This was a cross-sectional descriptive study, done in the first week of April 2020 by the Department of Respiratory Medicine, Jaipur National University Institute for Medical Sciences and Research Centre, Jaipur, India.

Inclusion criteria: Study participants were doctors (senior residents, junior residents, assistant professors, associate professors and professors) and staff nurses from all the departments of the medical college hospital, who gave consent to be a part of the study.

Exclusion criteria: Doctors and nurses who did not give consent and those who did not respond even after two visits were excluded from the study.

The sample size was calculated using a confidence level of 95%, margin of error 5%, response distribution of 50% and population size of 280. The sample size derived was 163. Questionnaire was distributed among 180 HCWs. The study received response from 164 participants making a response rate of 91.11% and strict protocol was followed to maintain the confidentiality of their response. The study was approved by the Institutional Ethics and Scientific Committee. (JNUIMSRC/IEC/2020/180, Jaipur).

Paper questionnaire were personally distributed to the participants who were approached on the basis of convenience and feasibility while on duty. They were encouraged to fill in the questionnaire honestly. The sheets were collected back in the same working shift, once it was completed. The questionnaire was standardised and well-constructed to assess the required objectives. The questions were framed as per guidance of the KAP survey methodology [5]. Previous articles on swine flu and Middle East respiratory syndrome (MERS) were reviewed [6,7]. Also, data from frequently asked questions about COVID-19 from WHO, and review article on COVID-19 were included to design the questions [2,8,9]. The proforma was prepared initially in English and then translated into Hindi, which is a local language. The questionnaire was pre-tested and tested. Questionnaire consisted of close ended questions. The questionnaire was divided into four parts. First part included demographic details of the participants, such as age, sex, qualification or job description, among other parameters. The second part included questions to assess the knowledge regarding the aetiology, epidemiology, pathogenesis, and clinical features of the disease. The third part dealt with infection control measures and prevention, which have to be followed in clinical practice or at the workplace. The fourth part contained questions for evaluation of attitudes of the individual towards the disease and its effects. Each question was scored as per the correctness of the response.

All data was entered in MS Excel spreadsheet. Analysis was done by using Epi info 7.2.1.0 version. Categorical variable was expressed as frequency and percentage. Statistical analysis like Chi-square test was used to analyse variables as appropriate. A p-value of <0.05 was taken to be statistically significant.

A total of 164 responses from the study subjects were collected and analysed. [Table/Fig-1] shows the demographic details of the respondents. Doctors comprised 43.9% of the total subjects while remaining 56.1% were nurses. A 78.3% of the nurses were in the age group of 20-29 years. Male to female ratio in the study subjects was 2:1. Approximately, 58% informed that they had received training about infection control. Most of the subjects had received information from multiple sources. [Table/Fig-2] describe the knowledge of the study subjects. Most of the HCWs were aware of the mode of spread of infection and common preventive measures. 90% of doctors felt that touching an infected person does not spread infection. Most of the participants recognised ARDS, death and pneumonia as possible complications of COVID-19 (90%). Almost all believed that washing hands and wearing a mask are important preventive measures. Incubation period was known to 95% of respondents. Only 48.9% of nurses thought that mild form of disease is most common [Table/Fig-2]. The present study assess the attitude of HCWs towards the disease and its preventive measures [Table/Fig-3,4, 5]. Most of them felt that the disease is dangerous but only 31% were scared to do hospital work. More nurses believed that government institutions would be able to control the pandemic. [Table/Fig-5] mentions the existing practice among HCWs. Nurses were better in doing hand hygiene before wearing a face mask. Around 60% of HCWs assumed that they knew the steps for wearing and removing PPE, but only 8.9 % and 5.8% could remember the exact sequence of donning and doffing, respectively [Table/Fig-4].

COVID-19 is a global pandemic and all the countries are fighting with this disease. Health care professionals like doctors and nurses are the most important front-line workers. It is important to know the knowledge and attitude of HCWs and also assess their practice. Hence, author’s evaluated these important aspects by standardised questionnaire in this study.

Since COVID-19 is caused by a novel virus and the disease is new, most of the information about COVID-19 comes from alternative sources rather than medical textbooks. In this study, common sources of information were internet, social media and television, followed by newspaper, government sources and radio. It is easier to access information from the internet but there is a concern regarding the authenticity of the material available. There is a risk that HCWs will be exposed to malicious or false data which can result in wrong behaviour or practice. Hence, it is important for the health authorities to disseminate reliable information via these medium. This will play an important role in controlling infection.

In this study, only 58% admitted that they had received formal training. Hence, there is huge potential at the institutional level to conduct more training sessions among HCWs. This will prepare them to perform their duties more efficiently in this difficult time.

Despite less training, this study observed that study subjects had good knowledge regarding the mode of spread, symptoms, disease complications, incubation period, high-risk populations and treatment options. This finding is in contrast to the observation made by Bhagavathula AS et al., which was done in the first week of March 2020. Only 50% of HCWs were aware of the incubation period as compared to 95% in this study [10]. In another study by Huynh G et al., from Vietnam, only 60-70% of the HCWs were aware of the incubation period, treatment options and route of transmission [11]. The higher awareness in the present study might be due to better information availability in the last two months. As the number of cases is increasing in India, HCWs are getting more knowledgeable. There was no significant difference between the knowledge of doctors and nurses except few aspects. For example, 19% of doctors assumed that they would not contract infection after touching an infected person, whereas this assumption was only 5% among nurses. This false presumption among some doctors could increase their risk of contracting disease from patients.

In this study, both nurses and doctors were aware of preventive measures, such as hand washing, wearing face masks and avoiding touching the eyes, nose, and mouth. This is similar to observations made by Khan MU et al., during the MERS-CoV epidemic [8]. It was also noted that doctors are better aware that the mild form of COVID-19 is the most common presentation and that the disease is more severe in case of elderly people more than 65 years of age.

Another important finding in the present study was that majority of HCWs had positive attitude towards the disease. They all admitted that they had seen increasing compliance with preventive measures in their practice. Many are worried about spreading the disease to their family members because of their hospital exposure. These findings are similar to the observation made by Huynh G et al., [11]. The high score on attitude in this study was possibly due to better knowledge among HCWs. It was also noted that doctors are less interested in newer information about the disease compared to nurses. This may be due to mental saturation from too much information received from various sources.

In this study, the authors also looked into the practices adopted by the study subjects while at work. Both nurses and doctors, practiced high levels of hand hygiene, cough hygiene and wearing face masks. This was reported to be 75% in a study done by Modi PD et al. In the same study, they looked into the use of PPE by HCWs and they found that three-fourth of respondents knew about correct use of PPE and use of N95 mask, indicating that the correct sequence of donning and doffing of PPE is equally important [12]. The practice of this aspect was lacking in the present study. Very few HCWs were aware of correct sequence of wearing and removing coverall PPE as recommended by WHO. This could be due to minimal exposure to handling suspected COVID-19 patients in a private teaching hospital as usually all patients are being referred to government run medical college hospitals.

This was a single center study and does not correctly depict KAP of doctors and nurses working in various teaching, non-teaching, public and private healthcare centers of the whole country.

The study highlights the level of existing KAP among health care professionals with regard to COVID-19. Health authorities should utilise social media and internet to disseminate best available information and facts about COVID-19. There is an urgent need to focus on training for the correct use of PPE which can safeguard health care professionals from contracting COVID-19.