ANALYSIS OF COMPLIANCE WITH THE USE OF PPE DURING THE COVID-19 PANDEMIC AT PUSKESMAS DUMBAYABULAN YEAR 2022
Hamawiyah Netrisya Djakaria
Master of Public Health Study Program, Universitas Muhammadiyah Jakarta K.H. Ahmad Dahlan St., Cireundeu, Ciputat, South Jakarta 15419
Email: wiyadjakaria@yahoo.com
ABSTRAK
Kasus Covid 19 di Indonesia sendiri pemerintah telah mengeluarkan status darurat bencana terhitung mulai tanggal 29 februari 2020 terkait pendemi virus ini. Alat Pelindung Diri (APD) dipakai untuk melindungi diri atau tubuh terhadap bahaya-bahaya kecelakaan kerja serta risiko tertularnya virus tersebut, khususnya terkait bahaya biologi, Walaupun demikian masih ditemukan petugas yang tidak patuh dalam menggunakan APD. Penelitian ini bertujuan untuk menganalisa faktor-faktor yang berhubungan dengan kepatuhan tenaga kesehatan terhadap pemakaian APD saat masa pandemik COVID-19 di Wilayah Kerja Puskesmas Dumbaya Bulan. Penelitian ini menggunakan desain Chi Square.
Populasi 38 orang dan disajikan sampel penelitian. Data dikumpulkan dengan analisis data menggunakan chi square.
Hasil : penelitian menunjukkan variable yaitu pengetahuan (p=0,007) dan informasi dan penelitian (p=0,010) memiliki hubungan yang signifikan dengan kepatuhan tenaga kesehatan dalam menggunakan APD di Puskesmas Dumbayabulan. Sedangkan persepsi tentang resiko (p=1,000), hambatan (p=0,252), beban kerja (p=0,160), iklim keselamatan (p=0,313) dan ketersediaan sarana dan fasilitas (p=0,517), tidak memiliki hubungan yang signifikan dengan kepatuhan tenaga kesehatan dalam penggunaan APD di Puskesmas Dumbayabulan. Perlu meningkatkan kewaspadaan dalam pencegahan dan pengendalian infeksi dalam melakukan perawatan kepada pasien dengan penggunaan APD.
Kata Kunci: Alat Pelindung Diri (APD), Covid 19, Petugas Puskesmas
ABSTRACT
In the Covid-19 case in Indonesia itself, the government has issued a status disaster emergency starting on February 29, 2020, related to this virus pandemic. Personal Protective Equipment (PPE) is used to protect oneself or the body against the dangers of work accidents and the risk of contracting the virus, especially related to biological hazards.
This study aims to analyze the factors related to health workers' compliance with the use of PPE during the COVID- 19 pandemic in the Dumbaya Bulan Health Center Work Area. This study uses a Chi-Square design. The population is 38 people, and the research sample is presented. Data were collected by data analysis using chi-square. Results:
the study showed that the variables, namely knowledge (p=0.007) and information and research (p=0.010), had a significant relationship with health workers' compliance in using PPE in Dumbayabulan Health Center. Meanwhile, perceptions of risk (p=1,000), barriers (p=0,252), workload (p=0,160), safety climate (p=0,313) and availability of facilities and facilities (p=0,517) did not have a significant relationship with compliance. health workers in the use of PPE at Dumbayabulan Health Center. Increasing vigilance in infection prevention and control in treating patients using PPE is necessary.
Keywords: Personal Protective Equipment (PPE), Covid 19, Health Center Office
INTRODUCTION
At the end of December 2019, Chinese public health authorities reported several acute respiratory syndrome cases in Wuhan City, Hubei province, China. This case was confirmed to be a new type of coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2), which causes Coronavirus Disease-2019 (COVID-19) (1).
Corona is a large family of viruses that cause human and animals disease. In humans, it usually causes respiratory tract infections, such as the common cold, to severe conditions, such
Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).
Since December 31, 2019, this case has spread rapidly worldwide. There have been 446,363,008 cases of Covid-19 worldwide, with the death toll reaching 6,019,640 (2).
During the past two years, several countries in the world are still experiencing a surge in positive cases of COVID-19. Among them are the following: Africa with a total of 11,386,065 instances, with the most cities suspecting Covid-19, namely South Africa, Morocco, and Tunisia. Asia with a total of 103,907,675 cases. The city with the most suspected cases of Covid-19 came to India, with as many as 42,967,315, and Indonesia, with 6,018,048 cases. The first case of covid-19 in Indonesia was delivered directly by President Joko Widodo on March 2, 2020. During these two years, the spread of Covid-19 in Indonesia has been quite fast, as evidenced by some regions in Indonesia that are still experiencing a spike in cases to date (3).
Based on data from the Gorontalo province COVID-19 task force, the number of people exposed to COVID-19 in Gorontalo is 13,875 723 people treated. 13,351 people are recovering, and 486 deaths. In Bone Bolango district, 621 people were confirmed, of which 17 people died, and 577 people recovered. (4).
The best way to prevent the transmission of COVID-19 is to avoid direct contact by practicing physical distancing. However, this is not easy for health workers to do. Health workers are most at risk of contracting Covid-19 because they interact directly with infected patients. In Indonesia, at least until March 9, 2022, through the health page. laporcovid19.org, there are 2,066 Health Workers who died due to Covid- 19. This number will continue to grow if efforts to prevent the spread and transmission of COVID-19 cannot be immediately addressed, one of which is the provision of effective and efficient PPE for health workers (5).
Personal Protective Equipment (PPE) is a device designed as a barrier against the penetration of substances, solid particles, liquids, or air to protect the wearer from injury or the spread of infection or disease. Since the outbreak of Covid-19, reportedly transmitted through physical contact, the government has appealed to health workers to be aware of the use of personal protective equipment (PPE) while on duty.
This prevents exposure to the virus in the body or transmission to other people. Personal protective equipment is recommended for use by health workers, such as masks, face shields, gloves, and personal protective equipment (Hazmat) (6). This study aimed to analyze the factors related to health workers' compliance with the use of PPE during the COVID-19 pandemic in the Dumbaya Bulan Health Center Work Area.
METHOD
This study uses a Chi-Square approach. This study analyzes health workers' compliance with the use of PPE during the COVID-19 pandemic in the Dumbaya Bulan Health Center Work Area. The total population in this study was 38 health workers.
RESULTS AND DISCUSSION
Based on table 1 shows that for the age category, the proportion of respondents aged 26-35, as many as 21 respondents (55.3%), the most gender female, as many as 32 respondents (84.2%), and male as many as six respondents (15.8%). It is three years, as many as 20 respondents (50.6%), and the most education is D-III as many as 22 respondents (57.9%).
Table 1. Characteristics of Dumbaya Bulan Public Health Center Employee Respondents in 2022
Characteristics Amount Percentage (%)
Age
a. 17 – 25 10 26.3
b. 26 – 35 21 55.3
c. 36 – 45 5 13.2
d. 56 – 65 2 5.3
Gender
a. Men 6 15.8
b. Woman 32 84.2
Length of Working
a. ˂ 3 years old 18 50.4
b. ˃ 3 years old 20 50.6
Last Education
SD 1 2.6
SMP 1 2.6
SMA 1 2.6
D-III 22 57.9
D-IV 6 15.8
S1 7 18.4
TOTAL 38 100 %
Table 2 shows that many respondents have good knowledge in the obedient compliance category (52.6%) and a good perception of risk in the compliance category (52.6%). The results of the logistics show that The knowledge variable (p = 0.007) was significantly related to the compliance of health workers in the application of standard precautions at Dumbaya Bulan Public Health Center (p <
0.05), which means that H1 was accepted with a value of r = 4.503, indicating a positive correlation direction, while the variable the perception of risk (p = 1,000) was not significantly related to the compliance of health workers in the use of PPE at the Dumbaya Bulan Health Center (p > 0.05), meaning that H1 was rejected.
Table 2. The Relationship Between Knowledge and Perception of Risk with the Compliance of Health Workers in the Application of Vigilance on the Use of PPE at Dumbaya Bulan
Number Individual factor
Obedience ∑ B (r) P Value
Not Obey Obey 1 Knowledge Deficient 11
(28.9%) 1 (2.6%)
12 (31.6%)
4.503 0,007*
Good 6
(15.8%) 20 (52.6%)
26 (84.4%) 2 Perception
of risk
Not Good 0 (0.0%) 1 (2.6%)
1 (2.6%)
-17.619 1,000
Good 17
(44.7%) 20 (52.6%)
37 (97.4%)
Table 3 shows that almost half of the respondents have low barriers to applying standard precautions in the non-compliance category (28.9%), a nearly half of the respondents have a high workload in the non-compliance category (36.8%). The results showed that the variable barriers to the application of standard precautions (p = 0.2522) and workload variables (p = 0.160) were not significantly related to the compliance of health workers in the application of standard precautions at the Dumbaya Bulan Health Center (p > 0.05), which means H1 rejected.
Table 3. The Relationship between Barriers to the Application of Standard Precautions and Workload with the Compliance of Health Workers in the Use of PPE at Dumbaya Bulan Health Center
Number Job factor Obedience
∑ B
(r) P Value Not Obey Obey
1 Barriers to the application of standard precautions
Low 11
(28.9%)
20 (52.6%)
31 (81.6%)
2.160 0,252
High 6
(15.8%)
1 (2.6%)
7 (18.4%)
2 Workload Low 3
(7.9%)
3 (7.9%)
6 (15.8%)
2.305 0.160
High 14
(36.8%)
18 (47.4%)
32 (84.2%)
Table 4 shows that half of the respondents have a good safety climate in the non-compliance category (34.2%), most of the respondents have insufficient information and training in the non- compliant compliance category (23.7%), and almost half of the respondents have complete facilities and facilities in the compliant compliance category (55.2%). The results showed that the information and training variables (p = 0.010) were significantly related to the compliance of health workers in the application of standard precautions at Dumbaya Bulan Health Center (p < 0.05), which means that H1 was accepted with a value of r = 4.444 indicating a positive correlation direction, while the variable The safety climate (p = 0.313) and the variable availability of facilities and facilities (p = 0.517) were not significantly related to the compliance of health workers in the use of PPE in Dumbaya Bulan Public Health Center (p > 0.05), meaning that H1 was rejected.
Table 4. Safety climate, Information, and Training, as well as the Availability of Facilities and Facilities with the Compliance of Health Workers in the Use of PPE at Dumbayabulan Health Center
Number Organizational factor
Obedience
∑ B (r) P Value
Not Obey Obey
1 Safety climate Not good 4
(10.5%)
3 (7.9%)
7 (18.4%)
1.716 0,313
Good 13
(34.2%)
18 (47.4%)
31 (81.6%) 2 Information
and training
Deficient 9
(23.7%)
1 (2.6%)
10 (26.3%)
4.444 0.160
Good 8
(21.0%)
20 (52.6%)
28 (73.7%) 3 Availability of
facilities and facility
Incomplete 0
(0.0%)
0
(0.0%) 0.211 0.517
complete 17
(44.7%)
21 (55.2%)
38 (100%)
This study's results align with research by Gultom et al. (2016) regarding the application of universal precautions. It is known that there is a significant relationship between knowledge and the application of universal precautions by nurses in internal medicine inpatient rooms (p = 0.000). The results of this study are also to the opinion of DeJoy et al. (1986) in Pradnyana (2020), a model of determinants of compliance behavior for the application of self-protection in the workplace, which states that knowledge is one of the factors related to one's health behavior. There is a positive relationship between knowledge and standard precautions. The results showed that based on the results of the analysis, the relationship between knowledge and compliance in the use of PPE has a positive correlation value, so it can be said that the better the respondent's understanding of standard precautions, the more obedient the respondent will be in the use of PPE (7).
The findings of knowledge researchers have a significant relationship with compliance in the application of standard precautions because respondents have good knowledge of standard precautions.
Almost half of the respondents, with good knowledge, comply with the application of standard precautions. A good understanding of the respondents is also supported by their high level of education, where from this research, it is known that most of the respondents are DIII, DIV, and S1 graduates. The questionnaire answers can also show good knowledge of respondents, where most of the respondents answered the questions about standard precautions correctly. This is to research by Eljedi and Dalo (2014), which states that health workers with good knowledge of standard precautions are mostly obedient in using PPE (8).
Based on the analysis, the results showed no significant relationship between risk perceptions and health workers' compliance with PPE. Most respondents have a good perception of risk. Most respondents have a good perception of the indicators of the possibility of being exposed to infection in the workplace. This result is the same as the research conducted by Herry (2020), which states that there is no relationship between perceptions of risk and compliance in the use of PPE (9).
The results showed that of the majority of respondents with good risk perception, almost half of the respondents did not comply with the use of PPE. This indicates that a good perception of risk does not always cause someone to adhere to using PPE and vice versa. The researchers found that the perception of risk did not have a significant relationship with compliance in the use of PPE because not all respondents with a good risk perception were obedient in the use of PPE; only almost half of the respondents with a good perception of risk adhered to the use of PPE. According to the researcher, the perception of risk is also influenced by the respondent's level of knowledge on the use of PPE. If the respondent's level of knowledge is good, a good perception of risk will be formed, shaping one's compliance behavior. However, based on the results of the study, somebody found that from the number of respondents (84.4%) who had good knowledge about the use of PPE, only some respondents (52.6%) had a good perception of risk, meaning that respondents knew that the use of PPE needed to be applied in services. To patients but respondents only consider the use of PPE to prevent the possibility of
infection as not something that should always be done. This may be due to the respondent's knowledge level, which is limited to knowing but has not yet reached the level of understanding.
Based on the analysis, the results showed no significant relationship between barriers to using PPE and health workers' compliance with the use of PPE. Most respondents have low barriers to the use of PPE. Most respondents have low barriers to the use of PPE on the indicator of the need to serve patients, most respondents have low barriers to the use of PPE on the indicator of lack of time, and many respondents have high barriers to the use of PPE on the indicator of discomfort using personal protective equipment. This is in line with the research conducted by Pradnyana and Muliawan (2020), which said there was no statistically significant relationship between barriers to using PPE and compliance behavior. The results of this study are also in line with the research of Sagita et al. (2019), which states that there is no significant relationship between barriers to using PPE (10).
According to the researcher, this may be related to the respondent's length of service, where almost half of the respondents have worked for three years. Respondents with short working hours will have little work experience, so they are not good at addressing obstacles in the use of PPE, such as knowing the need to serve patients, lack of time, and discomfort using personal protective equipment, where these obstacles will be a barrier for respondents to comply with the use of PPE or vice versa.
The results of the research findings, barriers to the application of standard precautions do not have a significant relationship with the compliance of health workers in the application of standard precautions because not all respondents with low barriers to the use of PPE are obedient in the application of standard precautions or vice versa. According to the researcher, this can occur because of a conflict of interest between the need to serve patients and protect themselves through standard precautions. As a result, in certain situations (emergencies), respondents often ignore the application of standard precautions, such as personal protective equipment.
Based on the analysis, the results showed no significant relationship between workload and health workers' compliance with the use of PPE. Almost all respondents have a high workload. Nearly all respondents have an increased workload on the indicators of demands for work that must be completed. This result is the same as the research conducted by Herry (2020), which states that there is no relationship between workload and nurse compliance in using PPE. The results of this study are also in line with Nurkhasanah's (2014) research regarding nurse compliance in the application of universal precautions that there is no significant relationship between workload and the use of PPE (11).
The results showed that of almost all respondents with a high workload, nearly half did not comply with the application of standard precautions, while from a small proportion of respondents with a low workload, only half complied with the use of PPE. From the analysis of the statements in the questionnaire used to measure the workload, it was found that most of the respondents agreed that their work requires respondents to work hard. Almost half of the respondents answered decided that their job requires respondents to work hard. Nearly half of the respondents agreed that they should work hard.
They complete a lot of work quickly, so it can be concluded that the respondents have a high workload.
According to the research findings, the workload does not have a significant relationship with compliance in using PPE because a high workload does not always cause respondents to be disobedient in using PPE or vice versa. According to the researcher, this is due to the different conditions of the patients in each room of the health worker, which causes the workload between each respondent to be different. Respondents in outpatient wards with critical patient conditions must work hard and fast with a high workload, which can sometimes neglect the application of standard precautions. This is the opinion of Pradnyana and Muliawan (2020), who states that the characteristics of the nurse work unit and the types of patients being treated are different, so it can affect the variation of the nurse's workload at any time (12).
Based on the analysis, it was found that there was no significant relationship between the safety climate and the compliance of health workers in the use of PPE. Almost all respondents have a good safety climate. Nearly all respondents have a good safety climate on indicators of commitment to protecting health workers, support from superiors and colleagues, and supervision in the workplace.
This result is the same as the research conducted by Yuliana (2012), which states that there is no significant relationship between the safety climate and the compliance of health workers in the use of PPE, where most of the respondents studied have a terrible safety climate.
The results showed that of almost all respondents with a good safety climate, nearly half did not comply with the use of PPE, while from a small number of respondents with a lousy safety climate, half were not compliant with the use of PPE. CDC (2016), in its Guideline for Isolation Precautions:
Preventing Transmission of Infection Agents in Health Settings, explains that the safety climate is how workers and management perceive safety expectations in a hospital environment. The results showed that all indicators were in a suitable category based on the safety climate indicators studied. Most of the respondents agreed with the components of the statements submitted, with the highest percentage on support indicators from superiors and colleagues (13).
The results of the research findings, the safety climate does not have a significant relationship with compliance in the use of PPE because a good safety climate does not always cause respondents to comply with the use of PPE or vice versa. One of the factors that affect the safety climate and also involves the use of PPE is safety policies and procedures. Safety policies and procedures in the form of the availability of standard operating procedures (SOP) and personal protective equipment can affect health workers' compliance with PPE. The results of observations at the research site showed that standard operating procedures (SOPs) were available in every room, including SOPs for washing hands and SOPs for using personal protective equipment.
Based on the analysis, the results showed a significant relationship between information and training and health workers' compliance with using PPE. Many respondents have good knowledge and training. This result is the same as the research conducted by Yuliana (2012), which states that there is
a significant relationship between information and training with the compliance of health workers in the use of PPE, where most of the respondents studied have good knowledge and training (14).
The results of this study are from research conducted by Pradnyana and Muliawan (2020), which states that there is a significant relationship between information and training with the compliance of health workers in the use of PPE, where respondents who receive comprehensive knowledge and training will be 1.7 times more obedient. Compared to respondents who received less complete information and training. The results of this study are also in line with the results of research by Sugiyatno et al. (2014), which is believed to have a significant relationship between training and nurse compliance in the use of PPE (15).
The results showed that of almost all respondents with insufficient information and training, most were not compliant in the use of PPE, while of the majority of respondents with good knowledge and training, most were obedient in using PPE. Based on the results of the analysis, the relationship between information and training with compliance in the use of PPE has a positive correlation value, so it can be said that the better the information and training on standard precautions received by the respondents, the more obedient the respondents in the use of PPE or vice versa.
Research findings, information, and training have a significant relationship with compliance in using PPE. The better knowledge and training received will affect the level of compliance in using PPE.
The better the information received, the more respondents will comply with the use of PPE.
Based on the analysis, the results showed no significant relationship between the availability of facilities and health workers' compliance with standard precautions. All respondents have the availability of complete facilities and facilities. All respondents have the availability of comprehensive facilities and facilities on the hand hygiene indicator (100%) and on the arrow of protection from the Covid-19 virus. This result differs from the research conducted by Yuliana (2012), which states a significant relationship between the availability of facilities and facilities and health workers' compliance with using PPE. However, most of the respondents studied have the availability of complete facilities and facilities (16).
With research conducted by Herry (2020), this study's result states that there is no relationship between the availability of facilities and facilities and health workers' compliance with using PPE.
In the context of compliance in the application of standard precautions, the availability of facilities and facilities, namely the existence of facilities and facilities that support the use of PPE. The results showed that of all respondents who had complete facilities and facilities, more than half of the respondents were obedient in the use of PPE, while a small proportion did not comply with the use of PPE. This study's results differ from Pradnyana and Muliawan's (2020) research, which states that respondents whose work units have complete facilities and facilities will be 5.31 times more obedient using PPE compared to respondents whose work units do not have complete facilities and facilities (17).
The results showed that based on the observed facilities and availability indicators, all indicators
were in a complete category: hand hygiene, personal protective equipment, and protection from the Covid-19 virus. This shows that the availability of facilities and facilities is total to support the use of PPE.
The results of the researcher's findings, the availability of facilities and facilities did not have a significant relationship with compliance in the use of PPE because there were still respondents in the room who provided complete facilities and facilities but did not comply with the use of PPE. According to the researcher, this is due to a lack of information and training to support the use of existing facilities in the previous discussion, and some respondents did not receive good information and training. Good knowledge and training can cause respondents to use facilities and facilities related to standard precautions so that respondents will automatically comply with the use of PPE
CONCLUSIONS AND SUGGESTIONS
Based on the results and discussion of this study, the following conclusions can be drawn:
1. There is a significant relationship between individual factors of knowledge and compliance in the use of PPE, and there is no significant relationship between personal factors of perception about risk and compliance with the use of PPE
2. There is no significant relationship between the factors of work barriers to the use of PPE and workload with the compliance of health workers in the use of PPE
3. There is a significant relationship between organizational factors of information and training with compliance in the use of PPE, and there is no significant relationship between organizational factors of health climate and the availability of facilities and facilities with compliance with the use of PPE.
ACKNOWLEDGMET
The author would like to thank the supervisor, Dumbayabulan Health Center, and research respondents willing to participate without coercion from any party.
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