Measuring the Self-Efficacy of Health Professionals in Hand Hygiene and Glove Usage during the COVID-19 Pandemic: A Brazilian Multicenter Observational Survey

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors measured the self-efficacy of health professionals for standard precautionary procedures, such as hand hygiene and the use of gloves, specific during the pandemic, and they did this as a multicenter study, which was conducted in Brazil. This field survey appears very promising, and provides very important qualitative information that supplements the existing literature.
However, they are areas of this work that can be improved, as follows:

a) the title would be better if it reads: "Measuring the self-efficacy of health professionals for hand hygiene and glove usage during COVID-19 pandemic: A Brazilian multicenter observational survey"

a) Introduction need additional information. Please authors combine the current version paragraphs one and two, as one paragraph ok. Then, COVID -19 is still an current global issue, so please look for the latest  2022/2023 publications as your reference, despite the fact that it began in later part of 2019.
Also, please dedicate second paragraph about the role of health professionals in pandemic situations, mention the various health professionals, their diversity of functions, and how they holistically contribute in elevating the quality of healthcare across the globe.
b) The methodology and results are well presented. Table 1, source is indicated as from Pereira et al. 2022...is it the entire Table? if yes, kindly justify why .
c) In your discussion, please kindly refer to Tables 2 and 3 in all the places where the data from each are being discussed. The reviewer expects to see (Refer to Table 2) or (Refer to Table 3) in various places in the discussion. This will help to guide the readers (as well as the reviewer)
Look forward to your revised manuscript.

Comments on the Quality of English Language

The english language needs a bit of sharpening. Authors can do it.

Author Response

Reviewer: 1

a) the title would be better if it reads: "Measuring the self-efficacy of health professionals for hand hygiene and glove usage during COVID-19 pandemic: A Brazilian multicenter observational survey"

Response: Thank you for the great title suggestion, which we accepted and added to the manuscript: "Measuring the self-efficacy of health professionals for hand hygiene and glove usage during COVID-19 pandemic: A Brazilian multicenter observational survey".

 

a) Introduction need additional information. Please authors combine the current version paragraphs one and two, as one paragraph ok. Then, COVID -19 is still an current global issue, so please look for the latest 2022/2023 publications as your reference, despite the fact that it began in later part of 2019. Also, please dedicate second paragraph about the role of health professionals in pandemic situations, mention the various health professionals, their diversity of functions, and how they holistically contribute in elevating the quality of healthcare across the globe.

Response: We have unified paragraphs 1 and 2 with the inclusion of current references in relation to COVID-19. Furthermore, we dedicate the second paragraph to multidisciplinary health.

“In December 2019 an epidemiological alert from World Health Organization (WHO) about a pneumonia of unknown cause, in China, turned into pandemic in March 2020. Such international public health emergency alerted the health professional community to the importance of precautionary procedures against a virus, identified as novel corona-virus (2019n-CoV) that, later, received official nomenclature of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1,2]. The disease caused by SARS-CoV-2 was named COVID-19 [2]. As of May 2023, nearly 766 million people were infected with COVID-19, and 6.94 million died worldwide [3]. The novel coronavirus has rapid spread and is mainly transmitted by droplets, aerosols, and respiratory secretions from infected people. Moreover, hands, surfaces, equipment, and fomites are important reservoirs in the transmission of SARS-CoV-2 to other people, by direct contact of hands with eyes, mouth, and/or nose [4]. Precautionary measures against contagion, recommended by WHO, were widely publicized by the media around the world, among them we can highlight those focused on attitudinal issues such as proper practice of hand hygiene (HH) and use of gloves [3]. Nonetheless, contradictory to such recommendation, Putrawan et al. (2021) demonstrated that HH compliance behavior was lower than adherence to glove usage in an intensive care unit during COVID-19 pandemic [5]. Additionally, HH compliance was poor at room entry during the first and second wave of the pandemic [6].

Different health professionals, including infectious disease specialists and emer-gency physicians, nurses, pharmacists, nutritionists, occupational therapists, physical therapists, physiologists, dental professionals etc., played a crucial role in pandemic situ-ations by providing a wide range of services aimed at mitigating the impact of the infec-tious disease. Their diversity of functions and expertise, along with their collective efforts, significantly contribute to improving the quality of healthcare across the globe during pandemics. The holistic contribution of these diverse health professionals enhanced the quality of healthcare during pandemics by addressing aspects related to prevention, di-agnosis, treatment, public health measures, and mental well-being. Their collaborative ef-forts were essential for effective pandemic response and the goal of safeguarding public health on a global scale [7].”.

 

b) The methodology and results are well presented. Table 1, source is indicated as from Pereira et al. 2022...is it the entire Table? if yes, kindly justify why .

Response: Yes, the Table 1 is the entire instrument validated by Pereira et al. (2022) and published in the Sustainability (Pereira EBS et al. Measuring the Self-Efficacy of Health Professionals for Practicing Hand Hygiene and Using Gloves: De-velopment and Validation of Instrument. Sustainability v. 14, p. 9486, 2022. https://doi.org/10.3390/su14159486). Thus, in the fifth paragraph of the material and methods, an explanation was added to make it clearer:

“The instrument, validated by Pereira et al. (2022) to evaluate self-efficacy of health professionals for HH and use of gloves (SEHP-HHG) has 19 items (Table 1), with con-tinuous response scale from 0 to 100 points, and the highest score corresponds to the greatest self-efficacy [23]. Together with the instrument of SEHP-HHG, a sociodemo-graphic questionnaire with questions about sex, age group, profession, education, pro-fessional course completion time (years in which the professional course was completed), and professional performance time (length of time the professional has worked during their training) was made available to study participants.”.

 

c) In your discussion, please kindly refer to Tables 2 and 3 in all the places where the data from each are being discussed. The reviewer expects to see (Refer to Table 2) or (Refer to Table 3) in various places in the discussion. This will help to guide the readers (as well as the reviewer).

Response: We agree with the consideration and “(Table 2) and/or (Table 3)” have been added where the results of the tables are described in the manuscript discussion.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Your paper entitled " Measuring the self-efficacy of health professionals for hand hygiene and using gloves during COVID-19 pandemic: a multicenter observational study" brings a useful contribution to the development of appropriate strategies for infection control in your country.

Please find below some recommendations for the improvement of the article.

In the Abstract section:

-the results of the study should be presented more concretely. For example, you could replace "Question 2" (line 25) with what it refers to, and "Question 14", too.

In the Introduction section:

-please add more detail about hand hygiene and gloves in relation with the COVID-19 pandemic

-the study objectives should be more precisely formulated.

In the Materials and Methods section:

-line 90: "School of Dentistry of the" - the sentence seems to need a continuation

-line 99: "according to the results obtained [17]" - please provide some details

-please provide details concerning the results of questionnaire validation

-please consider "gender" instead of "sex", throughout the entire manuscript

-please explain what "professional course completion time" and "professional performance time" mean

-Question 10 seems to be a little confusing, as hand hygiene and gloves wearing have precise indications and cannot replace each other

-lines 116-118 are part of the template and should be eliminated.

In the Results section:

-Table 2 - please change the title as to indicate exactly what it shows

-line 159-160 - please rephrase as it is confusing

-Table 3 - please pay attention to numbers expression in English (for example, 0.5 instead of 0,5)

-please add the detailed results of the statistical analysis, including the ones that were not statistically significant (they are part of the study results, too).

In the Discussion section:

-line 185: "A study showed..." - please give some details (year, country). The same for the study at line 213

-please reformulate the phrase between lines 230-233: "Conducted an online survey in cooperation with WHO through the application of Hand Hygiene Self-Assessment Framework (HHSAF) instrument [26], a self-administered questionnaire that aims at a systematic analysis of the HH situation in a health unit, measuring the level of HH implementation and their relationship with HAIs."

In the Conclusion section:

-please reformulate the conclusions of the study, so that they refer more concretely to its results.

Comments on the Quality of English Language

The article needs moderate editing of the English language.

Author Response

Reviewer: 2

In the Abstract section:

- the results of the study should be presented more concretely. For example, you could replace "Question 2" (line 25) with what it refers to, and "Question 14", too.

Response: We agree with the consideration. Thus, we added the results in a more concrete way to meet the maximum number of words in the abstract (200 words).

 

In the Introduction section:

- please add more detail about hand hygiene and gloves in relation with the COVID-19 pandemic

Response: We appreciate the suggestion and added a paragraph in the introduction section detailing the hand hygiene compliance behavior and use of gloves in the context of COVID-19 pandemic:

“Precautionary measures against contagion, recommended by WHO, were widely publicized by the media around the world, among them we can highlight those focused on attitudinal issues such as proper practice of hand hygiene (HH) and use of gloves [3]. Nonetheless, contradictory to such recommendation, Putrawan et al. (2021) demonstrated that HH compliance behavior was lower than adherence to glove usage in an intensive care unit during COVID-19 pandemic [5]. Additionally, HH compliance was poor at room entry during the first and second wave of the pandemic [6].”.

 

- the study objectives should be more precisely formulated.

Response: We reformulated the objectives of the manuscript to:

“Thus, the aim of this study was to evaluate whether health professionals consider their self-efficacy for HH and the use of gloves during the COVID-19 pandemic as well as verify the association between professional categories regarding whether they have self-efficacy for HH and glove usage.”.

 

In the Material and Methods section:

- line 90: "School of Dentistry of the" - the sentence seems to need a continuation

Response: We agreed with the consideration and changed the manuscript text to:

“According to the Resolution No. 466/2012, this Brazilian multicenter study was approved by the Research Ethics Committees of the University of São Paulo at Ribeirão Preto School of Dentistry (FORP-USP) – (CAAE: 39685720.0.0000.5419) and other coparticipants: University of São Paulo at Ribeirão Preto College of Nursing (EERP-USP) – (CAAE: 39685720.0.3002.5393); Federal University of Uberlândia (UFU) – (CAAE: 39685720.0.3001); and Clinical Hospital of the Federal University of Uberlândia (HC-UFU) – (CAAE: 39685720.0.3003.5152).”.

 

- line 99: "according to the results obtained [17]" - please provide some details

Response: We agreed with the consideration and added more details (“in data collection”) in the manuscript sentence.

 

- please provide details concerning the results of questionnaire validation

Response: We agreed with the consideration. Thus, the Table 1 is the entire instrument validated by Pereira et al. (2022) and published in the Sustainability (Pereira EBS et al. Measuring the Self-Efficacy of Health Professionals for Practicing Hand Hygiene and Using Gloves: De-velopment and Validation of Instrument. Sustainability v. 14, p. 9486, 2022. https://doi.org/10.3390/su14159486). Thus, in the fifth paragraph of the material and methods, an explanation was added to make it clearer:

“The instrument, validated by Pereira et al. (2022) to evaluate self-efficacy of health professionals for HH and use of gloves (SEHP-HHG) has 19 items (Table 1), with con-tinuous response scale from 0 to 100 points, and the highest score corresponds to the greatest self-efficacy [23]. Together with the instrument of SEHP-HHG, a sociodemo-graphic questionnaire with questions about sex, age group, profession, education, pro-fessional course completion time (years in which the professional course was completed), and professional performance time (length of time the professional has worked during their training) was made available to study participants.”.

 

- please consider "gender" instead of "sex", throughout the entire manuscript

Response: We decided to keep the “sex” term in the manuscript text according to the WHO that summarises the difference between sex and gender in the following way: Sex refers to “the different biological and physiological characteristics of males and females, such as reproductive organs, chromosomes, hormones, etc.” Gender refers to "the socially constructed characteristics of women and men – such as norms, roles and relationships of and between groups of women and men. It varies from society to society and can be changed. The concept of gender includes five important elements: relational, hierarchical, historical, contextual and institutional. While most people are born either male or female, they are taught appropriate norms and behaviours – including how they should interact with others of the same or opposite sex within households, communities and work places. When individuals or groups do not “fit” established gender norms they often face stigma, discriminatory practices or social exclusion – all of which adversely affect health.”.

 

- please explain what "professional course completion time" and "professional performance time" mean

Response: Professional course completion time: “(years in which the professional course was completed)”.

Professional performance time: “(length of time the professional has worked during their training)”.

In Brazil, some professionals work as technicians, but have higher education and, sometimes, continue in the technical profession until they obtain a position consistent with their professional training.

 

- Question 10 seems to be a little confusing, as hand hygiene and gloves wearing have precise indications and cannot replace each other

Response: The Table 1 is the entire instrument validated by Pereira et al. (2022) and published in the Sustainability (Pereira EBS et al. Measuring the Self-Efficacy of Health Professionals for Practicing Hand Hygiene and Using Gloves: De-velopment and Validation of Instrument. Sustainability v. 14, p. 9486, 2022.https://doi.org/10.3390/su14159486).

 

- lines 116-118 are part of the template and should be eliminated.

Response: We agreed with the consideration and eliminated it from the manuscript text.

 

In the Results section:

- Table 2 - please change the title as to indicate exactly what it shows

Response: We agreed with the consideration and Table 2 title was changed to: “Distribution of health professionals according to sociodemographic characteristics, education and other professional variables.”.

 

- line 159-160 - please rephrase as it is confusing

Response: We agreed with the consideration and rewrote the sentence to make it clearer:

“As for SEHP-HHG, the question most answered, by 167 (86.5%) professionals, with the maximum score (100 points) was Question 2 (How confident are you that hand hygiene and the use of gloves should be regular and frequent behaviors in your professional routine?).”.

 

- Table 3 - please pay attention to numbers expression in English (for example, 0.5 instead of 0,5)

Response: We agreed with the consideration and replaced all “,” with “.” in Table 3.

 

- please add the detailed results of the statistical analysis, including the ones that were not statistically significant (they are part of the study results, too).

Response: Thank you for the opportunity to add this information. We have performed this analysis previously and we did not find any association. We added this result in the manuscript as follow: “There is no association between being a physician, or nurse, or pharmaceutic, or other health professionals (except those cited and dentistry) and having or not self-efficacy (X² = 0.848; p = 0.488; X² = 0.505; p = 0.235; X² = 3.237; p = 0.104; and X² = 0.783; p = 0.411, respectively). It should be noted that a total of 57.1% physicians, 39.6% nurses, 20.0% pharmaceutics, and 55.6% other health professionals were classified as having self-efficacy. On the other hand, a significant association between being a dental pro-fessional and having self-efficacy (X² = 5.292; p = 0.031) was observed, with 64.1% of dental professionals having self-efficacy in relation to other professional categories. Additionally, we verified in each professional category the association of the level of education and time of work experience with having or not self-efficacy. We did not find any association between the level of education for physician, nursing, dentistry, pharmaceutics, or other health professionals (except those cited) with having or not self-efficacy (X² = 3.801; p = 0.553; X² = 0.690; p = 0.986; X² = 5.984; p = 0.327; and X² = 5.833; p = 0.222; and X² = 2.678; p = 0.851 respectively). Regarding the association between the time of work experience of physician, nursing, dentistry, pharmaceutics, or other health professionals (except those cited) with having or not self-efficacy, no statistical significant association was observed (X² = 2.771; p = 0.724; X² = 5.224; p = 0.405; X² = 2.413; p = 0.740; and X² = 5.833; p = 0.089; and X² = 1.157; p = 0.986 respectively).”.

 

In the Discussion section:

- line 185: "A study showed..." - please give some details (year, country). The same for the study at line 213

Response: We agreed with the consideration and added these details in the manuscript text:

“A 2021 study in France showed that most health professionals who worked on the front lines of combating the COVID-19 pandemic were nursing professionals [25].”.

…“On the other hand, a study carried out in the USA in 2021 evaluated the opportunities of 50 nurses to perform HH in patient health care.”.

“In 2019, an online survey was conducted in cooperation with WHO through the application of Hand Hygiene Self-Assessment Framework (HHSAF) instrument [31], a self-administered questionnaire that aims at a systematic analysis of the HH situation in a health unit, measuring the level of HH implementation and their relationship with HAIs.”.

 

- please reformulate the phrase between lines 230-233: "Conducted an online survey in cooperation with WHO through the application of Hand Hygiene Self-Assessment Framework (HHSAF) instrument [26], a self-administered questionnaire that aims at a systematic analysis of the HH situation in a health unit, measuring the level of HH implementation and their relationship with HAIs."

Response: We agreed with the consideration and rewrote the sentence to make it clearer:

“In 2019, an online survey was conducted in cooperation with WHO through the application of Hand Hygiene Self-Assessment Framework (HHSAF) instrument [31], a self-administered questionnaire that aims at a systematic analysis of the HH situation in a health unit, measuring the level of HH implementation and their relationship with HAIs.”.

 

In the Conclusion section:

- please reformulate the conclusions of the study, so that they refer more concretely to its results.

Response: We agree with the consideration and reformulated the manuscript conclusion to:

“Among health professional categories (dental professionals, physicians, nurses, pharmaceutics, and other health professionals), the dental professionals showed the highest frequency of self-efficacy regarding HH and glove usage during the COVID-19 pandemic. In addition, there was only a significant association between being dental professionals and having self-efficacy in relation to other health professional categories.”.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The study is interesting because it evaluates the self-efficacy of groups of health professionals for hand hygiene and glove use during the COVID-19 pandemic.

However, I have some observations to make:

Different categories of health professionals were considered but few results emerged regarding the categories medics, pharmacists and other health professionals.

In the categories of health professionals analysed, how much did the sociodemographic characteristics influence the answers obtained from the SEHP-HHG evaluation questionnaire? Did professionals with more work experience or those with a higher level of education give different answers than the others?

This information is important to identify weak points on which to act to promote the development of self-efficacy in healthcare professionals.

Author Response

Reviewer: 3

In the categories of health professionals analysed, how much did the sociodemographic characteristics influence the answers obtained from the SEHP-HHG evaluation questionnaire? Did professionals with more work experience or those with a higher level of education give different answers than the others? This information is important to identify weak points on which to act to promote the development of self-efficacy in healthcare professionals.

Response: Thank you for the opportunity to add this information. We have performed this analysis previously and we did not find any association. We added this result in the manuscript as follow: “There is no association between being a physician, or nurse, or pharmaceutic, or other health professionals (except those cited and dentistry) and having or not self-efficacy (X² = 0.848; p = 0.488; X² = 0.505; p = 0.235; X² = 3.237; p = 0.104; and X² = 0.783; p = 0.411, respectively). It should be noted that a total of 57.1% physicians, 39.6% nurses, 20.0% pharmaceutics, and 55.6% other health professionals were classified as having self-efficacy. On the other hand, a significant association between being a dental pro-fessional and having self-efficacy (X² = 5.292; p = 0.031) was observed, with 64.1% of dental professionals having self-efficacy in relation to other professional categories. Additionally, we verified in each professional category the association of the level of education and time of work experience with having or not self-efficacy. We did not find any association between the level of education for physician, nursing, dentistry, pharmaceutics, or other health professionals (except those cited) with having or not self-efficacy (X² = 3.801; p = 0.553; X² = 0.690; p = 0.986; X² = 5.984; p = 0.327; and X² = 5.833; p = 0.222; and X² = 2.678; p = 0.851 respectively). Regarding the association between the time of work experience of physician, nursing, dentistry, pharmaceutics, or other health professionals (except those cited) with having or not self-efficacy, no statistical significant association was observed (X² = 2.771; p = 0.724; X² = 5.224; p = 0.405; X² = 2.413; p = 0.740; and X² = 5.833; p = 0.089; and X² = 1.157; p = 0.986 respectively).”.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

I am satisfied with the authors' response.

Well done.

Author Response

Thank you, we appreciate the reviewer's considerations.