Compliance and associated factors of personal protective equipment among sanitary workers in selected public hospitals, Eastern Ethiopia: A cross-sectional study design.

Background: Adherence to the proper use of protective personal equipment (PPE) in health care facilities including public hospitals is challenging among sanitation workers(SWs) across the world in general and in developing countries in particular. Despite the emphasis inline up on various policies and guidelines for PPE use implementation, inconsistent use of PPE, disobedience to PPE regulations, negligence, ignorance, discomfort, and lacking infection prevention and control (IPC) practice have been identified as main associated factors. All these and other factors contributing for the non-compliance of PPE practice among SWs within the hospitals in nations with limited resources such as Ethiopia, as well as study regions. Thus, such non-adherence or improper application of PPE is a major concern, and ultimately the consequences of unworthy PPE use has had an influence on the health and safety of sanitary workers.

Objective: The aim of this study was to assess compliance and associated factors of personal protective equipment among sanitary workers in selected public hospitals, eastern Ethiopia.

Methods: A cross-sectional research design used with mixed of quantitative and qualitative data. Surveys were conducted on 809 hospital sanitary workers from May-to-August, 2023. Face-to-face interview was conducted for the quantitative data. Sixteen Key Informant interviews were participated. Field observation also conducted. Epi Data version 3.1 was used for data import, while Stata version 17 MP was used for analysis. Multilevel binary and multivariable regression were for the crude odds ratio and adjusted odds ratio. Variables were analyzed at four levels: Model-0, Model-1, Model-2, and Model-3 for outcome, individual level, hospital level, and individual and hospital levels, respectively. Of these, only model 3 was reported for the interpretation. The cut-point of p-value for crude odds ratio and adjusted odds ratio at model 3 were 0.20 and 0.05, respectively, with a 95% confidence interval reported.

Result: Out of 809 sanitary workers, 729 (90.11%) of them were responded. The prevalence of compliance and noncompliance with protective personal equipment practice among sanitary workers were 46.78(95% CI: 43.11%-50.47%) and 53.22% (95% CI: 50.19%-57.11%), respectively. Multivariable multilevel analysis of model 3 shows that the overall variation for compliance of protective personal equipment practice between sanitary workers from hospitals to hospitals was 26.66%. The model also found that those had daily supervision (AOR = 13.71, 3.18-59.11), good infection prevention and control practice (AOR = 11.34, 1.97-65.24), and perceived less severity of protective personal equipment (AOR = 1.46, 0.85-2.59) were more likely to increase protective personal equipment practice.

Conclusion: The study concluded that improper personal protective equipment practices among sanitary workers were caused by a shortage, discomfortable, wearing carelessly and negligence, felt less advantaged, and cues to action, and had worse self-efficacy. The study advised that maintaining a sufficient supply of protective personal equipment, increasing awareness of protective personal equipment utilization, and providing daily supervision are all necessary to improve the level of protective personal equipment compliance within the selected hospitals.