Infection Prevention & Control Knowledge, Attitudes and Practices among Canadian Physiotherapists in Pelvic Health : A Survey-Based Study

Abstract

ABSTRACT

Background: As we have observed unfortunately during the recent COVID-19 pandemic, all healthcare professionals are at a high risk of both acquiring and spreading infections. This includes physiotherapists working in pelvic health. If proper guidelines for infection control measures are lacking, there may be an increased risk of infection transmission. It is known that health-related behaviours are affected by knowledge, attitudes and practices. Yet, no studies exploring these concepts have been conducted in pelvic health physiotherapy practice, where assessment and treatment approaches can involve practices that are more invasive in nature than other areas of physiotherapy practice.

Objective: To explore the Knowledge, Attitudes, Practices & Clinical Settings (KAP) pertaining to infection prevention and control (IPAC) among Canadian physiotherapists working in pelvic health.

Methods: This was a cross-sectional, observational study that received ethic approval (University of Ottawa, #H-10-19-4764). Using a convenient sampling approach, Canadian pelvic health physiotherapists were recruited through pelvic health physiotherapy groups on social media and a Canadian continuing education provider. Between May 6th and 22, 2020, while clinics were closed, participants completed an investigator designed on-line questionnaire pertaining to respondents’ KAP using current best-practices. The questionnaire was comprised of 78 closed & open-ended questions and options to provide comments as well general demographic information. An exploratory data & descriptive analysis was performed. For open-ended questions, thematic coding was conducted.

Results: A total of 80 eligible physiotherapists completed the questionnaire. Results of this study revealed that participants achieved a mean score of 17.95/24 (74.8±10%) pertaining to IPAC on the knowledge section of the survey, a mean score of 8.87/10 (88.7±11.6) on recommended IPAC practices and a mean score of 9.09/14 (64.9±19%) on desirable attribute of clinical settings in terms of IPAC. Although physiotherapists’ 2-Attitudes: hepatitis B & influenza vaccination were perceived by a large proportion of respondents (33/70 and 41/80 respectively) as being somewhat or not important; vaccine uptake was 70/80 and 44/80 respectively. 3-Practices: non-bacteriostatic single packet lubricant is not universally used (23/80) for intravaginal/intra-anal palpation, and intra-rectal balloon catheters are used repeatedly in a given patient by most (19/30) physiotherapists who use them. 4-Clinical setting: 30% of participants (24/78) were not aware of infection control guidelines in the workplace prior to COVID-19, where some clinics (22/78) were carpeted and more than half (41/77) did not have a dedicated sink for cleaning equipment or handwashing (i.e. shared with kitchen or washroom).

Conclusions: While our findings demonstrate that pelvic health physiotherapists in Canada were generally following IPAC recommendations, some problematic KAP on IPAC were observed. Further studies should look into the impact of IPAC training for pelvic health physiotherapists, and the evolution of IPAC KAP throughout the COVID-19 pandemic.

Implications: This study identifies behaviours and practices that may hinder optimal IPAC in pelvic health physiotherapy practice. These findings provide guidance for the development of IPAC training and guidelines for pelvic health physiotherapy practice.

Keywords: Infection Control, Pelvic Health Physiotherapy, KAP survey.

Funding: This project was unfunded.

Full text

Marylène Charette PT1
Judy King PT, PhD2
Linda McLean PT, PhD2
1Population Health, University of Ottawa
2 Rehabilitation Sciences, University of Ottawa
Infection Prevention & Control Knowledge, Attitudes
and Practices among Canadian Physiotherapists in
Pelvic Health : A Survey-Based Study
© 2021 Marylène Charette

Marylène Charette
Received approval by:
The Health Sciences
and Sciences Research
Ethics Board
(University of Ottawa,
#H-10-19-4764)
I have no conflicts of interest
to disclose
Funding: This project was
unfunded
© 2021 Marylène Charette

Meet Alex
5-10
years
35-44 years old
Self-
employed
© 2021 Marylène Charette

Her practice
Treatment time:
45 minutes
Appointments:
11-20
patients/week
IPAC training:
Little (approx 1h)
Neutral on
«is it enough?»
Clientele:
>18 years old,
Male/Female
© 2021 Marylène Charette

To explore the
Knowledge, Attitudes,
Practices & Clinical
Settings (KAPs)
pertaining to infection
prevention and
control (IPAC)
among Canadian
physiotherapists
working in pelvic health.
Objective
© 2021 Marylène Charette

RESULTS
80 Participants
© 2021 Marylène Charette

Knowledge
Average: 74.8% ±10%
Medical gel recommandations Mode of transmission of infections
© 2021 Marylène Charette

Attitudes
Not at all important 3%
Not so important
10%
Somewhat
important
29%
Very
important
29%
Extremely
important
29%
Hepatitis B
Vaccinated: 70/80
Belief about importance
of vaccination:
Not at all important 4%
Not so
important
20%
Somewhat
important
27%
Very
important
21%
Extremely
important
28%
Influenza
Vaccinated: 44/80
Belief about importance
of vaccination:
© 2021 Marylène Charette

Attitudes –Contraction & Transmission
9
21
46
8
10
13
16
7
28
7
8
19
7
43
41
5
5
4
5
5
34
3
9
18
# OF PARTICIPANTS
Worried to contract Worried to transmit
Figure 4: Comparing number of PTs worried to contract vs. worried to transmitted different type of infections
© 2021 Marylène Charette

Practices
Average: 88.7% ±11.6%
© 2021 Marylène Charette

Practices –Equipment Cleaning
Ultrasound probe (external)
•Approximately 1/4 PTs using US are not
disinfecting the probe between patient.
Vaginal probe
•Single-patient use
•Clean it with soap and water
•Put it in a plastic bag for the patient to bring home
Gym equipment
•More than 1/2 PTs are only cleaning gym
equipment « sometimes/rarely »
© 2021 Marylène Charette

Pessaries
•Used by 21/80 PTs
•12/21 send it to a
contractor to autoclave
•12/16 PTs said having
received proper training
to CIDEX/Autoclave.
Practices –Specific skills
Rectal balloon
catheters
•Used by 31/80 PTs
•19/30 PTs use it more
than once with the
same patient.
© 2021 Marylène Charette

Clinical Setting
Average: 64.9% ±19%
© 2021 Marylène Charette

CONCLUSION
© 2021 Marylène Charette

How can Alex improve?
Update her knowledge
Advocate for better settings
Follow IPAC guidelines
already in place.
Discard the rectal
balloon catheter after
each use
Continue the good work
she is already doing
Reflect on her attitudes and
beliefs concerning IPAC.
Follow recommendations on medical gel:
•Single packet of bacteriostatic lubricant
•Advocate for clinic owner to buy single-use
bottles of US gel; discard it afterwards
Don’t come to work if sick
or wear appropriate PPE
if not possible.
© 2021 Marylène Charette

Do you recognize yourself in some of Alex’s KAPs?
Your practice in Pelvic Health?
© 2021 Marylène Charette

Follow-us:http://mfmlab.ca/ @mfmlabuottawa
@mfmlab
@mfm_lab
Contact info: mchar239@uottawa.ca
© 2021 Marylène Charette