Factors Influencing Compliance with COVID-19 Disinfection Safety Guidelines among Disinfection Workers in South Korea

Round 1

Reviewer 1 Report

The authors report an interesting manuscript on the preparation of Korean workers on the topic of preventive disinfection against COVID-19 infection. This is a very important topic for the strategy of prevention of COVID-19 infection. The authors administered a questionnaire to a population of workers between the ages of 20 and 60 of both sexes and evaluated what strategies they had adopted to prevent the virus. The study provides an important overview of the educational and preventive components adopted by workers.

The manuscript is well written and represents one of the few studies on the relationship between knowledge of good disinfection, use of protective devices and viral infection.

Author Response

Thank you very much for your comments and implications of our study.

Reviewer 2 Report

Dear Authors,

I have reviewed your submission titled "Factors Influencing Compliance with COVID-19 Disinfection Safety Guidelines Among Disinfection Workers in South Korea" First, allow me to commend you on addressing a highly relevant topic given the global health context. The emphasis on the knowledge and practices of disinfection workers amidst the COVID-19 pandemic is not only timely but also vital for improving public health safety standards.

 

After a careful evaluation of your manuscript, I believe it has substantial merit. However, there are a few areas that require clarification and strengthening to ensure that your paper meets the high standards of [Journal Name]. As such, I am suggesting a 'minor revision' for this manuscript. Here are my specific observations and suggestions:

 

1. Introduction & Literature Review:

While you highlight the importance of disinfection work, it would benefit the reader if there were a brief review of current practices worldwide. This would place your findings within a broader context and emphasize the uniqueness of the South Korean context.

2.Methodology:

The sample size and the mode of participant selection should be detailed more explicitly. Was there a particular reason for choosing 215 disinfection workers? Was random sampling employed?

While you've mentioned the use of SPSS 26 for data analysis, it would be insightful to understand any challenges or limitations faced during the data gathering process.

3. Results:

When discussing the significant findings from your regression analysis, it would be helpful to include some specific statistics (e.g., beta values, p-values) to provide readers with a clear understanding of the strength and significance of the observed relationships.

The finding about the gender difference (female workers) showing increased compliance with guidelines requires deeper exploration and interpretation. If possible, provide some context or hypotheses to explain this finding.

4. Discussion & Implications:

The discovery of a gap between perceived compliance and actual knowledge is intriguing. Delve a bit deeper into potential reasons for this gap and its implications for training programs.

The implications section could benefit from more specific recommendations for policymakers and institutions, especially regarding the structure and content of retraining programs.

5. Conclusion:

While the conclusion emphasizes retraining and enhancing qualifications, it might be useful to end with a forward-looking statement that anticipates future challenges or shifts in disinfection practices as the pandemic evolves.

6. Citations & References:

Ensure consistency in citation style throughout the manuscript and cross-check that all references are correctly listed in the bibliography.

Given the minor nature of these revisions, I am confident that once addressed, your manuscript will make a significant contribution to the literature on disinfection practices during pandemics. I look forward to reviewing your revised manuscript.

 

Warm regards,

Author Response

I express my sincere gratitude for your invaluable contribution to improving my manuscript titled “Factors Influencing Compliance with COVID-19 Disinfection Safety Guidelines Among Disinfection Workers in South Korea”. I am pleased to inform you that I have taken your feedback to heart and made revisions to address the points you raised.

 

1. Introduction & Literature Review:

While you highlight the importance of disinfection work, it would benefit the reader if there were a brief review of current practices worldwide. This would place your findings within a broader context and emphasize the uniqueness of the South Korean context.

 

We appreciate your insights and tried to provide a broader context of current disinfection practices in general and healthcare settings including misuse of disinfectants due to the lack of clear guidelines in the middle of chaos during the early stage of COVID-19 outbreak as follows (on page 2, line 1).

 

During the initial phase of the COVID-19 pandemic, it was evident that a lack of awareness regarding the proper use of disinfectants led to confusion. This resulted in high-risk behaviors such as excessive disinfectant use beyond the recommendations of the CDC and an increased frequency of inappropriate human exposure to disinfectants [7]. Particularly concerning was the widespread dissemination of misinformation regarding disinfectant use, underscoring the need for the government to prioritize effective health communication [8]. In healthcare settings, a diverse range of methods for infection control was proposed, including the use of chemical-based disinfectants as well as non-contact methods like ultraviolet (UV) disinfection and materials to prevent transmission [9]. In Korea, although healthcare facilities generally managed cleaning and disinfection well during the early stages of the pandemic, there was a recognized need for developing specific guidelines [10]. Furthermore, even when disinfection guidelines were unclear, extensive disinfection practices were prevalent in everyday settings [11]. Although basic surface cleaning proved effective when areas were left unoccupied for approximately a week, the prevalent approach in South Korea involved the application of disinfectants through spraying [11].

 

[7] Gharpure, R.; Hunter, C.M.; Schnall, A.H.; Barrett, C.E.; Kirby, A.E.; Kunz, J.; Berling, K.; Mercante, J.W.; Murphy, J.L.; Garcia‐Williams, A.G. Knowledge and practices regarding safe household cleaning and disinfection for COVID‐19 prevention—United States, May 2020. American Journal of Transplantation 2020, 20, 2946-2950.

[8] Enders, A.M.; Uscinski, J.E.; Klofstad, C.; Stoler, J. The different forms of COVID-19 misinformation and their consequences. The Harvard Kennedy School Misinformation Review 2020, 8, https://doi.org/ 10.37016/mr-2020-48.

[9] Choi, H.; Chatterjee, P.; Lichtfouse, E.; Martel, J.A.; Hwang, M.; Jinadatha, C; Sharma, V.K.; Classical and Alternative Disinfection Strategies to Control the COVID-19 Virus in Healthcare Facilities: a Review. Environmental Chemistry Letters 2021, 19, 1945-1951.

[10] Jeong, S.Y.; Kim, O.S.; Choi, JY; Ga, H.; Chae H.J.; Lee S.J. Status of Cleaning and Disinfection of Environmental Surfaces in Hospitals. Korean Journal of Healthcare-associated Infection Control and Prevention 2022, 27, 141-152.

[11] Choi, K. COVID-19 and Environmental Health Sciences – Pending Tasks and Future Outlook. The Korean Journal of Public Health 2020, 57, 1-8.

 

 

2. Methodology:

The sample size and the mode of participant selection should be detailed more explicitly. Was there a particular reason for choosing 215 disinfection workers? Was random sampling employed?

 

We appreciate that you bring up the question concerning the sample size. Korea's pest control and disinfection industry is predominantly governed by two major associations, with workers often participating in either one or both associations. We utilized their contact lists as a sampling frame without sharing recognizable information and asked them to participate in the survey voluntarily. A suggested sample size based on G-Power was 172, which is obviously a random sampling. We added the sampling procedure in detail on page 3 at line 6 as follows.

 

The participants were recruited from the Korea Pest Control Association and Korea Hygienist Association members as a total population. These two organizations are representative private entities responsible for issuing disinfectant licenses. Using random sampling, voluntary participants were recruited for the survey by sending text messages to potential candidates. A total of 215 participants were included in this study.

 

While you've mentioned the use of SPSS 26 for data analysis, it would be insightful to understand any challenges or limitations faced during the data gathering process.

 

Like many other survey-based studies, the data-gathering procedure could face challenges related to generalization if not conducted through probabilistic or stratified random sampling. We acknowledge the limitations in our sample representation and have made concerted efforts to gather responses from a broad range of workers. Furthermore, our concerns about the representation issues of survey participants have been addressed in the Limitation of the Discussion section, specifically in the second paragraph on page 10. We believe this discussion adequately addresses any queries you may have about our data-gathering process.

 

3. Results:

When discussing the significant findings from your regression analysis, it would be helpful to include some specific statistics (e.g., beta values, p-values) to provide readers with a clear understanding of the strength and significance of the observed relationships.

            

In the initial manuscript, we tried to provide detailed explanations of the significant findings of each outcome with model fitness and standardized regression coefficients along with its p-values of influencing factors in the Result (Section 3.3, on page 7). Furthermore, we have repositioned Table 3 to enhance its clarity.

            

The finding about the gender difference (female workers) showing increased compliance with guidelines requires deeper exploration and interpretation. If possible, provide some context or hypotheses to explain this finding.

We were also wondering about the gender differences in compliance with disinfection work guidelines, but we couldn’t find any previous studies examining it, especially within this specific vocation. However, in general, we were able to refer to previous health behavior-related studies. We have mentioned in the second part of the Discussion (Section 4.2, on page 9) that there were vulnerable groups based on their socioeconomic status including their gender. Therefore, we have provided a detailed explanation and our interpretation (on page 9), supporting previous study findings as follows.

In terms of adherence to general guidelines, women showed a higher compliance rate than men, which is consistent with several previous studies on gender differences concerning preventive measures and risk perception of COVID-19 [29-31]. It was also found within the Korean context that women tended to adopt newly introduced personal preventive behaviors in the early phase of the COVID-19 pandemic [32]. The gender-specific difference emerged primarily in disinfection guideline compliance, suggesting that this difference is influenced by characteristics such as heightened health consciousness that led to applying guidelines in practical work settings.

[37] Baek, J.; Kim, K.H.; Choi, J.W. Determinants of adherence to personal preventive behaviours based on the health belief model: a cross-sectional study in South Korea during the initial stage of the COVID-19 pandemic. BMC Public Health 2022, 22, 1-10.

4. Discussion & Implications:

The discovery of a gap between perceived compliance and actual knowledge is intriguing. Delve a bit deeper into potential reasons for this gap and its implications for training programs. The implications section could benefit from more specific recommendations for policymakers and institutions, especially regarding the structure and content of retraining programs.

We deeply appreciate you found our findings interesting. We elaborated more on the causes of the gap between perceived compliance and actual knowledge in the context of the training system in Korea and provided implications for future training as follows (on page 9 line 45).

As previously mentioned, the relatively short duration of training and insufficient on-the-job guidance have proven inadequate for practical fieldwork, particularly in mastering disinfectant usage. To address this, the establishment of a standardized training program is essential, accompanied by the promotion and intensive delivery of guidelines during pandemic periods. The inclusion of case management and rigorous practical training sessions within the standardized program is vital. A comparative analysis of training materials from other countries can serve as a benchmark. During the early stages of the pandemic, online-based in-service education solely introduced COVID-19-related situations in Korea. However, it is imperative to provide recurrent and practical guideline education to nurture true professionals in the field of disinfection. Future training initiatives must ensure the swift dissemination of the WHO and governmental guidelines in the context of (re)emerging infectious diseases. Moreover, there should be a concentrated effort to strengthen disinfectant usage training, particularly focusing on volume, concentration, frequency, exposure time, and differentiation between ordinary and healthcare settings. It is recommended to proactively strengthen the curriculum during endemic periods, complemented by integrating skill-focused practical sessions.

5. Conclusion:

While the conclusion emphasizes retraining and enhancing qualifications, it might be useful to end with a forward-looking statement that anticipates future challenges or shifts in disinfection practices as the pandemic evolves.

We do value your suggestion on concluding the manuscript with a forward-looking statement. Accompanying your remark regarding the future challenges and shifts in disinfection practices, which are going to be significant due to the ongoing pandemic crisis, we have outlined some practical implications of our findings and found the relation of them with sustainability as follows (on page 11, line 17).

The pandemic is anticipated to continue, necessitating more advanced disinfection measures in response to pathogens. This approach should be taken while considering the environmental impact of disinfection. However, as evident from our research findings, disinfection workers need help to consistently adhere to wearing PPEs, following guidelines, or accessing accurate information. In this context, the government should establish straightforward guidelines and instructions for disinfection practitioners to protect their health and ensure public safety. The government should implement comprehensive education programs for disinfection practitioners, with local authorities responsible for monitoring the effective execution of these training initiatives. Additionally, there is a critical need to elevate public awareness concerning the safe utilization of disinfectants and the anticipated advantages of disinfection. Such efforts are crucial to foster a heightened consciousness among citizens, ensuring the sustainability of disinfection practices during the pandemic era.

6. Citations & References:

Ensure consistency in citation style throughout the manuscript and cross-check that all references are correctly listed in the bibliography.

We have thoroughly reviewed and cross-checked the citation style of reference throughout the manuscript. Any identified discrepancies have been corrected, and the references now adhere to the MDPI citation style.

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

The authors have investigated factors influencing disinfection practice to enhance the quality and safety of infection control measures in South Korea. The authors have designed the survey questionnaire to collect information on demographic characteristics, disinfection methods, knowledge of COVID-19 disinfectants and their application. The authors have revealed a gap between perceived compliance and actual knowledge between groups. Overall, this work can inspire more ideas for retraining disinfection workers, enhancing their qualifications, and promoting responsible disinfection practices. Therefore, I would like to recommend this work to publish in Sustainability. Below are some comments for the authors.

 

1. For the introduction, there are too many short paragraphs. This paper would be more impressive if the authors could polish and condense the introduction into three or four paragraphs.

2. Each table should appear on its following paragraph. It is easier to read for reader.

Author Response

I express my sincere gratitude for your invaluable contribution to improving my manuscript titled “Factors Influencing Compliance with COVID-19 Disinfection Safety Guidelines Among Disinfection Workers in South Korea”. I am pleased to inform you that I have taken your feedback to heart and made revisions to address the points you raised.

 

1. For the introduction, there are too many short paragraphs. This paper would be more impressive if the authors could polish and condense the introduction into three or four paragraphs.

 

Initially, we separated to cases of South Korea to emphasize the unique patterns in terms of the policy and practice of disinfection. We completely understood your point, and reorganized the introduction into the five parts of paragraphs accordingly.

1. The reason why we focus on the disinfection safety issues based on COVID-19 situations
2. Global standard guidelines for disinfection in COVID-19 situation followed by US CDC and KCDC guidelines

• Disinfection practices Initial stage of COVID-19 pandemic (we added this paragraph according to the other reviewers’ recommendation.)

1. Pest control and disinfection job regulations worldwide including California state in US and South Korea
2. Previous studies examined the current disinfection practices and working environments in South Korea introduced and the aim of this study

 

2. Each table should appear on its following paragraph. It is easier to read for reader.

 

We greatly appreciate your valuable suggestions regarding the placement of tables, which will improve readability.

Tables 1, 2, and 3 were reorganized according to the body that appeared in the paragraph.

 

Reviewer 4 Report

The imperative importance of deriving lessons from the COVID-19 pandemic for the advancement of humanity is evident. The topics discussed in the manuscript hold intrinsic value despite their apparent simplicity.

 The manuscript's purpose is clear, utilizing appropriate methods for research and analysis. The study's results are of significant reference value. To further enhance the manuscript:

1. Consider incorporating more reviews of similar studies. Particularly, investigate if the initial chaos of the COVID-19 outbreak led to neglected research areas or insufficiently exploring the issue's health implications.

2.  The manuscript's presentation and analysis of findings are detailed. However, it's essential to elucidate the practical implications of these results. Can they swiftly inform public Standard Operating Procedures during future pandemics? Furthermore, delve into the manuscript's relation to sustainability.

 

Author Response

I express my sincere gratitude for your invaluable contribution to improving my manuscript titled “Factors Influencing Compliance with COVID-19 Disinfection Safety Guidelines Among Disinfection Workers in South Korea”. I am pleased to inform you that I have taken your feedback to heart and made revisions to address the points you raised.

 

1. Consider incorporating more reviews of similar studies. Particularly, investigate if the initial chaos of the COVID-19 outbreak led to neglected research areas or insufficiently exploring the issue's health implications.

 

We appreciate your insights and tried to provide a broader context of current disinfection practices in general and healthcare settings including misuse of disinfectants due to the lack of clear guidelines in the middle of chaos during the early stage of COVID-19 outbreak as follows (on page 2, line 1).

 

During the initial phase of the COVID-19 pandemic, it was evident that a lack of awareness regarding the proper use of disinfectants led to confusion. This resulted in high-risk behaviors such as excessive disinfectant use beyond the recommendations of the CDC and an increased frequency of inappropriate human exposure to disinfectants [7]. Particularly concerning was the widespread dissemination of misinformation regarding disinfectant use, underscoring the need for the government to prioritize effective health communication [8]. In healthcare settings, a diverse range of methods for infection control was proposed, including the use of chemical-based disinfectants as well as non-contact methods like ultraviolet (UV) disinfection and materials to prevent transmission [9]. In Korea, although healthcare facilities generally managed cleaning and disinfection well during the early stages of the pandemic, there was a recognized need for developing specific guidelines [10]. Furthermore, even when disinfection guidelines were unclear, extensive disinfection practices were prevalent in everyday settings [11]. Although basic surface cleaning proved effective when areas were left unoccupied for approximately a week, the prevalent approach in South Korea involved the application of disinfectants through spraying [11].

 

[7] Gharpure, R.; Hunter, C.M.; Schnall, A.H.; Barrett, C.E.; Kirby, A.E.; Kunz, J.; Berling, K.; Mercante, J.W.; Murphy, J.L.; Garcia‐Williams, A.G. Knowledge and practices regarding safe household cleaning and disinfection for COVID‐19 prevention—United States, May 2020. American Journal of Transplantation 2020, 20, 2946-2950.

[8] Enders, A.M.; Uscinski, J.E.; Klofstad, C.; Stoler, J. The different forms of COVID-19 misinformation and their consequences. The Harvard Kennedy School Misinformation Review 2020, 8, https://doi.org/ 10.37016/mr-2020-48.

[9] Choi, H.; Chatterjee, P.; Lichtfouse, E.; Martel, J.A.; Hwang, M.; Jinadatha, C; Sharma, V.K.; Classical and Alternative Disinfection Strategies to Control the COVID-19 Virus in Healthcare Facilities: a Review. Environmental Chemistry Letters 2021, 19, 1945-1951.

[10] Jeong, S.Y.; Kim, O.S.; Choi, JY; Ga, H.; Chae H.J.; Lee S.J. Status of Cleaning and Disinfection of Environmental Surfaces in Hospitals. Korean Journal of Healthcare-associated Infection Control and Prevention 2022, 27, 141-152.

[11] Choi, K. COVID-19 and Environmental Health Sciences – Pending Tasks and Future Outlook. The Korean Journal of Public Health 2020, 57, 1-8.

•  

 

2. The manuscript's presentation and analysis of findings are detailed. However, it's essential to elucidate the practical implications of these results. Can they swiftly inform public Standard Operating Procedures during future pandemics? Furthermore, delve into the manuscript's relation to sustainability.

We truly appreciate your suggestion regarding the conclusion of the manuscript. To provide a comprehensive ending, we have introduced practical implications to enhance the existing training and certification system (page 9, line 45). Additionally, we have identified how these implications are interconnected with sustainability (on page 11, line 17).

The pandemic is anticipated to continue, necessitating more advanced disinfection measures in response to pathogens. This approach should be taken while considering the environmental impact of disinfection. However, as evident from our research findings, disinfection workers need help to consistently adhere to wearing PPEs, following guidelines, or accessing accurate information. In this context, the government should establish straightforward guidelines and instructions for disinfection practitioners to protect their health and ensure public safety. The government should implement comprehensive education programs for disinfection practitioners, with local authorities responsible for monitoring the effective execution of these training initiatives. Additionally, there is a critical need to elevate public awareness concerning the safe utilization of disinfectants and the anticipated advantages of disinfection. Such efforts are crucial to foster a heightened consciousness among citizens, ensuring the sustainability of disinfection practices during the pandemic era.