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Appropriate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbreak in Singapore
  1. S E Chia1,
  2. D Koh1,
  3. C Fones1,
  4. F Qian1,
  5. V Ng1,
  6. B H Tan2,
  7. K S Wong2,
  8. W M Chew3,
  9. H K Tang3,
  10. W Ng4,
  11. Z Muttakin4,
  12. S Emmanuel5,
  13. N P Fong6,
  14. G Koh7,
  15. M K Lim1
  1. 1Faculty of Medicine, National University of Singapore
  2. 2Singapore General Hospital
  3. 3Tan Tock Seng Hospital
  4. 4Kandang Kerbau Hospital
  5. 5National Health Group Polyclinics
  6. 6St Luke’s Community Hospital
  7. 7Ang Mo Kio Community Hospital
  1. Correspondence to:
 Dr S E Chia
 Department of Community, Occupational and Family Medicine, Faculty of Medicine (MD3), National University of Singapore, 16 Medical Drive, Singapore 117597;


Background: Singapore was affected by an outbreak of severe acute respiratory syndrome (SARS) from 25 February to 31 May 2003, with 238 probable cases and 33 deaths.

Aims: To study usage of personal protective equipment (PPE) among three groups of healthcare workers (HCWs: doctors, nurses, and administrative staff), to determine if the appropriate PPE were used by the different groups and to examine the factors that may determine inappropriate use.

Methods: A self-administered questionnaire survey of 14 554 HCWs in nine healthcare settings, which included tertiary care hospitals, community hospitals, and polyclinics, was carried out in May–July 2003. Only doctors, nurses, and clerical staff were selected for subsequent analysis.

Results: A total of 10 236 valid questionnaires were returned (70.3% response); 873 doctors, 4404 nurses, and 921 clerical staff were studied. A total of 32.5% of doctors, 48.7% of nurses, and 77.1% of the administrative staff agreed that paper and/or surgical masks were “useful in protecting from contracting SARS”. Among this group, 23.6% of doctors and 42.3% of nurses reported working with SARS patients. The view that a paper and/or surgical mask was adequate protection against SARS was held by 33.3% of doctors and 55.9% of nurses working at the A&E unit, 30.5% of doctors and 49.4% of nurses from medical wards, and 27.5% of doctors and 37.1% of nurses from intensive care units. Factors which predicted for agreement that paper and/or surgical masks were protective against SARS, included HCW’s job title, reported contact with SARS patients, area of work, and Impact Events Scale scores.

Conclusion: A variety of factors determine appropriate use of personal protective equipment by HCWs in the face of a major SARS outbreak.

  • A&E, accident & emergency unit
  • HCW, healthcare worker
  • IES, Impact Events Scale
  • PAPR, powered air purifying respirator
  • PPE, personal protective equipment
  • SARS, severe acute respiratory syndrome
  • SARS
  • healthcare workers
  • occupational health
  • PPE

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  • Competing interests: none declared