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Year : 2022  |  Volume : 20  |  Issue : 1  |  Page : 59-62

Assessment of knowledge, attitude, and practice regarding safety laboratory measures during COVID-19 pandemic – A cross-sectional study among oral pathologists in Kerala

Department of Oral Pathology and Microbiology, Government Dental College, Kozhikode, Kerala, India

Date of Submission29-Mar-2021
Date of Decision02-Nov-2021
Date of Acceptance27-Dec-2021
Date of Web Publication25-Feb-2022

Correspondence Address:
Plakkil Viswanathan Deepthi
Department of Oral Pathology and Microbiology, Government Dental College, Kozhikode, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_50_21

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Keywords: Knowledge, laboratory infection, SARS-CoV-2, surveys and questionnaires

How to cite this article:
Deepthi PV, Shameena P M, Varma S, Navajeevraj M N. Assessment of knowledge, attitude, and practice regarding safety laboratory measures during COVID-19 pandemic – A cross-sectional study among oral pathologists in Kerala. J Indian Assoc Public Health Dent 2022;20:59-62

How to cite this URL:
Deepthi PV, Shameena P M, Varma S, Navajeevraj M N. Assessment of knowledge, attitude, and practice regarding safety laboratory measures during COVID-19 pandemic – A cross-sectional study among oral pathologists in Kerala. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2024 Mar 3];20:59-62. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2022/20/1/59/338521

  Introduction Top

Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, the seventh member of the family of coronaviruses that infect humans. It belongs to the genus Betacoronavirus, under the subgenus Sarbecovirus of Coronaviridae family.[1] The transmission of COVID-19 can occur either by direct contact through respiratory droplets or by indirect contact with surfaces in immediate environment or with objects used on the infected person.[2]

Health-care workers are always at the risk of infection since they are in contact with patients. Oral pathologists, who have to handle oral biopsy specimens, cytologic smears, and samples for hematology and microbiology, are also susceptible to infections. A safe working environment can be achieved in the laboratory by adhering to biosafety regulations published by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).[3],[4] The WHO recommends that all specimens collected for laboratory investigations should be regarded as potentially infectious.[4] Extensive measures are required to prevent the cross-infection of COVID-19.

Kerala is a small state in India, which was initially praised by many international agencies as “Kerala Model” for the strategies adopted by the government to curb the spread of this disease.[5] However, during the course of this survey, the state became the one with the most daily reported cases of COVID-19 in India, with a greater number of health-care workers being affected.[6] Thus, this study aimed to assess the knowledge, attitude, and practice (KAP) of safe laboratory measures by oral pathologists working in histopathologic laboratories in different regions of Kerala.

  Materials and Methods Top

The study was cross-sectional, online questionnaire based. It was conducted over a period of 1 month from October 15, 2020, to November 15, 2020, after obtaining ethical clearance (IEC no. 181/2020/DCC dated October 05, 2020). The study group consisted of practicing oral pathologists and those who are pursuing postgraduation in Oral Pathology. The sample size was calculated using the formula Z = 4pq/L2 and it was 161 when a standard error of 5% was assumed. As the study was conducted on an online platform, only 139 individuals responded to the questionnaire.

A questionnaire tool was provided using Google Forms. The questionnaire consisted of two parts. The first part was concerned with obtaining demographic variables including gender, work experience, and job category (faculty and postgraduate students). The second part consisted of 30 questions to analyze the KAP related to the basic information about the disease and the laboratory precautions to be taken during the pandemic. The questionnaire was pretested in the same setting with 15% of the samples.

The knowledge was assessed using 11 questions. The response was scored by giving the value “1” to the correct answer and “0” to the wrong answer. The total score of 6–11 was considered good knowledge. The attitude was evaluated from 7 questions. A score of >4 was considered good attitude. There were 12 questions to assess the practice of safety laboratory measures. A score of 7–12 was considered good practice.

Descriptive statistical analysis was done using the software IBM SPSS Version 25.0. (Armonk, NY, USA: IBM Corp.). Chi-squared test and independent sample t-test were applied to compare the differences in KAP by demographic characteristics. Pearson's rank correlation test was used to assess the correlation between KAP (P < 0.05).

  Results Top

Of the 139 respondents, 59.7% (n = 83) were faculties and 40.3% (n = 56) were postgraduate students. 38.8% of the participants were males and 61.2% females. 28.8% had more than 10 years of experience, whereas 71.2% had <10 years. The survey revealed that 95% of the participants had sufficient knowledge (7.259 ± 1.282) regarding COVID-19. Among the working category, 94% of faculties had good knowledge whereas it was 96.4% for postgraduate students. We could not find any relationship with the knowledge and the work experience, as both the groups studied (<10 years and >10 years) had almost equal knowledge score. 96.3% of the males and 94.1% of the females had good knowledge. All the study participants had positive attitude (6.856 ± 0.427) toward safety measures during the pandemic. Overall, 70.5% of the participants followed good practice of safety laboratory measures (7.914 ± 2.330). Postgraduate students had slightly more good practice (71.4%) than faculties (69.9%). Furthermore, individuals with <10 years of experience had good practice (72.7%) compared to those with >10 years (65.0%). Males had good practice than females. [Table 1] represents the differences in KAP of oral pathologists by demographic characteristics.
Table 1: Differences in knowledge, attitude, and practice by demographics

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Pearson's correlation test revealed a significant positive linear correlation between attitude and practice (r = 0.184, P = 0.030) [Figure 1]. There was also a positive correlation between knowledge and attitude (r = 0.108, P = 0.204) and between knowledge and practice (r = 0.037, P = 0.668).
Figure 1: Linear correlation between attitude and practice (r = 0.184, P = 0.030)

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  Discussion Top

SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) receptor in different tissues of the human body. High ACE2 expression was found in the mucosa of the tongue and floor of the mouth and in granular and ductal cells of salivary glands. Oral biopsy specimens could act as reservoirs of the virus as reported by Xu et al.[7]

KAP studies on health-care workers conducted in other study settings had shown sufficient knowledge and positive attitude regarding COVID-19.[8],[9] A study conducted by Nishat et al. found that the knowledge of oral pathologists was significantly more than the postgraduate students in the same specialty.[10] However, they did not assess the attitude and the practice of the study groups. Our survey revealed that oral pathologists including postgraduate students have adequate knowledge regarding safety laboratory measures during COVID-19 pandemic.

Although the present study reveals adequate knowledge and attitude of oral pathologists, there are some fields which need to be focused. Only 27% of the participants were aware of the time required for handwashing. According to the WHO, hands should be washed for 40–60 s when it is visibly soiled.[11] Cytopreparatory steps performed by either technicians or pathologists need special care as these may lead to aerosol formation. These include expelling aspirates from the needle, smearing and drying of smears, vigorous shaking, pipetting, diluting or centrifugation of fluids, and discarding the supernatant.[12] In the present study, only 21.6% of the participants had sufficient knowledge about the generation of aerosol during the above procedures. This indicates that the participants did not have sufficient knowledge about the potential risk involved in aerosol-generating laboratory procedures.

According to Duan et al., coronavirus becomes noninfectious after exposure to a temperature at 67°C for 60 min.[13] During the processing of tissue, the temperature required is 60°C–65°C for 2 h. Furthermore, fixation in formalin inactivates SARS-CoV.[14] Only 41% of the respondents were able to give an appropriate response to this query.

CDC guidelines insist on wearing appropriate personal protective equipment when handling potentially infectious specimens.[3] In the present study, 70% of the participants followed correct practices. Training programs have to be conducted in institutions to create awareness among oral pathologists regarding safety laboratory practices. El-Gilany et al. have reported that the KAP of laboratory technicians toward the laboratory safety and waste management increased after implementation of training programs.[15] Only 53% of the individuals received proper training on infection prevention measures. The use of appropriate personal protective equipment such as wearing gloves, masks, and eye protection helps to avoid person-to-person contamination in the laboratory. The survey revealed that 53% of the participants share microscope with colleagues. Only 56% of the surveyed individuals wear gloves while using microscopes. Moreover, a minority proportion keep their cell phones in ziplock bag while working in the laboratory.

The transmission of coronavirus can occur through surface contamination. Environmental surface in health-care settings must be properly disinfected to prevent transmission.[16] Chin et al. have reported that the coronavirus survived up to 1 day on cloth and wood, 2 days on glass, 4 days on plastic and stainless steel, and up to 7 days on the surface of a medical mask.[17] Cleaning is the first step in any disinfection process which removes debris and other organic matter on the surface but does not kill the microorganisms. Cleaning must be followed by the application of a chemical disinfectant to kill the microorganisms. Moreover, the use of disinfectant solution should be according to the manufacturer's recommendation for volume and contact time.[16] Eighty-six percent of the participants in the survey disinfect the work surface daily.

According to reasoned action theory, a person's intention to undertake a specific behavior is a function of their attitude toward that behavior.[18] Good knowledge might lead to a positive attitude. This study has identified a positive linear correlation between KAP. Although there are pitfalls in practice, we found a significant linear correlation between attitude and practice.

Our survey has found gaps in knowledge and practice that should be emphasized in future training programs. There are some limitations for this study, including the small study population and the use of online platform for survey. Responses could be dependent on scrupulousness of the participants. The measurement of KAP may be imprecise as the study population encompasses only a small state in the Indian subcontinent. Further studies are needed to resolve these issues.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.  Back to cited text no. 1
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 2022 Jan 25].  Back to cited text no. 2
Centers for Disease Control and Prevention (CDC). Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19). Available from: https://www.cdc.gov/coronavirus/2019-nCoV/lab/lab-biosafety-guidelines.html. [Last accessed on 2022 Jan 25].  Back to cited text no. 3
World Health Organization, 2021. Laboratory biosafety guidance related to coronavirus disease (COVID-19): Interim guidance. Geneva, Switzerland: WHO. Available from: https://www.who.int/publications/i/item/WHO-WPE-GIH-2021.1 [Last accessed on 2022 Jan 21].  Back to cited text no. 4
Heera R, Rajeev R. Curbing COVID-19: Kerala model. J Oral Maxillofac Pathol 2020;24:222-6.  Back to cited text no. 5
  [Full text]  
Coronavirus | 250 Healthcare Workers among 7,283 Positive Cases in Kerala. Available from: https://www.thehindu.com/news/national/250-healthcare-workers-among-7283-positive-cases-in-kerala/article32877543.ece. [Last accessed on 2021 Mar 07].  Back to cited text no. 6
Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 2020;12:8.  Back to cited text no. 7
Zhang M, Zhou M, Tang F, Wang Y, Nie H, Zhang L, et al. Knowledge, attitude, and practice regarding COVID19 among health care workers in Henan, China. J Hosp Infect 2020;105:183-7.  Back to cited text no. 8
Saqlain M, Munir MM, Rehman SU, Gulzar A, Naz S, Ahmed Z, et al. Knowledge, attitude, practice and perceived barriers among health care workers regarding COVID-19: A cross-sectional survey from Pakistan. J Hosp Infect 2020;105:419-23.  Back to cited text no. 9
Nishat R, Babu NA, Srinivas Murthy ST, Deepak V, Mukherjee S, Behura SS. Assessment of knowledge of oral pathologists and postgraduate students on safe laboratory practices during the COVID-19 pandemic. J Oral Maxillofac Pathol 2020;24:437-45.  Back to cited text no. 10
  [Full text]  
Hand Hygiene: Why, How & When? Available from: https://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf. [Last accessed on 2022 Jan 25].  Back to cited text no. 11
Pambuccian SE. The COVID-19 pandemic: Implications for the cytology laboratory. J Am Soc Cytopathol 2020;9:202-11.  Back to cited text no. 12
Duan SM, Zhao XS, Wen RF, Huang JJ, Pi GH, Zhang SX, et al. Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation. Biomed Environ Sci 2003;16:246-55.  Back to cited text no. 13
Henwood AF. Coronavirus disinfection in histopathology. J Histotechnol 2020;43:102-4.  Back to cited text no. 14
El-Gilany AH, El-Shaer S, Khashaba E, El-Dakroory SA, Omar N. Knowledge, attitude, and practice (KAP) of 'teaching laboratory' technicians towards laboratory safety and waste management: A pilot interventional study. J Hosp Infect 2017;96:192-4.  Back to cited text no. 15
World Health Organization, 2020. Cleaning and Disinfection of Environmental Surfaces in the Context of COVID-19: Interim Guidance. Geneva, Switzerland: WHO. Available from: https://apps.who.int/iris/handle/10665/332096. [Last accessed on 2022 Jan 21].  Back to cited text no. 16
Chin AW, Chu JT, Perera MR, Hui KP, Yen HL, Chan MC, et al. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe 2020;1:e10.  Back to cited text no. 17
Fisher WA, Fisher JD, Rye BJ. Understanding and promoting AIDS-preventive behavior: Insights from the theory of reasoned action. Health Psychol 1995;14:255-64.  Back to cited text no. 18


  [Figure 1]

  [Table 1]


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