Compliance with the national personal protective equipment guideline for COVID-19 among hospitals in Indonesia: a cross-sectional study.

BACKGROUND

The use of personal protective equipment (PPE) is essential to protect healthcare workers (HCWs) involved in COVID-19 care. In April 2020, the Ministry of Health of Indonesia issued a national PPE guideline for COVID-19, recommending specific PPE use across 15 situations based on location, personnel and activities. This study aimed to investigate the compliance with these recommendations in Indonesian hospitals, based on infection prevention and control (IPC) committee reporting, and to describe related challenges.

METHODS

A cross-sectional study was conducted in Indonesia from July to November 2021. Questionnaires were distributed to the hospitals' IPC committees. Responses to PPE questions were compared with the national guideline and categorised into underuse, compliant, overuse and simultaneous underuse and overuse per situation. Additional questions addressed HCW screening and environmental disinfection.

RESULTS

A total of 355 hospitals participated, of which 80.3% were COVID-19 referral hospitals. Overall compliance with the national PPE guideline was low (median 1 of 15 situations), while overuse predominated (median 7 of 15 situations). PPE items not recommended by the national guideline, including coveralls, double masking and N95 masks (situations without aerosol-generating procedures (AGPs)), were reported. Conversely, N95 mask use in AGP situations where it is mandatory was reported at <100%. Compliance in AGP situations was significantly associated with hospital characteristics, including COVID-19 referral status and hospital class (p<0.05). Most hospitals (85.4%) performed regular screening for COVID-19 in HCWs, mostly by screening body temperature (65.4%). A hypochlorite-based product was the most commonly used disinfectant (60.8%). The most frequently reported challenge was excessive PPE use by HCWs.

CONCLUSIONS

Compared with the national guideline, PPE compliance in most Indonesian hospitals was low with overuse most frequently observed. Overuse has implications for cost and environmental sustainability, whereas reduced compliance with the use of N95 masks in AGP raises safety concerns for HCWs and requires attention.