Beneath the mask: evaluating compliance with the guidelines for facemask use and bacteria contamination amongst healthcare workers with patient contacts at a Nigerian Tertiary Healthcare Facility

Olufemi O. AlukoDepartment of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria

Abisola M. OjebolaDepartment of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria

Adediwura O. OkeleyeDepartment of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria

Mayowa W. OlaoyeDepartment of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria

Samuel O. OnyekweliDepartment of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria

Olusegun T. AfolabiDepartment of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria

Olaniran OlarindeDepartment of Medical Microbiology, Obafemi Awolowo University, Ile-Ife, Nigeria

DOI:

https://doi.org/10.3396/ijic.v21.23783

Keywords:

facemasks, drug-resistant bacteria, antimicrobial sensitivity tests, COVID-19, healthcare workers

Abstract

Healthcare workers (HCWs) are the first responders in healthcare facilities and are disproportionately exposed to infectious diseases. Facemask is a potential barrier to containing the spread of infectious droplets, aerosols and contaminated surfaces. This study isolated the bacterial contamination associated with using facemasks amongst HCWs interacting with patients. This research utilised the descriptive cross-sectional study design to obtain data from 161 HCWs selected through a multi-stage sampling technique. 2 mm × 2 mm of nose and mouth regions of facemasks were aseptically collected and cultured using standard methods. Antibiotic sensitivity tests were done using standard diagnostic kits. Most (61.5%) of HCWs were females, and 70.8% were between 20 and 39 years. 39.1%, 31.7%, 14.3% and 9.9% were nurses, doctors, health attendants and laboratory technicians, respectively. In this study, 62.7% and 49.7% had a good perception of WHO guidelines for using and removing facemasks, respectively. 74.5% of HCWs volunteered their used facemasks, and 25.6% had growth when cultured. The predominant bacteria isolates were Enterobacter agglomerans (62.5%), Proteus stuarti (28.1%) and Morganella morganii (9.4%) and 96.9% resistant to Augmentin and Ceftazidime, 93.8% were resistant to Cefuroxime and 87.5% were resistant to Cefixime with the highest zones of inhibition to Ofloxacin. Most HCWs have good knowledge but fail to practice the appropriate guidelines for facemask use. Facemasks harbour nosocomial organisms, and many of them are resistant to common antibiotics.

 

How to Cite:

Aluko, O. O., Ojebola, A. M., Okeleye, A. O., Olaoye, M. W., Onyekweli, S. O., Afolabi, O. T., & Olarinde, O. (2025). Beneath the mask: evaluating compliance with the guidelines for facemask use and bacteria contamination amongst healthcare workers with patient contacts at a Nigerian Tertiary Healthcare Facility. International Journal of Infection Control, 21. https://doi.org/10.3396/ijic.v21.23783

References

  1. Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369: m1435. doi: 10.1136/BMJ.M1435

  2. World Health Organization. Mask use in the context of COVID-19. 2020. Available from: https://www.ashrae.org/technical-resources/resources [accessed 4 Apr 2024].

  3. Goh Y, Tan BYQ, Bhartendu C, Ong JJY, Sharma VK. The face mask: how a real protection becomes a psychological symbol during Covid-19? Brain Behav Immun 2020; 88: 1–5. doi: 10.1016/J.BBI.2020.05.060

  4. MacIntyre CR, Chughtai AA. Facemasks for the prevention of infection in healthcare and community settings. BMJ 2015; 350: h694. doi: 10.1136/BMJ.H694

  5. NCDC. Infection prevention and control and confirmed cases of COVID-19. 2020, pp. 2–14. Available from: https://covid19.ncdc.gov.ng/guideline/%0A2 [cited 17 April 2022].

  6. Lepelletier D, Grandbastien B, Romano-Bertrand S, Aho S, Chidiac C, Géhanno JF, et al. What face mask for what use in the context of the COVID-19 pandemic? The French guidelines. J Hosp Infect 2020; 105(3): 414–18. doi: 10.1016/J.JHIN.2020.04.036

  7. FDA. N95 respirators, surgical masks, face masks, and barrier face coverings. Official U.S Government; 2021. Available from: https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings [cited 10 February 2022].

  8. European Union Aviation Safety Agency. What is meant by a ‘medical face mask’? European Union Aviation Safety Agency; 2021, p. 1. Available from: https://www.easa.europa.eu/faq/115286 [cited 10 February 2022].

  9. World Health Organization. Mask use in the context of COVID-19. World Health Organization; 2020, pp. 1–10. Available from: https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak [cited 10 February 2022].

  10. Li H, Yuan K, Sun Y-K, Zheng Y-B, Xu Y-Y, Su S-Z, et al. Efficacy and practice of facemask use in general population: a systematic review and meta-analysis. Transl Psychiatry. 2022; 12(49). doi: 10.1038/s41398-022-01814-3

  11. Delanghe L, Cauwenberghs E, Spacova I, De Boeck I, Van Beeck W, Pepermans K, et al. Cotton and surgical face masks in community settings: bacterial contamination and face mask hygiene. Front Med 2021; 8: 1477. doi: 10.3389/FMED.2021.732047/BIBTEX

  12. Khan HA, Ahmad A, Mehboob R. Nosocomial infections and their control strategies. Asian Pac J Trop Biomed 2015; 5(7): 509–14. doi: 10.1016/J.APJTB.2015.05.001

  13. Luksamijarulkul P, Aiempradit N, Vatanasomboon P. Microbial contamination on used surgical masks among hospital personnel and microbial air quality in their working wards: a hospital in Bangkok. Oman Med J 2014; 29(5): 346. doi: 10.5001/OMJ.2014.92

  14. Pittet D, Allegranzi B, Storr J, Donaldson L. ‘Clean care is safer care’: the global patient safety challenge 2005–2006. Int J Infect Dis 2006; 10(6): 419–24. doi: 10.1016/J.IJID.2006.06.001

  15. Liao M, Liu H, Wang X, Hu X, Huang Y, Liu X, et al. A technical review of face mask wearing in preventing respiratory COVID-19 transmission. Curr Opin Colloid Interface Sci 2021; 52: 101417. doi: 10.1016/J.COCIS.2021.101417

  16. Lan F-Y, Christophi CA, Buley J, Iliaki E, Bruno-Murtha LA, Sayah AJ, et al. Effects of universal masking on Massachusetts healthcare workers’ COVID-19 incidence. Occup Med 2020; 70: 606–9. doi: 10.1093/occmed/kqaa179

  17. Romano-Bertrand S, Carré Y, Aho Glélé LS, Lepelletier D. How to address SARS-CoV-2 airborne transmission to ensure effective protection of healthcare workers? A review of the literature. Infect Dis Now 2021; 51(5): 410–17. doi: 10.1016/j.idnow.2021.05.005

  18. Lee LYK, Lam EPW, Chan CK, Chan SY, Chiu MK, Chong WH, et al. Practice and technique of using face mask amongst adults in the community: a cross-sectional descriptive study. BMC Public Health 2020; 20(1): 948. doi: 10.1186/S12889-020-09087-5

  19. Ejeh FE, Saidu AS, Owoicho S, Maurice NA, Jauro S, Madukaji L, et al. Knowledge, attitude, and practice among healthcare workers towards COVID-19 outbreak in Nigeria. Heliyon 2020; 6(11): e05557. doi: 10.1016/J.HELIYON.2020.E05557

  20. Tadesse T, Tesfaye T, Alemu T, Haileselassie W. Healthcare worker’s knowledge, attitude, and practice of proper face mask utilization, and associated factors in police health facilities of Addis Ababa, Ethiopia. J Multidiscip Healthc 2020; 13: 1203. doi: 10.2147/JMDH.S277133

  21. Aluko OO, Adebayo AE, Adebisi TF, Ewegbemi MK, Abidoye AT, Popoola BF. Knowledge, attitudes and perceptions of occupational hazards and safety practices in Nigerian healthcare workers. BMC Res Notes 2016; 9(1): 71. doi: 10.1186/S13104-016-1880-2

  22. Bolarinwa O. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger Postgrad Med J 2015; 22(4): 195. doi: 10.4103/1117-1936.173959

  23. Khan LB, Swift S, Kamal T, Read HM. Simulation of MICROBACT strip assay using colored liquids to demonstrate identification of unknown gram-negative organisms in undergraduate laboratory. J Microbiol Biol Educ 2018; 19(2): 19.2.76. doi: 10.1128/jmbe.v19i2.1565

  24. Aluko OO, Udechukwu JN, Arowosafe PO, Loto OA, Ojogba GO, Orisawayi O, et al. Attitudes Towards Menstrual Health by Female In-School Adolescents: A Comparative Cross-Sectional Study in Southwest Nigeria. Women’s Reproductive Health. 2023. Available from: https://www.tandfonline.com/doi/abs/10.1080/23293691.2023.2287528 [cited 16 April 2024].

  25. Duong MC, Nguyen HT, Duong BT. A cross-sectional study of knowledge, attitude, and practice towards face mask use amid the COVID-19 pandemic amongst university students in Vietnam. J Community Health 2021; 46(5): 975–81. doi: 10.1007/s10900-021-00981-6

  26. Peng Y, Pei C, Zheng Y, Wang J, Zhang K, Zheng Z, et al. A cross-sectional survey of knowledge, attitude and practice associated with COVID-19 among undergraduate students in China. BMC Public Health 2020; 20(1): 1292. doi: 10.1186/s12889-020-09392-z

  27. Kumar J, Katto MS, Siddiqui AA, Sahito B, Jamil M, Rasheed N, et al. Knowledge, attitude, and practices of healthcare workers regarding the use of face mask to limit the spread of the new coronavirus disease (COVID-19). Cureus 2020; 12(4): e7737. doi: 10.7759/cureus.7737

  28. WHO. Infection prevention and control assessment framework at the facility level. Introd User Instruct 2018; 2016: 1–15. Available from: http://www.who.int/infection-prevention/ [cited 12 May 2020].

  29. Akpoka OA, Enaigbe AA, Irodi CC. Bacterial contaminations of used face masks collected from different clinical sections in a university teaching hospital during Covid-19 pandemic crises in Nigeria. Bacter Emp 2021; 4(1): 8–10. doi: 10.36547/be.2021.4.1.8-10

  30. Brauer M, Zhao JT, Bennitt FB, Stanaway JD. Global access to handwashing: implications for COVID-19 control in low-income countries. Environ Health Perspect 2020; 128(5): 057005. doi: 10.1289/ehp7200

  31. Alzyood M, Jackson D, Aveyard H, Brooke J. COVID-19 reinforces the importance of handwashing. J Clin Nurs 2020; 29(15–16): 2760–1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267118/ [cited 31 August 2020].

  32. Wodnik B, Freeman M, Ellis A, Awino Ogutu E, Webb Girard A, Caruso B. Development and application of novel caregiver hygiene behavior measures relating to food preparation, handwashing, and play environments in rural Kenya. Int J Environ Res Public Health 2018; 15(9): 1994. doi: 10.3390/ijerph15091994

  33. Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt WP. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health 2011; 8(1): 97–104. doi: 10.3390/ijerph8010097

 

Copyright (c) 2025 Olufemi O. Aluko, Abisola M. Ojebola, Adediwura O. Okeleye, Mayowa W. Olaoye, Samuel O. Onyekweli, Olusegun T. Afolabi, Olaniran Olarinde

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors retain copyright of their work, with first publication rights granted to IJIC. Read the full Copyright- and Licensing Statement.

Previous
Previous

Evaluation of occupational exposure in healthcare workers via a trio-strategy of pre-KAP survey, educational intervention, and post-KAP survey

Next
Next

A scoping review of published reports of the infection prevention and control assessment framework: a comparison to the findings of the global report on infection prevention and control