCWs could tolerate face masks for 6 hours or longer. Hence, one need to ensure certain measures to be taken to prevent non compliance. The working hours can be reduced to reduce stress on HCWs.

Only 32.9% respondents store mask for re-use in properly labeled paper bags as advised and only 37% of those receiving N95 masks have been storing it in paper bags before reuse. Rest of the respondents have been resorting to ineffective ways or potentially damaging methods of storing and reusing the masks. Extended use and reuse of N95 respirators have been suggested as measures to meet increased demands during pandemic but the safety and efficacy of such practices remain doubtful. Methods like microwaving, hydrogen peroxide gas plasma, autoclaving, alcohol and soaking in soap and water can significantly deteriorate mask’s filtration capacity and integrity. Treatment with bleach may lead to release of chlorine gas on exposure to moisture. Also, repeated doses of ultraviolet irradiation may compromise strength of mask material and straps (18). Moreover, data from a study also showed to decrease the fit factor of the N95 mask below acceptable limit after five consecutive donning (19).

Wearing masks and respirators may interfere with respiration, vision, communication with coworkers, thermal equilibrium, etc. there appears to be a great variability in tolerance to such interferences and the way people deal with these (17). In present study, the major problem faced by HCWs due to mask was sweating and itching in 52.8% respondents. Similar findings were reported in another Indian study where sweating was found to be the major problem in HCWs (68%) under study and itching in 52% (20). Ours being a tropical country, hot and humid weather in most parts is frequent. Despite resisting touching the face repeatedly, it might not be totally avoidable and then forgetting to perform hand hygiene.

For HCWs who were very alert and careful about mask etiquettes and hand hygiene, they would either not drink water during the whole shift like 27.3% respondents did in present study; or they would take all precautions and remove the mask properly (29%) before having water. Other problems like rashes or mild allergy may be managed by emollients or lotions, using fresh mask in every shift etc (21).

Difficulty in communication was the major problem faced by some due to the mask (8.5%). This might lead to decreased compliance or pulling down the mask while trying to communicate. Majority of respondents felt dizzy at least once while the mask is on which might be due to hot and humid conditions in our country. Other factors may be dehydration, exertion due to heavy workload or reusing of soiled masks. Moreover, improving the design and material used in the manufacturing of mask may also increase tolerability and compliance (22).

As per WHO and CDC guidelines, it is advisable to perform hand hygiene before and after donning, before and after doffing and also in case one touches the mask accidently after donning (6),(7). Only 58% of the respondents knew and were following hand hygiene at all these steps. Therefore, one need to emphasise repeatedly upon the very basic hand hygiene while using the masks so that HCWs don’t put themselves at risk of transmitting the disease and getting infected via contaminated hands or contamination of their masks.

Last but not the least, even if fully equipped with the PPE, HCWs may contaminate themselves by not removing PPE in the proper order taking all precautions. Face mask should be removed in the end after removing the other components of PPE (2). In present study 37% of the respondents were not following all precautions while removing the mask. Thus, regular training should be ensured for the best possible protection of the HCWs. The training on hand hygiene, mask etiquettes should lay emphasis on type of mask for different areas, donning and doffing of surgical masks and respirators since masks have proven to be very effective in curtailment of cases throughout the world where these practices have been followed or enforced by law.

Limitation(s)

Current study had few limitations. First, as this study was based on self-reported data hence this study might have some recall bias. Second, this was a cross-sectional study, it was unable to establish a cause-and-effect relationship; a follow-up study could be more useful. Third, moreover, the population that responded to the questionnaire would be those having an internet access and who might actually be interested in the subject leading to respondent bias.

Conclusion

We are still amidst the pandemic and some countries faced second waves, some have just started experiencing a second/third wave, future waves may be predicted due to mutations of the virus causing current pandemic. It becomes unavoidable to address the issues related to mask and respirators which play the most vital role in prevention of transmission especially among the HCWs. Knowledge about good mask practices, individual and organisational factors which determine the compliance and adherence to recommendations for respirators, all need to be given equal importance to reduce occupational transmission of the disease during this unprecedented situation.

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DOI and Others

DOI: 10.7860/JCDR/2022/55258.16684

Date of Submission: Jan 29, 2022
Date of Peer Review: Apr 05, 2022
Date of Acceptance: Jun 01, 2022
Date of Publishing: Aug 01, 2022

AUTHOR DECLARATION:
• 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

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 01, 2022
• Manual Googling: May 31, 2022
• iThenticate Software: Jun 30, 2022 (9%)

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