The highly contagious nature of the Covid-19 virus has presented significant challenges to the public and healthcare personnel. Healthcare workers are at an increased risk of contracting the virus. ^{1, 2} This is primarily because COVID-19 is mainly transmitted through respiratory droplets and contact. Risk of transmission is higher in situations where protective measures like masks are not utilized, or where people are less than one meter apart. Since dental procedures often generate aerosols, they further increase the risk of transmission of virus. Therefore, oral healthcare workers are considered to be having increased risk of contracting and transmitting the virus. ^{3, 4}

A study conducted in Mexico focusing on dentists' knowledge, attitudes, and practices towards COVID-19 prevention found that the dentists, in general, possess a high level of knowledge on SARS-CoV-2 transmission routes and infection control measures to protect themselves and their patients. However, the research identified that some of their practices were not fully in compliance with the recommended guidelines for infection control in dental healthcare settings. Despite the dentists' knowledge, there are still significant concerns regarding the possibility of contracting COVID-19. ³

A recent survey conducted in China revealed that healthcare workers possess satisfactory knowledge about COVID-19, with 89% of them demonstrating adequate understanding of the disease. However, a considerable majority (85%) expressed concerns about contracting the virus themselves while on the job. The study also found that healthcare workers' attitudes and practices towards COVID-19 were influenced by various factors, such as job category and work experience, with doctors exhibiting higher knowledge levels than nurses and paramedics. ⁵ According to study conducted among healthcare workers in Ethiopia, it was observed that while most healthcare workers had good knowledge about COVID-19, their prevention practices were relatively lower. Factors such as a shortage of personal protective equipment, high workload, co-morbidities, limited knowledge, and restricted access to infection prevention training and guidelines were identified as constraints that limited their prevention practices. ⁶ A study conducted in India has found that dental health professionals require regular educational activities and training programs on infection prevention practices, particularly regarding COVID-19, not only to improve their own practice but also to be better equipped to support the healthcare sector in case of a demanding situation. ⁷

Sri Lanka has successfully controlled several COVID 19 waves. To continue providing oral health services to the public, it is highly necessary to assess the levels of knowledge, attitude and practices related to prevention of COVID 19 infection among this group of people who are at a higher risk in contamination of COVID 19. There are around 700 government out-patient department dental clinics as well as several specialized dental clinics in Sri Lanka. Dental clinics have been functioning throughout this pandemic period according to the guidelines developed by relevant authorities in the Ministry of Health, Sri Lanka and also adhering to institutional level guidelines. The present study aimed to assess the knowledge, attitudes, and practices towards COVID 19 among all categories of OHCWs at a tertiary dental hospital in Sri Lanka.

This was a descriptive cross-sectional study among all categories of OHCWs at tertiary dental hospital in Sri Lanka. The study was conducted towards the end of the COVID-19 pandemic between 01st of December 2022 to 15th of December 2022. The investigators of the current research and any staff member who was on long-term leave such as maternity leave was excluded from the sample. Self-administered questionnaire was prepared using already used questionnaires in literature which contained socio demographic data, questions related knowledge, attitudes, and practices in prevention of COVID 19. Face validity, content validity and consensual validity were assessed. Questionnaire was pretested among sub sample of 15 health care staff personnel in another dental hospital in Sri Lanka. Relevant changes on wording and phrasing were done accordingly to maximize the understanding.

The knowledge section of the questionnaire consisted of 10 questions, with yes, no or don’t know answers. “No” and “don’t know” answers were considered as incorrect answers at the analysis. Correct answers were scored as “1” and incorrect answers were scored as “0”. Overall knowledge score ranged from 0-10. Knowledge was categorized into three levels: poor, moderate, and excellent, based on the percentage of the overall score. If the percentage falls below 60%, it was considered poor knowledge, if it ranges from 61% to 80%, it was considered moderate knowledge, and more than 80%, was considered excellent knowledge. ^{8, 9} Attitudes were assessed using 10 statements, in a 5-point Likert scale ranging from strongly agreed to strongly disagreed. Score ranged from 1 to 5. Positive attitudes received a higher score, and negative attitudes received a lesser score. The overall attitude scores, which ranged from 10 to 50, was categorized based on the same criteria used for the knowledge score. An overall score of 30 or below was classified as poor attitudes, scores ranged from 31 to 40 were considered moderate, and scores of 41 or above were regarded as excellent attitudes. Practices were assessed using 8 questions with 3- point Likert scale ranging from always (score 2), sometimes (score 1), and never (score 0) answers. Overall practice score ranged from 0-16. Cut-off points for practice score were set same as for the knowledge score. Therefore, overall score of 9.6 or below was considered as poor, score ranged from 9.7 to 12.8 were considered as moderate and a score above 12.9 was considered as excellent. Sample frame was the list of health staff present on the day of the study. After obtaining the written informed consent, self-administered questionnaire was distributed among heath care personnel. Data analysis was done using Statistical Package for Social Sciences (SPSS) software 20th version. Data was summarized and presented as mean, percentages and prevalence. Chi square test and ANOVA test were used to assess significance of the association between independent and dependent variables. The p-value below 0.05 was considered as significance level to determine the above associations. Multiple linear regression was used to assess the contributing factors to knowledge, attitude, and practices. Before the analysis certain variables were combined to create fewer categories. In the "ethnicity" variable, the categories of Tamil and other were merged to create a new category called "other ethnicities." Similarly, in the "oral healthcare worker category" variable, consultants and dental surgeons were combined to form the category "clinicians," while dental technicians, paramedical staff, attendants, and nursing officers were grouped together to create the category "other staff". Ethical clearance was granted by Ethics Review Committee, Postgraduate Institute of Medicine, University of Colombo (ERC/PGIM/2022/017).

The study included all 172 oral healthcare workers who consented on the day of the research, which accounted for 90% of the entire staff of the dental hospital. Mean age of the sample was 41.8 years (SD 9.2). The sample consisted of 75.6% females, and the majority of the population (97.1%) were Sinhalese. Of the study sample, 89% obtained COVID-19 information through mass media, while only 11% obtained information through social media. The study found that 46.5% of the sample had already infected by the COVID-19 infection. Sociodemographic profile of the study sample is shown in Table 1.

Oral healthcare workers in a tertiary dental care hospital in Sri Lanka had a moderate level of knowledge and attitude but excellent practices towards the COVID-19 infection. Continuous in-service training programs should be conducted among all oral healthcare workers to improve the level of knowledge and practices as well as to maintain good practices towards the prevention and transmission of COVID-19 infection. This will help to ensure the safety of both healthcare workers and patients in the dental setting during any pandemic periods.

The authors express their sincere appreciation to all the participants who took part in the study.