Pulmonary hygiene is formerly referred to as pulmonary toilet which is a set of methods used to clear mucus and secretions from the airways. It is also called as respiratory health, pulmonary rehabilitation and pulmonary health [1]. Pulmonary hygiene is a technique designed to help clear mucus and secretions from your lungs. It can be used for people who have chronic obstructive pulmonary disease (COPD), pneumonia, cystic fibrosis, or bronchiectasis. It depends on consistent clearance of airway secretions. Normal airway clearance is accomplished by 2 important mechanisms: the mucociliary clearance system and the ability to cough. Impaired mucociliary clearance is linked to poor lung function in a broad range of diseases and disabilities. Because at-risk individuals are prone to recurrent episodes of respiratory inflammation, infection, and, eventually, irreversible lung damage, improvement of mucociliary clearance is a vital treatment goal - one that can be accomplished with an individualized bronchial hygiene plan that includes effective airway clearance therapy [2].

The word pulmonary refers to the lungs. The word toilet is related to the French toilette, refers to body care and hygiene; this root is used in words such as toiletry that also relate to cleansing. Pulmonary hygiene prevents the collapse of the alveoli of the lungs and rids the respiratory system of secretions, which could cause respiratory infections. It can also decrease pulmonary shunting, increase the functional reserve capacity of the lungs, and prevent respiratory infection after chest trauma [3].

Methods used for pulmonary hygiene include chest physiotherapy, postural drainage, coughing and breathing exercise, suctioning and tapping, incentive spirometer, bronchoscopy, blow bottles, tracheostomy care and so on. Pulmonary hygiene used to prevent and reduce the life threatening pulmonary complications such as obstruction, hypoventilation, hypoxemia and infections in order to restore muscular and pulmonary function as fast as possible. Globally more than 1.5 million deaths annually from respiratory infections are attributable to the environment, including at least 42% of lower respiratory infections and 24% of upper respiratory infections in developing countries [4]. Both globally and regionally there is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally [5].

WHO reported that, tuberculosis is accounted for 2.4% of deaths (230,000 deaths) in sub Saharan Africa countries and the environmental burden by the disease category the Respiratory infections stands/ranks 2^nd in Ethiopia [6]. Centers for Disease Control and Prevention (CDC) Global Health- Ethiopia 2014, says Lower respiratory infections accounts for 10% of death and it is the leading cause of death in the country [7]. According to The National Center for Biotechnology Information (NCBI) chronic obstructive pulmonary (COPD) account for 2.7% to 4.3% morbidity in Amhara Region, Ethiopia [8]. Thus, the pulmonary hygiene and its associated elements are very essential in preventing and promoting respiratory health, since health professionals are the life savers of the patients based this result interventional strategies could be applied to increase the efficacy on pulmonary hygiene among health professionals.

Objectives

Research Design

Institution based cross sectional study design was employed.

Setting and Sampling

The study was conducted in Dessie Referral Hospital and Kemissie General Hospital East Amhara, Ethiopia, 2017. Systematic sampling technique was used to select total of 112 health professionals 32 General Practitioners and 75 Nurses.

Description of the Tool

The tool is divided into mainly two parts,

Part-A: Demographic pro-forma of the Health professionals.

Part-B: Structured attitude questionnaire

Content Validity

Validity of the tool was ascertained in consultation with prepared by emergency and critical care and adult health specialty professionals. The experts were requested to judge the items for accuracy, relevance, appropriateness and degree of agreement. The suggestions of the experts were incorporated into the tool and the tool was modified accordingly.

Pilot Study

Pilot study was conducted in Woldia General Hospital with 10% of the sample size before the main study to identify potential problems in the proposed study such as data collection tools and to check the performance of the data collectors and questionnaires used in the pre-test did not included in the analysis as part of the main study. English version of questionnaire was used to assess the attitude and socio demographic factors on pulmonary hygiene among health professionals.

Data Collection Procedure

Prior permission was obtained from the concerned authority. Informed consent obtained from the subjects. Once all necessary data obtained, data was checked for completeness edited, cleaned, coded and entered in to and analyzed by SPSS version 20 for windows. Bivariate and multivariable regressions used to identify the independent predictor on pulmonary hygiene.

Statistical Analysis

The collected data were analyzed by using descriptive (frequency, distribution, percentage, mean and standard deviation) and inferential statistics (Logistic regression). This was done by entering each independent variable separately into bivariate analysis. Then, variables that showed statistical significant association with p-value of less than 0.25 on bivariate analysis were entered into multivariate logistic regression. Then, variables which showed statistical significant association with p-value less than 0.05 on multivariable regression were considered as predictors of the attitude and socio demographic factors affecting on pulmonary hygiene.

Socio-Demographic Characteristics

A total of 112 participants were included in this out of total participants, 69 (61.6%) were females and their mean age was 26.10 (±3.47SD) years. Fifty eight (51.8%) of respondents were more than 25 years old. The majority of the respondents were Orthodox 53 (47.3%) followed by Muslims 47 (42%). Fifty- five (49.1%) of the participants were single. In this study the majority of participants 91(81.3%) had work experience less than five years. Majority of the respondents (52%) had no recent training on pulmonary hygiene. Around sixty- three percent of participants were nurses.

Table I. Socio-demographic characteristics of the study participants (n =112) in Dessie Referral & Kemissie Hospitals, Ethiopia, 2017

Level of attitude on pulmonary hygiene

Attitude was computed using 10 questions related to pulmonary hygiene. The mean attitude score of the total sample was 6.53 (+ 3.47 SD). Subjects who scored above the mean value were categorized as having good level of attitude. Forty- five (40 %) study participants had poor attitude about pulmonary hygiene (Fig 1). n=112

Socio-demographic factors related to level of attitude

Among variables entered in the bi-variate analysis, Sex and recent training showed significant associations with the level of attitude on pulmonary hygiene. Variables with P-value < 0.25 were entered in the multivariate logistic analysis. But only marital status & recent training were significantly associated with the level of attitude on pulmonary hygiene. In the multivariable logistic analysis, single subjects were 2.8 times (AOR = 2.8, CI=1.2, 6.5) more likely to have poor level of attitude as compared to married individuals. Participants who had no recent training on pulmonary hygiene were 0.25 times (AOR = 0.3, CI = 0.1, 0.8) more likely to have good level of attitude than subjects who had recent training on pulmonary hygiene.

Table II. Bivariate and multivariate logistic regression predicting the level of attitude of participants towards pulmonary hygiene among study participants of Dessie Referral& Kemissie Hospitals, Ethiopia, 2017. (n =112).

*(p < 0.05)