PONE-D-22-12028Pre-COVID-19 knowledge, attitude and practice among nurses towards infection prevention and control in Bangladesh: A hospital-based cross-sectional surveyPLOS ONE

Dear Dr. Harun,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

This is an interesting and valuable study of the infection control knowledge, attitudes, and practices among nurses at a large hospital in Bangladesh. While there are strengths of the study that make it worth publishing, the reviewers have identified several weaknesses that will need to be addressed. Please make the following required changes before resubmitting the manuscript:

1. Referring to comment #1 from Reviewer #1, please include information on whether the study site had an infection prevention and control program at the time the study was conducted.

2. Referring to comment #2 from Reviewer #1, please provide additional citations for the development of the questionnaire.

3. Referring to comment #3 from Reviewer #1, please specify in the methods section how the questionnaire was evaluated and what changes were made after the evaluation process.

4. Referring to comment #6 from Reviewer #1, it seems that the questionnaire has been translated into English, but the translation includes several errors that can create confusion in interpreting the results of the study. For example, it is unclear what is being asked in the item “All staff working in the hospital word /carefully deal with the patient should be considered potentially infection control guideline”. For the item “What resources/ supplies needed to comply with infection prevention guidelines”, it is not clear whether this was a generic question about whether nurses felt that they know what supplies are needed, or whether nurses were asked to identify specific supplies. A third example is the item “Bathing after sending time in infection suspected areas in hospital is for avoiding safety from infection”. As there are several more examples of confusing questionnaire items, the authors will need to review the translation of the questionnaire and ensure that it accurately represents the questions that were asked of the participants. The manuscript as a whole will also benefit greatly by being reviewed for grammar and spelling errors.

5. Please address the comment from Reviewer #2 regarding your questionnaire item that states that “Stethoscope must be cleaned/sterilized before and after every patient examine”.

6. Please address the comment from Reviewer #2 regarding the statement “it is recommended that the use of glutaraldehyde for at least 10 minutes for sterilizing surgical and ward instruments”.

For Lab, Study and Registered Report Protocols: These article types are not expected to include results but may include pilot data. 

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Please submit your revised manuscript by Nov 12 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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We look forward to receiving your revised manuscript.

Kind regards,

Cindy Prins

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In this well written paper, Harun and co-workers have constructed a questionnaire to investigate nurses' knowledge, attitudes and practices regarding infection prevention and control. The theme is timely and important. The statistical methods are sound and the results are clearly presented and easy to understand.

I have only minor comments and suggestions:

1. Study design and setting: Please write whether or not the institution had impelemented an infection control and prevention programme at the time of the study. If ypu like, the descritpion of the progamme could e.g. be compared to the core competencies of infection prevention and control as described by WHO: https://apps.who.int/iris/bitstream/handle/10665/335821/9789240011656-eng.pdf. Maybe this is a relevant reference for justifying some of the questions you ended up wih.

2. Methods, line 133-135: The authors state that the questionnaire was developed based on litterature reviews and expert opinion. The only reference to litterature is reference 25, a master thesis. Please state examples of other litterature sources (e. g. I see that one of the questions refers to WHO's "5 moments for hand hygiene").

3. Line 135: How was the questionnaire evaluated? Were there made adjustments after evaluation? Please add this information to the manuscript.

4. Line 162: Educational level was also part of the analyses and should be added along side socioeconomic and demographic variables.

5. Discussion: it would be interesting to hear whether or not you would recommend this tool to be used in other instiutions, whether it could be used internationally and what adaptions that might be necessary for a broader use.

6. Appendix. Please check the translation of the questionnaire as there are several mis-spellings and incomplete sentences.

Please check spelling in line 39, 89, 230, 303 and table 2 (monthly family ...) and in the translated questionnaire.

Reviewer #2: Dear authors

We believe that this research question you have embraced is extremely important. It is crucial to explore and understand Knowledge, attitudes and practices related to the prevention of healthcare acquired infections as a means of improving educational approaches. In this regard, we encourgae you to continue the research.

However, this work has important flaws. There are mistaken concepts of healthcare infection prevention. As examples, in Table4, section "universal precautions" you state that stethoscopes should be cleaned/sterilized before and after patient "examine". Stethoscopes are considered non critical items as they get in touch with the skin of patients, so they need low level disinfection after the patient examination. If there are skin lesions or the patient is in contact precautions due to colonization/infection by a multidrug resistant pathogen, non critical items should be dedicated to the patient (preferably, if you have such items available). Another example of misconception is the exposition time of medical devices/equipments to glutaraldehyde. In line 297 you state that "it is recommended that the use of glutaraldehyde for at least 10 minutes for sterilizing surgical and ward instruments". This is not correct. For chemical sterilization it is required 8 to 10 hours of exposition of glutaraldehyde. I suggest a look at https://www.cdc.gov/infectioncontrol/guidelines/disinfection/tables/table1.html for the revision of methods of sterilization and disinfection of medical items.

Table 4 is intended to scrutinize Knowledge of nurses about HAIs prevention. However, they have generic questions about the existance of guidelines and do not explore the knowledge of principles of infection prevention like routes of pathogen transmission, universal and specific precautions (aerossol/droplets), modes of cleaning/disinfection/sterilization of items, immunization, good practices of invasive devices care (ex. central venous catheters), reuse of items (syringes, needles), waste management just to stay with some examples. Thechnical concepts of infection should be thoroughly revised.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-22-12028R1Pre-COVID-19 knowledge, attitude and practice among nurses towards infection prevention and control in Bangladesh: A hospital-based cross-sectional surveyPLOS ONE

Dear Dr. Harun,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Thank you for revising and resubmitting your manuscript, “Pre-COVID-19 knowledge, attitude and practice among nurses towards infection prevention and control in Bangladesh: A hospital-based cross-sectional survey”. Most of the reviewers' comments have been addressed adequately with the exception of two issues.

The first issue relates to the knowledge item about glutaraldehyde sterilization. In the original manuscript, responses to the survey item “A contaminated item soaked in glutaraldehyde for 10 minutes is sterilized” were listed as 29% “Correct” and 71% “Incorrect”. Reviewer #2 had commented that “In line 297 you state that "it is recommended that the use of glutaraldehyde for at least 10 minutes for sterilizing surgical and ward instruments". This is not correct. For chemical sterilization it is required 8 to 10 hours of exposition of glutaraldehyde.”

The text in the original manuscript’s results section (lines 202 – 206) stated, “On the contrary, a low percentage of correct answers were found for knowledge questions related to the resources needed to comply with infection prevention guidelines (23.3%), bending used needles (4.3%), drenching in glutaraldehyde for 10 minutes for decontamination (29.0%) and compliance with IPC guideline even in heavy workload (40.3%)”.

This indicates that the responses to this survey item were originally considered to be correct if a respondent agreed that an item could be sterilized if soaked in glutaraldehyde for 10 minutes. In the revised manuscript, the authors added the following to the discussion (lines 298-300), “It is recommended that the use of glutaraldehyde for 10 hours at 20-35°C for sterilizing surgical and ward instruments is a recommended approach (34). In our study, only 29% of the nurses knew how to properly use this chemical.” However, the survey item still contains the original statement “A contaminated item soaked in glutaraldehyde for 10 minutes is sterilized” and the response rates are the same as they were in the previous version. There is a major concern about what time frame the survey item originally stated (10 minutes versus 10 hours) and why the percentage of “correct” and “incorrect” responses remains the same in the revised manuscript. If a respondent answered that 10 minutes was not adequate then they actually had the right answer, which would indicate that 71% of respondents were “Correct” instead of “Incorrect”. The authors must address this issue and assure that those results are presented consistently and accurately throughout the manuscript.  

The second issue that needs to be addressed is the survey item “All staff working in the hospital should follow the IPC instructions and carefully deal with the patient is considered a potential infection control practice”. The translation of this item to English is confusing and thus the meaning of the item is unclear.  The first part of the item (All staff working in the hospital should follow the IPC instructions) does not need to be changed but the second part of the item (and carefully deal with the patient is considered a potential infection control practice) needs to be edited for clarity.

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Please submit your revised manuscript by Dec 12 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Cindy Prins

Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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Pre-COVID-19 knowledge, attitude and practice among nurses towards infection prevention and control in Bangladesh: A hospital-based cross-sectional survey

PONE-D-22-12028R2

Dear Dr. Harun,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Cindy Prins

Academic Editor

PLOS ONE

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