The Role of Infection Control Measures in Ophthalmology: Do They Prevent COVID-19 Infection Among Ophthalmologists in Egypt? A Survey-Based Study

Figures & data

Table 1 Relation Between Socio-Demographic Characteristics and COVID-19 Infection

Characteristics	Total N (%)	Infected with COVID-19 N (%)	p-value
Age
Age groups (years)
≤34	82.0 (50.9)	51.0 (62.2)
>34	79.0 (39.1)	34.0 (43.0)	0.015
Sex
Male	69.0 (42.8)	35 (50.7)
Female	92.0 (57.2)	50.0.0 (54.3)	0.649
Marital status
Single	50.0 (31.1)	25.0 (50.0)
Married	111.0 (68.9)	60.0 (54.1)	0.634
Job title
Resident	40.0 (24.8)	25.0 (62.5)
Assistant lecturer/Specialist	63.0 (39.1)	36.0 (57.1)
Consultant	19.0 (11.8)	8.0 (42.1)
Lecturer	39.0 (24.2)	16.0 (41.0)	0.170
Place of work
Educational institute	13.0 (8.1)	9 (69.2)
Ministry of health	29.0 (18.0)	17 (58.6)
Private	22.0 (13.7)	13 (59.1)
University hospital	97.0 (60.2)	46 (47.4)	0.351
Subspecialty
Cornea and refractive	55 (34.2)	27.0 (49.1)
Investigative	20 (12.4)	8.0 (40.0)
Pediatric	20 (12.4)	12.0 (60.0)
Retina	23 (14.4)	13.0 (56.5)
Oculoplastic	18 (11.2)	11.0 (61.9)
Glaucoma	12 (7.5)	8.0 (66.7)
Others*	13 (8.1)	6.0 (46.2)	0.701
Number of years in ophthalmology practice
<10	108.0 (67.1)	66.0 (61.1)
≥10	53.0 (32.9)	19.0 (35.8)	0.003

Notes: N (%) Values are presented as number (%). *Other subspecialties include strabismus, uveitis and neuro-ophthalmology.

Table 2 Beliefs of Ophthalmologists About COVID-19 and COVID-19 Infection and Vaccination

Characteristics	Total N (%)	Participants Infected with COVID-19 N (%)	p-value
Perception of COVID-19 infection
Moderately dangerous	65.0 (40.4)	37.0 (56.9)
Very dangerous	96.0 (59.6)	48.0 (50.0)	0.338
Concerns of being at risk of COVID-19 infection as an eye care practitioner
No	2.0 (1.2)	1.0 (50.0)
Yes	159.0 (98.8)	84.0 (52.8)	–
Preference to avoid encountering/examining a patient who is a suspect of COVID-19
Disagree	57.0 (35.4)	30.0 (52.6)
Agree	104.0 (64.6)	55.0 (52.9)	0.975

Notes: N (%) number (percentage). ‘–’ denotes p-value could not be determined due to small number of participants having no concerns in both groups.

Table 3 Relation Between Application of Infection Control Measures by Medical Facilities and COVID-19 Infection

Measures	Total N (%)	Infected with COVID-19 N (%)	p-value
Limitation of number of patients
No	58.0 (36.0)	32.0 (55.2)
Yes	103.0 (64.0)	53.0 (51.5)	0.650
Assessment of staff members for fever before work
No	123.0 (76.4)	66.0 (53.7)
Yes	38.0 (23.6)	19.0 (50.0)	0.693
Assessment of patients for fever before examination?
No	113.0 (70.2)	62.0.0 (54.9)
Yes	48.0 (29.8)	23.0 (47.9)	0.419
Obligation of patients to put on masks
No	7.0 (4.3)	3.0.0 (42.9)
Yes	154.0 (95.7)	82.0 (53.2)	0.780
Good ventilation of examination room
No	78.0 (48.4)	40 (51.3)
Yes	83.0 (51.6)	45 (54.2)	0.709
Number of examination sets in the same room
1	70.0 (43.5)	39.0 (55.7)
2	54.0 (33.5)	26.0 (48.1)
3	19.0 (11.8)	10.0 (52.6)
>3	18.0 (11.2)	10.0 (55.6)	0.858
Disinfectants are always available
No	27.0 (16.8)	17.0 (63.0)
Yes	134.0 (83.2)	68 (50.7)	0.246
PPE are always available
No	96.0 (59.6)	54.0 (56.3)
Yes	65.0 (40.4)	31.0 (47.7)	0.268
A clear shield is mounted on the slit-lamp routinely
No	33.0 (20.5)	22.0 (66.7)
Yes	128.0 (79.5)	63.0 (49.2)	0.073

Note: N (%) number (percentage).

Abbreviation: PPE, personal protective equipment.

Table 4 Relation Between Application of Infection Control Measures by Ophthalmologist in Clinics and COVID-19 Infection

Measures	Total N (%)	Infected with COVID-19 N (%)	p-value
Rubbing hands between patients
No	30.0 (18.6)	15.0 (50.0)
Yes	131.0 (81.4)	70.0 (53.4)	0.734
Having the slit lamp disinfected between patients
No	86.0 (53.4)	45.0 (52.3)
Yes	75.0 (46.6)	40.0 (53.3)	0.898
Refraining from talking to patients during slit-lamp examination and asking the patient not to talk
No	33.0 (20.5)	16.0 (48.5)
Yes	128.0 (79.5)	69.0 (53.9)	0.578
Taking precautions while examining patients without respiratory illness
Did not take full precautions	133.0 (82.6)	75.0 (56.4)
Took full precaution	28.0 (17.4)	10.0 (35.7)	0.046
Taking precautions while examining patients with respiratory illness
Did not take full precautions	98.0 (60.9)	59.0 (60.2)
Took full precautions	63.0 (39.1)	26.0 (41.3)	0.019
If a patient with known COVID-19 infection presents to your clinic (outside hospital) for urgent ophthalmic care, you would:
I work at a hospital, and this is not applicable to me	30.0 (18.6)	10.0 (33.3)
Send the patient to a hospital equipped to deal with COVID-19 and urgent eye conditions.	58.0 (36.0)	30.0 (51.7)
Take precautions and treat the patient.	73.0 (45.3)	45.0 (61.6)	0.032

Notes: N (%) number (percentage). Full precautions while examining patients without respiratory illness are wearing a surgical mask, washing hands before and after examinations, asking the patient to refrain from speaking, and ensuring the patient wore a mask. Full precautions while examining patients with respiratory illness, are wearing an N95 mask, gowns, gloves, and eye protection, in addition to the aforementioned precautions.

Table 5 Relation Between Application of Infection Control Measures by Ophthalmologist in Operating Room and COVID-19 Infection

Measures	Total	Infected with COVID-19	p-value
	Median (Range)	Median (Range)	p-value
Number of urgent surgeries per month	2.0 (0.0–35.0)	2.0 (0.0–30.0)	0.878
Number of elective surgeries per month	4.0 (0.0–250.0)	4.0 (0.0–40.0)	0.165
	N (%)	N (%)	p-value
Before admission of urgent patients, they are asked for
None	66.0 (41.0)	32.0 (48.5)
CT chest only	12.0 (7.5)	6.0 (50.0)
PCR only	12.0 (7.5)	4.0 (33.3)
CRP and CBCs	71.0 (44.1)	43.0 (60.6)	0.271
Before admission of elective patients, they are asked for
None	56.0 (34.8)	27.0 (48.2)
CT chest only	12.0 (7.5)	8.0 (66.7)
PCR only	77.0 (47.8)	45.0 (58.4)
PCR and CT chest	16.0 (9.9)	5.0 (31.3)	0.371
Have operated upon COVID-19 suspect or confirmed cases
No	100.0 (62.1)	48.0 (48.0)
Yes	61.0 (37.9)	37.0 (60.7)	0.116
While operating upon suspected COVID-19 patients, you:
Did not take full precaution	86.0 (53.4)	54.0 (62.8)
Took full precaution	75.0 (46.6)	31.0 (41.3)	0.007
While operating upon non-suspected COVID-19 patients, you
Did not take full precaution	130.0 (80.7)	76.0 (58.5)
Took full precaution	31.0 (19.3)	9.0 (29.0)	0.003

Notes: N (%) number (percentage). Full precautions includes wearing full PPE while operating on a nonsuspected COVID-19 case, while for suspected COVID-19 cases, precautions includes referring the patient to an isolation ward postoperatively and closing the operating room for disinfection.

Table 6 Multivariate Analysis of Risk Factors Affecting Contracting COVID Infection

Measures	Beta	Standard Error	p-value	Odds Ratio	95% Confidence Interval
Number of years in ophthalmology practice (<10 years versus ≥10 years)	0.0	0.4	0.024	2.4	1.1–4.6
Operating upon suspected COVID-19 patients (without taking full precautions versus with taking full precautions)	0.7	0.3	0.039	2.0	1.0–3.9
Operating upon non-suspected COVID-19 patients (without taking full precautions versus with taking full precautions)	1.0	0.5	0.026	2.6	1.1–5.6