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Table of Contents
SHORT COMMUNICATION
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 55-58

An online study to assess the disposal of personal protective equipment at home amid COVID-19 pandemic in India


Department of Community Medicine, Lady Hardinge Medical College, Delhi, India

Date of Submission14-Jan-2021
Date of Acceptance14-May-2021
Date of Web Publication29-Jun-2021

Correspondence Address:
Dr. Archana Thakur
F 705, Maple Heights, Sushant Lok Sec 43, Gurugaon - 122 003, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcfm.ijcfm_2_21

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  Abstract 

Introduction: In the current COVID-19 pandemic, when most of cases are asymptomatic or mild, and being kept on home isolation, personal protective equipment (PPE) used by them is potentially infectious and needs to be treated like biomedical wastes. The objective of the study is to assess the disposal of PPE used by general public in the current COVID-19 pandemic in India.
Materials and Methods: This was a 1-week online cross-sectional descriptive study conducted among residents of India, in the age group of >18 years. The sample was convenient. The study tool was online self-designed, semi-structured, pretested, and self-administered questionnaire.
Results: A total of 559 study subjects were analyzed. Maximum (77.8%) subjects were of age 18–40 years with almost equal proportion of male and female. Overall satisfactory disposal of PPE was done by 9.7% of subjects.
Conclusion: The PPE disposal in the community is not satisfactory despite majority of the study participants claimed to be aware of PPE disposal guidelines.

Keywords: COVID-19 pandemic, disposal of personal protective equipment at home, personal protective equipment


How to cite this article:
Thakur A, Sangle ST, Rao S, Vaz RP, Singh P, Rasania S K. An online study to assess the disposal of personal protective equipment at home amid COVID-19 pandemic in India. Indian J Community Fam Med 2021;7:55-8

How to cite this URL:
Thakur A, Sangle ST, Rao S, Vaz RP, Singh P, Rasania S K. An online study to assess the disposal of personal protective equipment at home amid COVID-19 pandemic in India. Indian J Community Fam Med [serial online] 2021 [cited 2021 Sep 22];7:55-8. Available from: https://www.ijcfm.org/text.asp?2021/7/1/55/319968


  Introduction Top


COVID-19 disease has a wide spectrum from asymptomatic cases, mild-to-moderate cases, to serious and severe acute respiratory illness. With an incubation period of 2–14 days, patients are most infectious during the initial days of infection when symptoms are mildest or not present. These titers have been the highest at the time of patient presentation, and viral levels are just as high in asymptomatic or presymptomatic patients.[1],[2] The disease is transmitted by either direct contact with COVID-19–positive cases or surroundings or objects rendered infectious by them. Further, the duration of stay of virus on different objects is different (4 h to 3 days).[3],[4]

In the absence of any treatment and highly effective preventable vaccine and based on the current COVID-19 epidemiology, infection control measures are the only effective measure we have till now. Infection control measures being focused upon are frequent hand washing and use of personal protective equipment (PPE). Wearing these PPE while in home isolation, home quarantine, and even if we are stepping in public places is rendering these potentially infectious. Hence, these should be considered as infectious waste and should not be disposed of in general waste without any disinfection treatment. These infectious wastes can be a major threat to our sanitation workers and rag pickers, and subsequently, they could be the carriers of infections in the community.

Hence, biomedical waste management is one of the key components of infection control measure that must be strictly implemented in hospitals as well as at home to curb COVID-19 spread. The current COVID-19 pandemic has revealed this issue of home-generated biomedical infectious waste, and so, on March 20, Central Pollution Control Board (CPCB), India, came up with the guidelines for collection and management of home-generated biomedical waste for home-isolated COVID-19–positive patient, which quoted that disposal of infectious waste such as mask or tissue would be done in separate yellow bag and that would be collected by local authorities.[5] Recently, May 11, 2020, Ministry of Health and Family Welfare (MOHFW), GOI, has come up with the guidelines for disposal of waste at home during home quarantine and home isolation.[6],[7]

Hence, the study was conducted to assess the disposal of PPE used by public in the current COVID-19 pandemic in India, with the aim to request authorities for generation of IEC material for management of home-generated biomedical waste.


  Materials and Methods Top


The present study was an online cross-sectional descriptive study carried out over a period of 1 week in the month of May 2020 among residents of India, in the age group of >18 years. Inclusion criteria were residents of India, age group >18 years having, access to internet and having e-mail id or e-mail id of any person in the family, who could comprehend with English and Hindi, and who gave consent for the study. We excluded those who by any means found difficulty in understanding the language of the form and did not have access to internet and/or not have e-mail id of any person in the family.

Study subjects were enrolled by direct recruitment. Phone directory of all supervisors was used, and their contacts were contacted through phone call and consent was taken. E-mail id of the contacted person or any family member was taken. In addition, phone numbers of their phone directory were asked with consent from them for further enrolment of study participants. One member of the family was contacted via e-mail id and included in the study. The sample was convenient, and all subjects enrolled in 1-week study period and qualified inclusion criteria were included.

The study tool was pretested, self-designed, semi-structured, and self-administered online questionnaire. The form was designed in Google Forms, and the link of the questionnaire was sent to one member of the family via given e-mail id. First section of the form was participant information sheet and next is consent. If participant further gave consent for the survey, then he/she could go to the next section of infection control measures and disposal of PPEs at home, current status of the family in terms of living in containment zone area, any COVID-19–positive patient in the family on home isolation, and any family member on home quarantine. In addition, details related to source of their information regarding disposal of used PPE were also collected.

Statistical analysis

Primary outcome variable was satisfactory disposal of PPE at home. Satisfactory disposal of PPE has been categorized as per “Biomedical Waste Guidelines by CPCB” and “Revised guidelines for Home Isolation of Very Mild/Presymptomatic COVID-19 Cases” and “Guidelines for Home Quarantine: by MOHFW 2020.” This has been further individualized for each PPE such as face mask, gloves, head cover, and body gown.

Satisfactory disposal of face mask, head cover, and body gown has been considered if these were disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial whereas for gloves, satisfactory disposal was considered if disposed of in yellow biomedical waste bag.

“Overall satisfactory disposal” includes satisfactory disposal of all the PPEs that were being used by the study participants.

Data were entered in excel and analyzed in SPSS Statistics for Windows, version 16.0 (SPSS Inc., Chicago, Ill., USA). Proportions were calculated for qualitative data. Subgroup analysis was done for healthcare and nonhealthcare personnel. Chi-square test and Fisher's exact test have been applied accordingly. A P < 0.05 was considered statistically significant.

The ethical approval has been taken prior conducting the study from the institutional ethics committee. Study questionnaire was sent online with a brief patient information sheet explaining about the study and associated risk or benefits. Confidentiality and privacy were taken care. Informed consent was taken before starting the study questionnaire on Google Form. Study tool was designed in a way that after submission of their response, a brief knowledge of handling of home-generated biomedical waste as per current knowledge was disseminated via e-mail.


  Results Top


The study was carried out for 1 week and a total of 564 study participants were enrolled. Out of those 564, 5 did not give consent for the study. Finally, 559 study subjects were analyzed.

Out of 559 respondents, maximum (77.8%) were in the age group of 18–40 years. Male (47.9%) and female (52.1%) equally participated in our study. Majority (77.5%) were graduates and postgraduates followed by 12th pass (18.8%). There was a good mix of various profession including healthcare personnel (18.4%). Majority (64.6%) participants were from metro city.

[Table 1] shows proportion of satisfactory disposal of PPE at home among healthcare personnel and nonhealthcare personnel. A total of 556 subjects were analyzed in this as three subjects did not respond for these questions. Face mask was used by almost all the study subjects (556), gloves used by 57.9%, head cover used by 24.6%, and body gown used by 19.9%. Overall satisfactory disposal of PPE was done by 54 (9.7%) study subjects.
Table 1: Disposal of personal protective equipment at home among study subjects

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Satisfactory disposal of PPE was followed by 7.3% of subjects living in containment zone, while none of the subjects with COVID-19–positive patients in the family and 6.1% of subjects with any member on quarantine in the family were practicing satisfactory disposal of PPE.

Majority (70.3%) subjects reported that they were informed about guidelines related to PPE Disposal at home. Main source of information was online (61.9%) and news (55.8%) [Table 2].
Table 2: Information regarding guidelines of personal protective equipment disposal at home and source of information among study subjects

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Out of total 391 subjects who had information regarding guidelines related to PPE disposal used during COVID-19, 11.8% of subjects reported satisfactory disposal of PPE at home.


  Discussion Top


This study was carried out to address the issue related to disposal of PPEs used by public including those on home isolation and home quarantine for COVID-19 disease. In the present study, all (100.0%) study subjects reported use of face mask. Few nonhealthcare workers also reported use of gloves (44.2%), head cover (14.7%), and gown (11.5%), which is not recommended for public.[8] Overall satisfactory disposal of PPE was practiced by only 9.7% of subjects. This pattern of unsatisfactory disposal was also seen among healthcare personnel (19.7%). Most common practice followed among study subjects was directly throwing of these PPE in the public or home dustbin (49.6%) followed by washing with detergent before disposal in public dustbin (26.7%). Few subjects (16.1%) reported that they did not dispose PPE at all. The situation was even worse among subjects with COVID-19–positive patient in family and those on quarantine as none of the family with COVID-19–positive patient disposed PPE as per the guidelines, and only 6.1% of subjects with family member on home quarantine disposed PPE properly.

In the present study, awareness about PPE disposal guidelines during COVID-19 was reported by 70% of subjects, but out of those, only 11.8% of subjects followed PPE disposal guidelines which show a huge gap in knowledge and practice of PPE disposal. Important source of information for the participants was online and news. Arogya-Setu app was reported by only one study participant contrary to the fact that the app has been downloaded by majority Indian population as mandated by the government.

Limitation

The study has been carried out online, and study subjects have been enrolled using phone directory of supervisor of the study which led to enrollment of highly educated subjects, and we could not assess the situation among illiterate and poor people.


  Conclusion Top


Our study concluded that PPE disposal in the community is not satisfactory despite majority of the study participants claimed to be aware about PPE disposal guidelines. Further, there is misuse of PPE such as gloves, head cover, and gowns among study participants. There is a need to generate awareness about mode of coronavirus transmission, rational use of PPE among general public, and proper disposal of PPE at home or community settings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
To KK, Tsang OT, Leung WS, Tam AR, Wu TC, Lung DC, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: An observational cohort study. Lancet Infect Dis 2020;20:565-74.  Back to cited text no. 1
    
2.
Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 Viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382:1177-9.  Back to cited text no. 2
    
3.
World Health Organization. Modes of transmission of virus causing COVID-19: Implications for IPC precaution recommendations. Available from: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid- 19-implications-for-ipc-precaution-recommendations. [Last accessed on 2020 May 01].  Back to cited text no. 3
    
4.
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564-7.  Back to cited text no. 4
    
5.
Central Pollution Control Board. Ministry of Environment, Forest, and Climate Change. Guidelines for Handling, Treatment and Disposal of Wastes Generated during Treatment/Diagnosis and Quarantine of COVID 19 Patient. Delhi: CPCB MOEFoCC; 2020.  Back to cited text no. 5
    
6.
Ministry of Health and Family Welfare, DGHS (EMR) Government of India. Guidelines for Home Quarantine. Available from: https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf. [Last accessed on 2020 May 12].  Back to cited text no. 6
    
7.
Ministry of Health and Family Welfare, DGHS (EMR) Government of India. Revised guidelines for Home Isolation of very mild/pre-symptomatic COVID-19 cases. Available from: https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofverymildpresymptomatic COVID19cases10May2020.pdf. [Last accessed on 2020 May 12].  Back to cited text no. 7
    
8.
World Health Organization. Q and A on Coronavirus. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses. [Last accessed on 2020 May 01].  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2]



 

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