PPE Transmission Research

THE PERCEPTION OF OT PERSONNEL
REGARDING THE ROLE OF PERSONAL

PROTECTIVE EQUIPMENT IN REDUCING THE
TRANSMISSION OF INFECTIOUS AGENTS IN
THE OPERATING ROOM
Research Project Report

BS SURGICAL
By
Mr. Muhammad Rafay
Mr. Afaq Ahmad Taj
Mr. Irfan Khan
Mr. Jehangir Khan
DEPARTMENT OF SURGICAL TECHNOLOGY

PREMIER INSTITUTE OF HEALTH MANAGEMENT
SCIENCES
Affiliated With
KHYBER MEDICAL UNIVERSITY
Peshawar Khyber Pakhtunkhwa Pakistan
Session 2019-2023
THE PERCEPTION OF OT PERSONNEL
REGARDING THE ROLE OF PERSONAL
PROTECTIVE EQUIPMENT IN REDUCING THE
TRANSMISSION OF INFECTIOUS AGENTS IN
THE OPERATING ROOM
Research Project Report

BS SURGICAL
By
Mr. Muhammad Rafay
Mr. Afaq Ahmad Taj
Mr. Irfan Khan
Mr. Jehangir Khan
DEPARTMENT OF SURGICAL TECHNOLOGY

PREMIER INSTITUTE OF HEALTH MANAGEMENT
SCIENCES
Affiliated With
KHYBER MEDICAL UNIVERSITY
Peshawar Khyber Pakhtunkhwa Pakistan
Session 2019-2023
CERTIFICATE
This research project report by Muhammad Rafay, Afaq Ahmad ,Irfan Khan &
Jehangir Khan is accepted in its present form, by the Department of Surgical technology,
PiHMS University system Peshawar, as satisfying research project report requirements for
award of degree of BS Surgical Technology.
Supervisor: ____________________
Mr. Shah Hussain

Lecturer Surgical Technology
External Examiner: ____________________
Mr. Sulieman
Demonstrator Surgical Technology KMU IPMS
Internal Examiner: ____________________
Mr. Wajid Jamil
Coordinator/Lecturer Surgical Technology
Head of Institute: ______________________
Mr. Haroon
Director PiHMS University System
Date: ____________________
i
DEDICATION
This research study is dedicated to our parents and family members who always guided,
supported, and helped us to complete our BS program. This success is achieved because of
our parents’ prayers. Without their support we were unable to achieve anything. We thank
Allah Almighty for blessing us with such kind and loving parents and family members.
ii
DECLARATION
We hereby declare that the work accomplished in this research project report is our own
research effort carried out at Tertiary Care Hospitals Peshawar (HMC, KTH) the research
project report has been written and composed by us.
The work in this research project report has neither been previously submitted for
examination leading to the award of a degree nor does it contain any material from the
published resources that can be considered as the violation of the international copyright
law.
We also declare that we are aware of the terms ‘’copyright’’ and ‘’plagiarism’. We will be
solely responsible for the consequences of violation to these rules (if any) found in the
research project report. The research project report has been checked for plagiarism by
Turnitin software.
Name: Muhammad Rafay
Signature: _____________
Name: Afaq Ahmad
Signature: _____________
Name: Irfan Khan
Signature: _____________
Name: Jehangir Khan
Signature: _____________
Date: _________________
iii
ACKNOWLEDGMENTS
Thanks to Allah, Almighty for all his blessing on us throughout our life and who enabled
us to complete our research project report because of his blessings were able to achieve this
goal. We sincerely pay our humble and hearted thanks to our most affectionate parents who
supported and encouraged us throughout our lifetime in completing our education. Our
success is the fruit of their devoted prayers.
We deeply oblige our supervisor Shah Hussain and our Co-Ordinator Sir Wajid Jamil
who guided us during our research and research project report. His keen interest and
valuable suggestions made this work possible.
Mr. Muhammad Rafay

Mr. Afaq Ahmad
Mr. Irfan Khan
Mr. Jehangir Khan
iv
Table of Contents
Certificate...................................................................................................................i
Dedication....................................................................................................................ii
Declaration……...........................................................................................................iii
Acknowledgment........................................................................................................iv
List of Figures.............................................................................................................vi
List of Tables................................................................................................................vii
List of Abbreviations................................................................................................viii
Abstract..........................................................................................................................ix
Introduction..................................................................................................................1
Literature Review.......................................................................................................10
Objectives.......................................................................................................................11
Materials &Methods..................................................................................................12
Results……………………….........................................................................................14
Disscussion.....................................................................................................................21
Conclusion & Recommendations …….................................................................23
References.....................................................................................................................24
v
List of Figures
FIGURE 1 SHOWING THE USE OF FACE SHIELDS IN

O.T ......................................................... 15
FIGURE 2 SHOWING USAGE OF SURGICAL MASKS BY
RESPONDENTS ........................................... 16
FIGURE 3 SHOWING RATIO BETWEEN TRAINED &
UNTRAINED RESPONDENTS ........................... 17
FIGURE 4 SHOWING RESPONSE OF RESPONDENTS . 18
FIGURE 5 HISTOGRAM SHOWING THE DECREASED
INCIDENCES IN HAI'S AFTER IMPLEMENTATION OF
INFECTION CONTROL PROTOCOLS .................. 19
FIGURE 6 SHOWING THE POSITIVE AND NEGATIVE
FEEDBACK OF RESPONDENTS. ........................ 20
FIGURE 7 HISTOGRAM SHOWING IMPORTANCE OF
PPE IN TRANSMISSION OF INFECTION IN HCW'S
.............................................................. 20
vi
List of Tables
TABLE 1 SHOWING EDUCATION LEVEL OF

RESPONDANTS ........................................... 14
TABLE 2 SHOWING USE OF FACE SHIELDS IN O.T .. 15
TABLE 3 SHOWING USAGE OF SURGICAL MASKS IN
O.T ......................................................... 16
TABLE 4 SHWOING PROPER TRAINING FOR USE OF
PPE ........................................................ 16
TABLE 5 SHOWING THE NUMBER OF
RESPONDENTS WITH ANSWER.................. 17
TABLE 6 SHOWING THE RESPONSE OF
RESPONDANTS ...................................... 18
TABLE 7 SHOWING THE PERCENTAGE OF
RESPONSES FROM RESPONDENTS ............. 19
vii
List of Abbreviations
1. HMC Hayatabad Medical Peshawar

2. KTH Khyber Teaching Hospital
3. PPE Personal Protective Equipment
4. SARS Sever Acute Respiratory Syndrome
5. HCW Health Care Worker
6. EVD Ebola Virus Disease
7. OPD Outpatient Department
8. SPSS Statistical Package for Social Sciences
9. DH Dentine Hypersensitivity
10. KMU Khyber Medical University
11. HAI Healthcare Associate Infection
viii
ABSTRACT
Aims: Enhancing PPE Management and Awareness in Operating Theaters for Infection
Control: A Study at HMC, KTH.
Introduction:
This study addresses the need to enhance Personal Protective Equipment (PPE)
management and awareness in operating theaters at HMC, KTH, aiming for improved
infection control.
2. Materials and Methods:

A cross-sectional study from August 9 to October 15, 2023, involved 160 respondents at
HMC, KTH. Data collected through a questionnaire was analyzed using SPSS software,
emphasizing the importance of PPE protocols and awareness campaigns.
3. Results:
Surveying healthcare professionals, positive adherence to PPE usage (86.25% for surgical
masks, 76.25% for face shields) and high training rates (92.5%) were observed. Concerns
about PPE supply availability (45%) highlight the need for targeted interventions. The
majority (66.88%) believes strict adherence reduces healthcare-associated infections.
4. Conclusion:
Positive adherence to PPE usage is commendable, but challenges in supply underscore the
need for interventions and improved supply chain management. Diverse professional
responses highlight the importance of tailored education and intervention strategies. The
majority's belief in reduced infections through adherence contributes to future initiatives
for infection control enhancement.
Keywords:
PPE, Operating Theaters, Infection Control, Adherence, Healthcare Professionals, Supply
Chain Managemen
ix
CHAPTER 1
1. INTRODUCTION
Healthcare is a fundamental aspect of human well-being, and understanding the intricacies
of healthcare systems is paramount to ensuring the delivery of high-quality care to
individuals. One essential component of healthcare is the classification of healthcare
facilities, particularly tertiary care hospitals, which serve as critical hubs for advanced
medical treatment and specialized care.
Tertiary care hospitals occupy a pivotal position in the healthcare ecosystem. These
hospitals are the apex of medical care and are equipped to provide highly specialized and
complex treatments that go beyond the capabilities of primary and secondary care facilities.
Tertiary care hospitals are essential in managing severe illnesses, advanced surgical
procedures, and intricate medical conditions. As such, they play a crucial role in improving
patient outcomes, advancing medical knowledge, and training the next generation of
healthcare professionals. The operation of tertiary care hospitals is subject to rigorous
regulations and standards to ensure the safety, quality, and effectiveness of the care
provided. These regulations encompass a wide array of areas, including patient safety,
medical ethics, facility management, and healthcare financing. Regulatory bodies and
government agencies closely monitor and enforce compliance with these standards, with
the overarching goal of safeguarding the interests of patients and the broader community.
Within the framework of tertiary care hospitals, operating theaters (OTs) serve as critical
spaces where intricate surgical procedures are performed. These OTs are designed to
provide a sterile and controlled environment that minimizes the risk of infections and
complications during surgeries. Depending on the hospital's specialization and capacity,
there are various types of operating theaters tailored to specific surgical needs, such as
general surgery, cardiac surgery, neurosurgery, and orthopedic surgery, among others. The
personnel allowed to work within the operating theater are a highly specialized team, each
with distinct roles and responsibilities. Surgeons, anesthetists, nurses, and surgical
technicians form the core of the OT team. Their collaboration ensures the smooth execution
of surgical procedures, with an emphasis on patient safety, precision, and efficient use of
THE PERCEPTION OF OT PERSONNEL REGARDING THE

ROLE OF PERSONAL PROTECTIVE EQUIPMENT IN
1
REDUCING THE TRANSMISSION OF INFECTIOUS AGENTS
IN THE OPERATING ROOM"
resources. The selection, training, and continuous education of OT staff are vital to
maintaining the highest standards of care within these critical healthcare environments.
Operation theatre staff face a heightened risk of contracting blood-transmitted infections

due to frequent exposure to patients' blood and bodily secretions. AdditionallyThe
prevalence of hospital-acquired infections is significantly influenced by surgical site
infections. Key factors contributing to this risk include the behavior of operating theatre
personnel in terms of decontamination practices, hand hygiene/antisepsis, and adherence to
universal precautions. In response to these concerns, many countries, including Italy, have
established multidisciplinary Infection Control Committees within hospitals. These
committees are tasked with providing guidance on infection control matters, setting
standards, and recommending policies. Despite the existence of guidelines, issues related
to hospital infection control practices continue to be debated in most Italian healthcare
institutions. Several studies have examined disinfection and sterilization procedures, the
knowledge and practices of hospital staff, and their compliance with universal precautions.
Unfortunately, specific data for Italy remain scarce, making it imperative to gather
information to assess personnel readiness in preventing hospital-acquired infections (1).
To ensure the safety of healthcare workers in operating theaters and hospital environments,
Personal Protective Equipment (PPE) plays a crucial role. PPE, including specialized
clothing, equipment, and gear, serves as a barrier against potential health and safety hazards
in various environments, particularly in occupational settings. The selection and use of
appropriate PPE are essential for ensuring the safety, health, and well-being of individuals
facing workplace or environmental dangers that could lead to injury, illness, or adverse
effects. In the healthcare context, PPE has been a vital element in preventing the
transmission of infections for centuries.
The historical context of safeguarding healthcare workers and preventing infection

transmission reveals that the concept of PPE dates back to the war era. Its primary purpose
was to shield individuals from contamination due to chemical warfare. Respirators, for
example, were initially developed as a means for soldiers to protect themselves against
toxic chemicals, with the concept attributed to Leonardo da Vinci in the 16th century.
Respiratory protection technology has evolved and been standardized over time, with clear

2
safety requirements outlined by organizations such as the National Institute for
Occupational Health and Safety (NIOSH) and the Occupational Safety and Health Agency
(OSHA).
Among the most commonly used PPE items are cover gowns and gloves, originating from
guidance provided by the Centers for Disease Control and Prevention (CDC). In 1970, the
CDC published a manual titled "Isolation Techniques for Use in Hospitals," introducing
category systems for isolation and incorporating the use of limited PPE. By the mid-1970s,
approximately 93 percent of hospitals had adopted these guidelines. As the healthcare
landscape evolved, new challenges emerged, including the rise of resistant bacteria. In
response, healthcare professionals sought guidance, leading to the release of the "Guideline
for Isolation Precautions in Hospitals" in 1983 by the CDC, replacing the 1975 isolation
manual and introducing significant changes in practice.
The use of PPE gained further prominence with the identification of the human
immunodeficiency virus (HIV) in 1985, leading to the introduction of Universal
Precautions (UP). UP aimed to prevent infections resulting from needlestick injuries and
potential skin contamination, expanding the traditional use of gloves and gowns to
encompass face masks and eye shields for protection against mucous membrane exposure.
The guideline was updated in 2007, with comprehensive coverage of PPE usage and
detailed instructions for donning and doffing, accompanied by helpful illustrations. As the
incidence of multidrug-resistant organisms, including Clostridium difficile infection (CDI),
surged following the guideline's release, healthcare facilities faced increasing pressure to
educate and monitor healthcare workers involved in direct patient care. PPE became a
universal requirement whenever the likelihood of hand, clothing, or mucous membrane
contamination was anticipated. To uphold infection prevention, healthcare institutions
prioritized ongoing education, direct observation, monitoring, written documentation of
compliance, and defined actions for non-compliance. Valuable input from healthcare
workers regarding PPE barriers was considered essential, recognizing that PPE can be
uncomfortable, and some staff members may have allergies to certain products. This input
encompassed aspects such as the choice of gown fabrics to ensure impermeability and
comfort, as well as the introduction of various types of gloves, including powder-free,
nitrile, and latex-free options, with continuous evaluation. Eye protection options expanded

3
to include reusable goggles, cleaned according to the manufacturer's instructions, and
disposable face shields, with or without attached masks. Various types of procedure masks
were also introduced to meet the evolving needs of healthcare professionals. In essence, the
history of PPE in healthcare underscores its evolution from its origins in wartime chemical
protection to its critical role in safeguarding HCWs and patients from infectious diseases
in modern healthcare settings. This journey reflects a continuous commitment to improving
safety and infection prevention practices within the healthcare sector.(2)
The utilization of Personal Protective Equipment (PPE) stands as a paramount strategy in

safeguarding the well-being of both patients and healthcare workers (HCWs) from
potentially transmissible pathogens. In high-risk environments, PPE serves the crucial
purpose of mitigating the transmission of these pathogens between patients and HCWs,
especially in situations where effective treatment or prophylaxis for the specific disease
may not be available.
The operating theater, often referred to as the "sterile zone," is a controlled environment
dedicated to surgical procedures. The maintenance of sterility is crucial to prevent
infections and complications. As such, the utilization of appropriate PPE is imperative. The
following is a brief overview of the PPE items essential in the operating theater:
Surgical Masks: These masks are designed to cover the mouth and nose, serving as a
barrier to prevent the spread of microorganisms from the wearer's respiratory secretions.
Face Shields: Providing full facial protection, including the eyes, face shields are
employed to safeguard against potential splashes and sprays during surgical procedures.
Safety Goggles: Protecting the eyes from potential contaminants, especially during
procedures where splattering or exposure to bodily fluids is a concern.
Disposable Gowns: Covering the entire body, disposable gowns are worn to prevent
contamination of clothing and skin. These gowns are typically fluid-resistant, crucial for
maintaining a sterile field.

4
Gloves: Hand protection is paramount in the operating theater. Surgeons and other
healthcare staff typically wear sterile gloves during procedures to minimize the risk of
contamination.
Hair Covers and Caps: These are used to contain hair and minimize the risk of hair falling
into the sterile field.
Shoe Covers: Designed to prevent contaminants from shoes from entering the operating
theater, these are essential for maintaining the sterile environment.
Respiratory Protection: Depending on the nature of the surgical procedure, N95

respirators or other respiratory protection devices may be necessary to filter out airborne
particles, ensuring the safety of the surgical team.
Aprons: An additional layer of protection, aprons are employed, particularly during

procedures with a high risk of splashes or exposure to bodily fluids.
Boot Covers: These may be used to cover footwear, adding an extra layer of protection and
minimizing the risk of contamination via shoes.
Historically, sporadic instances of PPE usage can be traced back to periods preceding the
18th century. Records reveal the use of various protective gear by plague doctors in the
Middle Ages, including masks, leather gowns, and distinctive black overcoats, all
employed to prevent the transmission of the plague while treating afflicted patients. The
recognition of the necessity for standardized personal protective equipment gained
momentum in the United States during the 1970s and 1980s. This momentum was largely
fueled by the enactment of the Occupational Safety and Health Act of 1970, emphasizing
the importance of worker safety
Further progress in promoting PPE usage occurred with the intervention of the United
States Centers for Disease Control and Prevention (CDC) in 1982, during the height of the
HIV epidemic. The CDC published recommendations specifically aimed at safeguarding
clinical and laboratory personnel working with AIDS patients (2). In 1983, the CDC
extended its efforts by updating guidelines for the care of isolated hospital patients, advising
healthcare personnel to wear appropriate protective gear, such as masks, gowns, or gloves,

5
based on the assessment of the likelihood of exposure to infectious agents. These milestones
underscore the evolving significance of PPE in the realm of healthcare, highlighting its
critical role in infection control and the protection of both patients and HCWs.(3)
In [2020], the COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2,

rapidly spread across the globe. This infectious disease presented a severe threat to public
health, demanding a multifaceted approach to control its transmission. Among the crucial
components of this approach was the widespread use of Personal Protective Equipment
(PPE), which includes various garments and gear designed to shield individuals from viral
exposure.COVID-19 differs significantly from Ebola virus disease (EVD), primarily in
terms of transmission. While COVID-19 primarily spreads through respiratory droplets,
EVD is transmitted through infected bodily fluids. These distinctions in transmission routes
necessitate distinct PPE requirements for each disease.Specifically, coveralls, sometimes
referred to as Ebola PPE, are essential when managing EVD patients due to the risk of
exposure to bodily fluids. However, when dealing with COVID-19 patients, the PPE
requirements are different. Coveralls are not required, as COVID-19 primarily spreads
through respiratory droplets, and the focus is on protecting against airborne transmission
rather than contact with bodily fluids.(4) The initial viral load serves as a crucial indicator
of disease severity, mirroring a phenomenon akin to what is observed in cases of influenza.
Individuals afflicted with COVID-19 who manifest prolonged viral shedding tend to
experience a more unfavorable prognosis. Healthcare professionals, who tirelessly serve at
the forefront of patient care, confront an augmented susceptibility to contracting the illness,
primarily attributable to their heightened exposure to elevated viral concentrations. It is
imperative to underscore that should the virus become aerosolized, its infectivity surges,
thereby amplifying the risk borne by healthcare staff.(5)
Additionally, a recent report from the Chinese Center for Disease Control and Prevention
revealed that only 3.8% of all cases were healthcare personnel. Among them, 15% were
classified as severe or critical cases, with a mortality rate of 0.2%. During the earlier stages
of the pandemic, the infection rate among healthcare workers was as high as 29%, but this
rate significantly decreased over time. This decline in infection rates likely reflects the
successful implementation of comprehensive PPE measures designed to protect healthcare
workers effectively.(6)

6
In the brief span of this pandemic's existence, medical resources, including Personal
Protective Equipment (PPE), have faced rapid depletion. Recent reports have highlighted
critical shortages, particularly in gowns and masks, prompting renowned businesses to step
in with support, alongside philanthropic contributions. Alarming accounts have emerged of
healthcare workers resorting to procuring their own PPE due to these scarcities.
Recognizing the inadequacy of the global PPE stockpile, both in addressing the present
needs and meeting the escalating demand in the future, organizations like the WHO have
prompted revisions to PPE guidelines worldwide. Notably, Public Health England (PHE)
has drawn Criticism has been directed toward the Public Health England (PHE) for basing
its guidance on resource availability rather than prioritizing the safety of healthcare
professionals. The most recent updates from PHE, dated April 17, 2020, suggest three
options in case of PPE supply depletion: sessional use of PPE, reusing it, or exploring
alternatives to standard PPE. This approach, driven by scarcity and accompanied by unclear
and changing guidance, has led to considerable anxiety and confusion among healthcare
workers.
A survey conducted by the Royal College of Surgeons of England (RCS) revealed that
almost one-third (32.5%) of UK surgeons face a shortage of masks, gowns, or eye
protection. This survey, involving 1,978 surgeons and surgical trainees, highlights the
widespread scarcity of PPE for frontline medical personnel. The RCS emphasizes that
surgeons should not be forced to compromise their health due to insufficient PPE. In
response to the shortage, ENT UK stressed that while FFP3 masks are crucial for saving
lives, clinical staff themselves are life-saving assets deserving the best protection available
(7).
In February 2020, Belgian authorities released guidelines outlining measures to combat

COVID-19. These included patient cohorting, proper hand and face hygiene, droplet and
contact precautions, and the use of FFP2 masks in aerosol-generating procedures. However,
at that time, no specific directives were provided regarding the duration of PPE usage, the
correct procedures for donning and doffing, or guidelines for waste management. The
responsibility for training healthcare workers in infection prevention and the proper use of
PPE was left to individual hospitals (8).

7
The process of donning and doffing PPE is not a routine but a carefully choreographed
series of steps aimed at safeguarding healthcare workers and preventing the transmission
of infectious agents. The appropriate use of PPE can significantly contribute to mitigating
the nosocomial spread of infectious diseases (9). it's essential to explore the nuances of
this procedure, including variations in PPE requirements for different diseases and settings,
the impact of training and education on healthcare worker compliance, and the
effectiveness of various donning and doffing techniques in reducing the risk of
contamination. Research can delve into the challenges and barriers healthcare workers face
in correctly donning and doffing PPE, such as issues related to fatigue, discomfort, and the
time-consuming nature of the process. Investigating innovations in PPE design and
technology, as well as their implications for ease of use and safety, is another avenue of
exploration Furthermore, examining the role of healthcare policies and guidelines in
shaping donning and doffing practices, especially during pandemics or outbreaks, can
provide valuable insights into the healthcare system's preparedness and response. Research
can also assess the psychological impact of prolonged PPE use on healthcare workers and
explore strategies to mitigate stress and burnout. In general, education utilizing simulation
techniques proves to be efficacious in imparting clinical competencies and fostering
effective team communication skills.(10)
Overall, a comprehensive research approach to donning and doffing of PPE should

encompass various facets, from the technical and procedural aspects to the psychological
and systemic factors that influence its effectiveness in infection control and healthcare
worker safety.
Hence, we assert that the development of an online module adhering to international

guidelines for the proper usage and disposal of Personal Protective Equipment (PPE) is an
imperative endeavor. The primary objective of our study is to evaluate the perceived
effectiveness of online simulation training in the correct donning and doffing of PPE.
Simulation-based training for PPE procedures has been well-established as an effective
means of enhancing provider safety and fostering adherence to meticulous technique . It's
noteworthy that medical simulation stands out as one of the most rapidly evolving domains
within medical education.

8
However, despite the acknowledged benefits of simulation-based training, our investigation
unearthed certain perceived shortcomings. Notably, a substantial majority of our
participants (over 69%) fell within the 20-29 age group, which typically correlates with a
high degree of digital proficiency. Surprisingly, only 41.98% of our participants reported
prior engagement with virtual simulation training. This dearth of exposure to virtual
simulation may have influenced the perceptions and responses of the remaining 57.02% of
participants, underscoring the need to address potential biases.(11)
Personal Protective Equipment (PPE) items allocated to Dental Healthcare Personnel

(DHCP) for the process of donning and doffing encompassed safety goggles, face shields,
disposable surgical or isolation-style masks, disposable gowns, gloves available in various
sizes, and alcohol-based hand sanitizer. It's worth noting that due to supply limitations
linked to COVID-19, the specific brands of PPE accessible to participants exhibited
variability throughout the course of the study. Notably, all brands of disposable gowns
utilized in this research featured a head opening, thumb loops, and ties positioned at the
gown's rear for secure fastening.(12) The CDC's recommendations served as the benchmark
for the accurate order of PPE donning and doffing procedures.(13)
Hospital-acquired infections (HAIs) within healthcare facilities stand as a significant

contributor to heightened mortality rates and increased illness among hospitalized
individuals. These infections extend patients' hospital stays and elevate the overall cost of
healthcare provision.(14) In Europe, HAIs afflict one out of every ten hospitalized patients
and result in nearly 5000 annual fatalities. In Saudi hospitals, the recorded rate of HAIs was
8% in 2003, with an incidence of 4.5 cases per 1000 discharged patients in 2004.(15)
Similarly, at healthcare institutions in Taif, Saudi Arabia, the rate of nosocomial infections
was documented at 1.86 and 2.09 for the years 2010 and 2011, respectively.(16) Notably,
HAIs can manifest within 48 hours of a patient's hospital admission, and this risk persists
for up to 3 days or up to 30 days following a surgical procedure.(17) The highest
concentration of microorganisms is typically found in heavily contaminated substances like
bodily fluids.(18) Such circumstances underscore the critical importance of infection
control measures within healthcare settings. Operating theater personnel should
contemplate thorough handwashing, the application of dual layers of gloves, and the choice
of surgical gowns before each procedure to diminish bacterial presence on their attire.

9
These proactive measures are essential in minimizing the risk of HAIs and maintaining a
sterile surgical environment.(19)
1.2 Literature review
Personal protective equipment (PPE) plays a crucial role in the healthcare setting,
especially in the context of reducing the transmission of infectious agents within operating
theaters. In light of the ongoing challenges posed by infectious diseases and pandemics, the
significance of PPE in infection control cannot be overstated. This literature review
examines the multifaceted role of PPE in reducing the transmission of infectious agents,
with a focus on its impact on the spread of infections, its contributions during the COVID-
19 pandemic, and its role in preventing nosocomial infections.
PPE and the Spread of Infection:
Recent studies emphasize the primary strategies of using PPE and transmission-based
precautions to reduce the transmission of infectious agents in healthcare settings(20)
Observations conducted in clinical units revealed the occurrence of failures in transmission-
based precautions, including PPE use, by healthcare personnel. These failures had the
potential to lead to self-contamination or transmission during routine hospital care (20).
These failures involved violations, process or procedural mistakes, and slips. Violations, in
particular, often entailed entering patient rooms without wearing some or all recommended
PPE (20).
PPE's Role in the COVID-19 Pandemic:
The COVID-19 pandemic highlighted the paramount importance of PPE in safeguarding

healthcare workers and patients against infectious agents. The routes of transmission of the
SARS-CoV-2 virus underscored the necessity of stringent PPE usage, especially in cases
where there was a risk of exposure to infectious materials (21). The use of PPE, combined
with repetitive training and demonstrated competency in wearing and removing PPE,
served as a pivotal measure to minimize the risk of exposure to the virus (21).
PPE in Preventing Nosocomial Infections:

10
Nosocomial infections, particularly in the context of COVID-19, have raised concerns
about the spread of infectious agents in healthcare settings. PPE, including gowns, gloves,
masks, goggles, and face shields, constitutes an integral part of the precautionary measures
to reduce nosocomial transmission of COVID-19 infection (22). Proper donning and
doffing, fit testing, and fit checking have been highlighted as essential aspects of using PPE
effectively (22). Additionally, comprehensive measures that encompass patient and staff
screening, controlling the flow of individuals within hospitals, physical distancing, hand
hygiene, and appropriate waste disposal have been recommended to minimize nosocomial
transmission (22).
In conclusion, the multifaceted role of PPE in reducing the transmission of infectious agents
is evident from various studies. The proper utilization of PPE is instrumental in controlling
the spread of infections within the healthcare environment, especially in the challenging
context of pandemics and nosocomial infections. By adhering to current guidelines and
staying updated with evolving research and recommendations, healthcare workers can
effectively minimize the transmission of infectious agents within operating theaters.
Objectives:
• Assess The effectiveness of different Types of PPE In minimizing the Transmission

of Infectious Agents
• Examine the impact of training & Education programs on the proper use of PPE in
the Operation Theater

11
CHAPTER 2
Materials and Methods
This chapter includes research study design, study population, study duration, sampling
technique sample size, data collection procedure and data analyzing procedure.
2.1 Study design:
The current study is descriptive cross-sectional study.
2.2 Study population:
The people who were visiting to Hayatabad Medical Complex, Khyber Teaching Hospital
Peshawar
2.3 Study duration:
Months from July 2023 to October 2023
2.4 Sampling Technique:
Non-Probability Convenience Sampling Technique
2.5 Sample Size:
Sample size for this study was 160
2.6 Sampling selection:
a. Inclusion criteria:
• Operation Theater Staff: Include all staff members working directly in the operation
theater, such as surgeons, nurses, anesthesiologists, and technicians. This ensures that the
study focuses on individuals directly involved in surgical procedures.
• Entrants Aged 25 & above...
b. Exclusion criteria:
• Having Experience less than 1 Years

12
• Untrained
• Unwilling
• Janitor
Data collection Procedure:
A descriptive cross-sectional study was conducted to determine the effectiveness of PPE

in controlling infection transmission among healthcare workers in the operation theater.
The study took place at Hayatabad Medical Complex and Khyber Teaching Hospital in
Pakistan from July to October 2023. Data collection occurred over a period of 3 weeks.
In order to ensure the confidentiality and privacy of the healthcare workers participating
in the study, verbal consent was obtained from all the operation theater staff, including
nurses, healthcare technologists, and surgeons, prior to administering the questionnaire.
The sample size for this research study was determined to be 160 participants.
2.7 Data analyzing procedure:

Descriptive statistics (frequencies & percentage) was applied to analyze data for the study
subjects. Frequencies and percentage of the study variables was calculated, and data was
represented through (tables and figures etc.). The data was analyzed by using SPPS version
26.

13
CHAPTER 3
RESULTS
This chapter includes results.
3.1 Usage of Face Shields
Examining the use of face shields contributes to understanding the extent to which
healthcare professionals recognize the importance of additional facial protection. The
positive trend of 76.25% adherence is promising. However, the 23.75% who do not use
face shields presents an opportunity for educational initiatives or policy reinforcement.
Strengthening the understanding of the role of face shields in infection prevention is crucial
for a comprehensive approach to personal protective equipment (PPE) usage.
3.2 Education Level Breakdown:

• MBBS: 76.71% adherence
• Surgical Technicians: 79.31% adherence
• Anesthesiologists: 81.82% adherence
• Nurses: 71.43% adherence
• KHALA: 100% adherence
•
Table 1 Showing Education level of Respondants

14
Use Face Shields in O.T
Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 122 76.3 76.3 76.3
No 38 23.8 23.8 100.0
Total 160 100.0 100.0
Table 2 Showing Use of Face Shields in O.T
Figure 1 Showing The use of Face Shields in O.T
3.3 Usage of Surgical Masks:
Inquiring about the routine use of surgical masks during medical procedures provides a
critical insight into the baseline infection control practices of healthcare professionals. The
86.25% adherence rate indicates a commendable level of awareness and compliance.
However, the 13.75% who reported not using surgical masks highlights an area for
improvement, emphasizing the need for targeted interventions and education to ensure
comprehensive adherence to this fundamental infection control measure.

15
Do you use Surgical Mask For All Procedures
Cumulative
Valid Yes 138 86.3 86.3 86.3
No 22 13.8 13.8 100.0
Total 160 100.0 100.0
Table 3 Showing Usage of Surgical Masks in O.T
Figure 2 Showing Usage of Surgical Masks by Respondents
3.4 Training on PPE Usage and Disposal:
Assessing whether healthcare professionals have received training on PPE usage and
disposal provides insights into the knowledge base and skills related to infection control
measures. The significant majority (92.5%) having received training is a positive indicator
of a strong foundation. This underscores the importance of ongoing training programs to
ensure that healthcare professionals stay abreast of evolving guidelines and best practices
in PPE usage and disposal.
Training on the proper use and disposal of PPE

Cumulative
Valid Yes 148 92.5 92.5 92.5
No 12 7.5 7.5 100.0
Total 160 100.0 100.0
Table 4 Shwoing Proper Training for Use of PPE

16
Figure 3 Showing Ratio Between Trained & Untrained Respondents
3.5 Availability of PPE Supplies:
Exploring the availability of PPE supplies in the Operating Theater is crucial for
understanding the operational environment. While a slight majority (55%) reported ready
availability, the concerns expressed by 45% underscore challenges in the supply chain.
Addressing these concerns is vital to maintaining a consistent and reliable supply of PPE,
which is fundamental to ensuring the safety of healthcare professionals and patients.
PPE supplies readily available in the operating theater

Cumulative
Valid Yes 88 55.0 55.0 55.0
No 72 45.0 45.0 100.0
Total 160 100.0 100.0
Table 5 Showing the Number of Respondents with Answer

17
Figure 4 Showing Response of Respondents
3.6 Impact on Healthcare-Associated Infections:
Investigating the perceived impact of strict adherence to infection control protocols and
PPE usage on healthcare-associated infections (HAIs) provides a qualitative measure of the
effectiveness of implemented measures. The majority (66.88%) reporting a decrease in
HAIs indicates a positive trend. This perception aligns with the intended positive outcomes
of stringent infection control measures and emphasizes the need for their continued
implementation and reinforcement.
The incidence of healthcare-associated infections (HAIs) decreased

since the implementation of strict adherence to infection control
protocols and PPE usage in the operating theater
Frequency Percent Valid Percent Cumulative Percent

Valid Yes 107 66.9 66.9 66.9
No 52 32.5 32.5 99.4
Total 160 100.0 100.0
Table 6 Showing the Response of Respondants

18
Figure 5 Histogram Showing the Decreased Incidences in HAI's After implementation of Infection Control Protocols
3.7 Monitoring for PPE Compliance:
Inquiring about the regular monitoring of healthcare workers for compliance with PPE
usage is critical for maintaining a culture of adherence to infection control protocols.
Approximately 60.63% reporting regular monitoring suggests a proactive approach.
Continuous monitoring, coupled with feedback and reinforcement, plays a pivotal role in
sustaining high standards of infection control.
Are healthcare workers regularly monitored for compliance

with PPE usage in the operating theater
Cumulative
Valid Yes 97 60.6 60.6 60.6
No 63 39.4 39.4 100.0
Total 160 100.0 100.0
Table 7 Showing the Percentage of Responses from Respondents

19
Figure 6 Showing the Positive and Negative feedback of Respondents.
3.8 Perceived Importance of PPE:
Evaluating the perceived importance of PPE among healthcare professionals gauges the
level of awareness and commitment to infection prevention. The substantial majority
(83.75%) expressing that they believe PPE is extremely important underscores a strong
consensus on the critical role of PPE. This shared understanding provides a solid foundation
for a collective commitment to infection control practices in the Operating Theater.
Figure 7 Histogram Showing Importance of PPE in Transmission of Infection in HCW's

20
CHAPTER 4
DISCUSSION
The presented survey aimed to assess the adherence to personal protective equipment (PPE)
usage and infection control measures among healthcare professionals in an Operating
Theater setting. The total sample size of 160 participants included a diverse range of
healthcare professionals with varying roles and responsibilities, comprising 73 MBBS
workers, 58 Surgical Technicians, 11 Anesthesiologists, 14 Nurses, and 6 KHALA’s. The
breakdown of results across different educational backgrounds offers valuable insights into
the nuances of infection control practices within this heterogeneous group.
1. PPE Usage Patterns:
The survey revealed encouraging patterns of PPE usage among the respondents. The
majority reported using surgical masks (86.25%) and face shields (76.25%) during medical
procedures, indicating a generally high level of awareness and adherence to basic infection
control measures. This aligns with established guidelines emphasizing the importance of
these precautions in preventing the transmission of infectious agents.
The breakdown across education levels indicated consistently high adherence, with minor
variations. Notably, Anesthesiologists demonstrated slightly higher adherence to both
surgical masks and face shields, suggesting a heightened awareness among this group.
2. Training and Education:
The finding that 92.5% of respondents have received training on the proper use and disposal
of PPE is a positive indicator of a robust foundation in knowledge and skills related to
infection control measures. Ongoing training programs play a pivotal role in ensuring that
healthcare professionals stay informed about evolving guidelines and best practices.
Anesthesiologists demonstrated a 100% training rate, emphasizing the critical role of

continuous education, particularly among professionals with specialized roles.
3. PPE Supply Chain Challenges:

21
The survey uncovered concerns regarding the availability of PPE supplies, with 45% of
respondents expressing apprehension. This underscores the challenges in maintaining a
consistent supply chain, a critical aspect of ensuring a safe working environment for
healthcare professionals.
Nurses and KHALA respondents reported a higher level of concern, signaling a need for
targeted interventions to address specific challenges faced by these groups.
4. Impact on Healthcare-Associated Infections (HAIs):
Most respondents (66.88%) believed that the incidence of healthcare-associated infections

(HAIs) has decreased since the implementation of strict adherence to infection control
protocols and PPE usage in the Operating Theater. This positive perception aligns with the
intended outcomes of stringent infection control measures.
Nurses exhibited the highest reported decrease in HAIs, suggesting a potential correlation
between their role and the observed impact on infection rates.
5. Monitoring for PPE Compliance:
Approximately 60.63% of respondents reported that healthcare workers are regularly

monitored for compliance with PPE usage. Regular monitoring is a cornerstone of
maintaining a culture of adherence to infection control protocols, ensuring ongoing
compliance.
Anesthesiologists and KHALA respondents reported higher rates of regular monitoring,

indicating a proactive approach in these specific groups.
6. Perceived Importance of PPE:
The majority (83.75%) expressed a belief that PPE is extremely important in preventing
the transmission of infectious agents in the Operating Theater. This shared understanding
provides a solid foundation for a collective commitment to infection control practices.
All educational categories, including KHALA, demonstrated a high percentage believing

in the extreme importance of PPE, emphasizing a universal acknowledgment of its critical
role.

22
CHAPTER 5
CONCLUSION & RECOMMENDATION
Conclusions:
In interpreting survey results, it's crucial to note that data reflects infection control
practices solely within the government healthcare sector. Variations in adherence may
exist in the private sector due to factors like resource allocation and management
practices. The complexity of PPE protocols, especially disposal and implementation,
presents inherent challenges. Infections among healthcare workers may be influenced by
factors beyond this survey's scope. Further research should explore comparative analyses
between government and private sector hospitals for a comprehensive understanding.
Delving into intricate aspects of PPE protocols may unveil areas for improvement,
maintaining a holistic perspective to enhance safety across diverse healthcare settings.
RECOMMENDATION:
Regular Training Programs: Implement consistent and targeted training to keep

healthcare professionals informed about evolving guidelines.
Supply Chain Enhancement: Address supply chain concerns through efficient

procurement processes and regular stock assessments.
Tailored Interventions: Design interventions recognizing the unique needs of diverse

healthcare professional groups to maximize infection control impact.
Collaborative Research: Foster comparative studies between government and private

sector hospitals for a comprehensive understanding of effective practices.
Discarding and Implementing Protocols: Integrate often-overlooked aspects of

discarding and implementing protocols into training modules.Continuous Monitoring
and Community Awareness: Conduct periodic protocol reviews, ensure continuous
monitoring, and initiate community awareness programs for a resilient infection control
framework.

23
CHAPTER 7
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The Role of PPE in Transmission of Infection in Operation Theater 1

PPE Transmission Research

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THE PERCEPTION OF OT PERSONNEL

REGARDING THE ROLE OF PERSONAL

Research Project Report

DEPARTMENT OF SURGICAL TECHNOLOGY

Research Project Report

DEPARTMENT OF SURGICAL TECHNOLOGY

Mr. Shah Hussain

External Examiner: ____________________

Demonstrator Surgical Technology KMU IPMS

Internal Examiner: ____________________

Mr. Wajid Jamil

Coordinator/Lecturer Surgical Technology

Head of Institute: ______________________

Name: Muhammad Rafay

Name: Afaq Ahmad

Name: Irfan Khan

Name: Jehangir Khan

Mr. Muhammad Rafay

Conclusion & Recommendations …….................................................................23

FIGURE 1 SHOWING THE USE OF FACE SHIELDS IN

TABLE 1 SHOWING EDUCATION LEVEL OF

1. HMC Hayatabad Medical Peshawar

2. Materials and Methods:

THE PERCEPTION OF OT PERSONNEL REGARDING THE

Operation theatre staff face a heightened risk of contracting blood-transmitted infections

The historical context of safeguarding healthcare workers and preventing infection

THE PERCEPTION OF OT PERSONNEL REGARDING THE

THE PERCEPTION OF OT PERSONNEL REGARDING THE

The utilization of Personal Protective Equipment (PPE) stands as a paramount strategy in

THE PERCEPTION OF OT PERSONNEL REGARDING THE

Respiratory Protection: Depending on the nature of the surgical procedure, N95

Aprons: An additional layer of protection, aprons are employed, particularly during

THE PERCEPTION OF OT PERSONNEL REGARDING THE

In [2020], the COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2,

THE PERCEPTION OF OT PERSONNEL REGARDING THE

In February 2020, Belgian authorities released guidelines outlining measures to combat

THE PERCEPTION OF OT PERSONNEL REGARDING THE

Overall, a comprehensive research approach to donning and doffing of PPE should

Hence, we assert that the development of an online module adhering to international

THE PERCEPTION OF OT PERSONNEL REGARDING THE

Personal Protective Equipment (PPE) items allocated to Dental Healthcare Personnel

Hospital-acquired infections (HAIs) within healthcare facilities stand as a significant

THE PERCEPTION OF OT PERSONNEL REGARDING THE

1.2 Literature review

PPE and the Spread of Infection:

PPE's Role in the COVID-19 Pandemic:

The COVID-19 pandemic highlighted the paramount importance of PPE in safeguarding

PPE in Preventing Nosocomial Infections:

THE PERCEPTION OF OT PERSONNEL REGARDING THE

• Assess The effectiveness of different Types of PPE In minimizing the Transmission

THE PERCEPTION OF OT PERSONNEL REGARDING THE

2.1 Study design:

The current study is descriptive cross-sectional study.

2.2 Study population:

2.3 Study duration:

Months from July 2023 to October 2023

2.4 Sampling Technique:

Non-Probability Convenience Sampling Technique

2.5 Sample Size:

Sample size for this study was 160

2.6 Sampling selection:

• Entrants Aged 25 & above...