Effectiveness of Personal Protective Equipment against Coronavirus Disease 2019 Transmission: A Case-Control Study.

Abstract

Several health care workers (HCWs) succumbed to infection during the recent coronavirus disease 2019 (COVID-19) pandemic. In some cases, HCWs were even blamed for ignorance of standard operating procedures while using personal protective equipment (PPE). This case-control study evaluated the effectiveness of PPE in prevention of transmission by comparing attitudes toward use of PPE. In a retrospective 1:1 case-control design, HCWs who contracted COVID-19 infection were identified as cases and telephonically contacted. Those HCWs who were working in the same patient care area but were not COVID-19 positive before nor at that point in time when the paired case had tested positive were included as controls. Responses around the use of PPE were collected on an indigenously developed questionnaire on a Likert scale using a mix of questions. Those infected with COVID-19 (cases) were younger, felt that single gloves were sufficient, believed that full PPE was not as effective in preventing infection, and did not prefer using a face shield when in comparison with the controls who believed otherwise. The cases reported greater discomfort while using PPE and were more likely to remove protective equipment because of discomfort. The controls were more likely to be vaccinated and be following the WHO protocol for hand hygiene, although these differences were not statistically significant. The differences in attitudes and practices between cases and controls revealed characteristics that could be associated with transmission. Vaccination, improved hand-hygiene practices, and an emphasis on eye protection with face shields might ensure a healthier frontline workforce.