Biosafety: physiotherapy students’ knowledge about techniques and behavior on cross-infection control

Introduction: Biosafety consists in the set of measures applied to prevent the spread of infectious agents. Through biosafety, it is possible to avoid and inhibit the risks that compromise the health of the individual, animals and the environment. Objective: To evaluate the knowledge about biosafety in undergraduate physiotherapy students and physiotherapists. Methods: The work was a field study with a defined universe, and classified as descriptive, exploratory, quantitativequalitative. The sample consisted of 93 physiotherapy students from the Universidade Estadual do Norte do Paraná (State University of Northern Paraná), Jacarezinho, Brazil, and 10 professionals working in the region. Data were collected through a questionnaire on knowledge about biosafety and cross-infections. A statistical analysis was performed using SPPS software version 25.0, and the data was evaluated by the Shapiro-Wilk normality test, and the variables expressed as median and interquartile range (25% -75%). The chi-square test was applied to determine statistically significant differences between the different years of the physiotherapy course and the trained professionals. Through content analysis, open treatment and analysis of qualitative data were chosen. The level of significance used was 5%. Results: There was a small deficit in the knowledge of biosafety; however, this knowledge increased to some extent with the evolution of students in the course (p < 0.05). Conclusion: Most students and professionals have enough knowledge to control or even eradicate the risks of certain activities and prevent cross-infection in the practice of physiotherapy. The perceived deficit in knowledge in biosafety can be easily resolved with the adequate dissemination of knowledge on the subject.


Introduction
Biosafety is related to the set of measures and forms of disease prevention. 1 This science is characterized by being responsible for decreasing and eliminating the risks of research, production, teaching, technological development and service provision activities that subject the individual and the environment to exposure to infectious agents, which can compromise health and well-being. 2 In Brazil, the National Technical Biosafety Commission (CTNBio), created in 1995, establishes the national biosafety policy through normative instructions that must be complied at all levels. 3 Compliance with biosafety parameters is particularly critical in research and teaching environments, especially in university laboratories and clinics, due to the high turnover of users. 4 Physiotherapists are health professionals who can work in different environments, some of which can be especially contaminated. Since, they are working in contaminated environments, such as intensive care unit (ICU), nursing home, physiotherapy clinic, basic health unit (BHU) and health center, they can develop various infectious diseases. 5 That said, preventive measures must accompany all these professionals´ actions. The best way to avoid the necessity of drug treatments against infections is global biosafety measures that can guide the professional's steps in their workplace and ensure their safety and that of their patients. 6 Knowledge about the types and methods of hygiene procedures is of paramount importance for all health professionals, so that there is no risk of selfcontamination or cross-infection. 7 Therefore, the aim of this study was to determine the knowledge about biosafety of undergraduate physiotherapy students and physiotherapists, and how they contribute to the maintenance of a healthy clinical environment.

Methods
We carried out a field study with a statistical universe,  Chi-square test was applied to search for statistically significant differences between the different years of the physiotherapy course and trained professionals. The open questions, the treatment and analysis of qualitative data were chosen through content analysis. 11 The level of significance was 5%.

Results
One hundred three (103) volunteers participated in the study, where 9.7% were professionals and 90.3% were students in the undergraduate physiotherapy course, with ages ranging from 18 to 36 years old or more.
Regarding the sex of the participants, the majority were women, representing 82.5%, while 17.5% were men.
The results show that the largest share of participants (31.07%) corresponded to the 1st year of course, due to dropout during the course or failure, which occured in the following years. The age of the participants was mostly between 20 and 25 years, followed by 18-20 years ( Figure 1).
When comparing the results of the questionnaires, 66% of the participants considered having knowledge of biosafety, and 34% said they did not know (Table1).
Whether the participants knew the meaning of biosafety, students increased their knowledge (answer "yes") over the study years; for working professionals it was 90% ("yes" answer) ( answers were higher according to the progress in the course. However, 20% of the trained professionals had difficulty and answered that they did not know how to behave in a clinical environment (Table 1).

Discussion
It was possible to see that through the analysis of the database that there was a small deficit of knowledge in biosafety, but this knowledge had, in a way, increased as the course progressed.
This study had 103 participants, and the results showed significance for several questions. Figure 1 corresponds to the frequency of volunteers in the year of course and professional training, and the age of the participants. Of these, 31  Questions on biosafety standards were brought up, and among the participants, 66.7% said that they did not know about them, while 33.3% said they did. It was found that knowledge about biosafety law is low and that it is not dependent on level in the course, which is detrimental to the safety of the workplace that depends on everyone involved.
Biosafety consists in actions that aim to prevent and protect against the adverse risks of exposure, manipulation and use of living organisms, to benefit the health of humans, animals, and to preserve the environment. 21 Thus, the techniques are part of several

Authors´ contributions
THMS and AYS were responsible for the writing, research, data collection, analysis and discussion. LVO conducted the research, data collection and analysis.
VPCJ and MDGLP were responsible for the review and analysis of the data obtained. DFS worked on the writing, research, data collection, analysis and discussion, and provided guidance.