Adherence to Infection Prevention and Control Practices among Health Care Workers and its Outcome in Non-covid Areas in a Tertiary Care Hospital

Copyright © 2021 Phcog.Net. This is an openaccess article distributed under the terms of the Creative Commons Attribution 4.0 International license. Cite this article : Mini PN, Mohan A, Chandran P, Durga N, Philomina BJ. Adherence to Infection Prevention and Control Practices among Health Care Workers and its Outcome in Non-covid Areas in a Tertiary Care Hospital. Int J Med Public Health. 2021;11(2):x-x. ABSTRACT Aim and Objectives: 1. To study the adherence to Infection Prevention and Control (IPC) practices by health care workers in non COVID areas. 2. To compare the proportion of COVID affected health care workers among those adhering to proper IPC and those with non-adherence. Background: Hospitals serve as frontline health care institutions caring for the increased number of COVID-19 patients. The health care personnel working in hospitals are at increased risk of acquiring the disease during the pandemic. It is the prime responsibility of the Hospital Infection Control Committee to protect the health care workers (HCW) and prevent nosocomial transmission. Material and methods: In the cross sectional study,all health care workers from non covid areas of the hospital who were exposed to covid 19 patient during the study period were assessed according to the risk assessment criteria. Result: A total of 1049 health care workers had contact with COVID 19 patients. Of this only 6 health care workers were diagnosed with COVID 19. Conclusion: The HCW diagnosed with Covid 19 was less than one percentage of exposed. This implies the impact that the IPC training had on the HCW which made them ensure their own safety and prevent the nosocomial spread of SARS CoV 2 within the hospital.


INTRODUCTION
SARS-CoV-2 is a Novel Corona virus belonging to the beta group of Corona viruses. It was first noted as causing an epidemic in Hunan seafood market in Wuhan, a business hub of China at the end of December 2019, rapidly infecting more than 50 people. It was reported by the Chinese government as cluster cases of pneumonia with unfamiliar aetiology to WHO. Initially named as Wuhan Corona virus or 2019 novel Corona virus was later renamed by the International Committee on Taxonomy of Viruses (ICTV) as SARS-CoV-2 and the disease as COVID 19.¹ Based on current evidences, novel Corona virus is transmitted between people through close contacts and droplets. Airborne transmission also occurs during Aerosol generating procedures and support treatments (like Non-invasive ventilation). The aerosols can penetrate the human body (lungs) via inhalation through the nose or mouth. Hospital infection control committee regularly provides measures to manage COVID 19 infections in the hospital. The health work force is a valuable resource for the smooth functioning of the health care delivery system. With large number of health personnel being affected by the pandemic and getting isolated for treatment and their contacts being quarantined, there will be a scarcity of human resource to be allocated for ensuring the flawless management of sick patients. Currently there is no vaccine to prevent COVID 19. The best way to prevent the illness is to avoid being exposed to virus, and thus comes the importance of Infection Prevention and control strategies. Use of PPE is only one of the IPC measures and not to be relied on as the primary prevention strategy. Prevention of COVID 19 transmission relies on adherence to both the standard and transmissionbased precautions and also on appropriate risk assessment of exposed individuals and their timely management.²

MATERIALS AND METHODS
Study design: Cross sectional study Study Setting: Non COVID areas of Government Medical College Kozhikode. Study Period: 1 st August 2020 -31 st August 2020 Sample size: All the HCW in non COVID areas of the hospital who were exposed to COVID 19 patients during the study period This study includes the health care workers attending to patients admitted in the non COVID areas in Government medical college Kozhikode. As per the institutional guidelines HCW in different settings of hospital shall follow infection prevention and control (IPC) practices appropriate to their risk profile. The HICC gives regular training regarding standard and transmission-based precautions and other aspects of IPC to all the HCW in the institution. According to the advisory put forward by the Ministry of Health and Family Welfare (dated 15 May 2020),³ health care workers in both COVID and non COVID areas of hospital are subjected to risk assessment and further management. Risk assessment committee of the hospitals will Demographics characteristics and clinical symptoms of HCWs diagnosed with COVID-19 Out of the 6 positive HCW's 3(50%) were in the age group of 20-30 years, 2(33.3%) in the age group of 40-50 years and only 1(16.6%) in the age group of 30-40 years ( Table 2). Out of the 6 positive cases (Table 3), only one(16.6%) was a male and five (83.3%) were female.

Designation Frequency
Doctor 3

Staff nurse 3
Three (50%) of the affected HCW were doctors and three (50%) were staff nurse (Table 4). 3 (50%) of affected HCW were working in the surgical ICU when they had contact with COVID 19 cases. 33.3% of HCW were working in the medical ICU and one (16.6%) each working in the wards (Table 5).

Risk category
All the 6 diagnosed health care workers were belonging to the highrisk group according to the Risk assessment Committee. All except one HCW had symptoms ranging from mild cough and fever to severe sore throat and anosmia.

Nature of relation to the COVID 19 patients
Two out of six HCW gave history of multiple contacts with other COVID 19 positive Doctors and Nurses. Two had history of contact with COVID 19 patients and two of them couldn't account for the possible contacts.

DISCUSSION
SARS CoV 2 similar to SARS CoV has been reported to be rapidly spreading in the community and the hospital settings and soon emerged to be a pandemic. High attack rate of SARS-CoV-2 among healthcare workers with direct patient care as well as with co-workers has been observed worldwide, including China, Italy, and United States.⁴ Our  19) is suspected or confirmed, to mount an optimal response to the COVID-19 outbreak, a facility level IPC programme with a dedicated and trained team or at least an IPC focal point should be in place and supported by the national and facility senior management. In countries where IPC is limited or inexistent, it is critical to start by ensuring that at least basic IPC standards are in place at the national and health-care facility level to provide minimum protection to patients, health workers and visitors. These are known as the minimum requirements for IPC that have been developed by WHO in 2019 based on a broad consensus among international experts and institutions to facilitate the implementation of the WHO recommendations on the core components for IPC programmes. 8 The five IPC strategies required to prevent or limit transmission of COVID-19 in health care facilities include the following: 1. Screening and triage for early recognition of patients with suspected COVID-19, and rapid implementation of source control measures 2. Applying standard precautions for all patients 3. Implementing additional precautions • Isolation and cohosting of patients with suspected or confirmed COVID-19 • Contact and droplet precautions • Airborne precautions 4. Implementing administrative controls: Administrative controls and policies for the prevention and control of transmission of COVID-19 within the health-care facility include, but may not be limited to: establishing sustainable IPC infrastructures and activities; educating patients' caregivers; developing policies for early recognition of patients with suspected COVID-19; ensuring access to laboratory testing for COVID-19 detection; preventing overcrowding, especially in the emergency department; providing dedicated waiting areas for symptomatic patients; planning for and isolating COVID-19 patients; ensuring adequate supplies of PPE; and ensuring adherence to IPC policies and procedures in all aspects of health care.

Implementing environmental and engineering controls
Besides the frontline healthcare workers, IPC professionals also played a significant role in emergency preparedness and responses (ie, fevertriage strategies, screening measures, and quarantine practices for infected or suspected patients) to contain the spreading of the virus, especially transmission of infection from patients to healthcare workers. 7 In Government medical college Kozhikode, the HICC has always played an indispensable role in managing all forms of threats including management of HAI, Sterilization and disinfection of hospital settings, Biomedical waste management, Managing cases of Needle Stick Injury and Antimicrobial stewardship. This in turn has helped in confronting threats like MDRO outbreaks, the NIPAH and Diphtheria outbreak and also the current SARS CoV 2 pandemic. This in turn is reflected in the number of health care workers who became infected with COVID 19 during their patient contact and other works in the hospital settings. The committee had actively started educating all tiers of HCW regarding the ICP long before the pandemic has reached the country, in addition to the regular trainings. Online education and telephonic supports were continued even during the peak of the pandemic. The institution being one of the most patient populated tertiary care centres in northern Kerala faced similar situations during the peak of the COVID 19 pandemic, being immediately declared as a COVID hospital, tending to the whole lot of patients hailing from Kasargode, Kannur and also Malappuram districts. In addition to samples being tested from admitted and referred patients, many of the Primary health centres and Community health centres collected the samples from periphery for conducting the test in the well equipped Virus Research and Diagnostic Laboratory in Government medical college, Kozhikode. This study emphasises the importance of adhering to the IPC in non COVID areas because, one of the most important task of the HICC is to prevent the emergence of Hospital acquired Infections. During the peak of the pandemic, along with the community spread of virus rampantly affecting the general population, a minor proportion of cases were also documented as being nosocomially acquired. So the prevention of cross infection among hospital admitted patients is mainly in the hands of the HCW, who were sometimes forced to work in both COVID and Non -COVID areas of the hospital owing to the inadequacy of staff. In our study done during the month of August 2019, which was one of the months were the COVID 19 pandemic was at its peak, only 6 HCW became infected with SARS CoV2, in spite of nearly 1049 HCW having contact with positive cases. Considering the demographic characteristics, Of the 6 positive HCW's all were in the age group of 20-40 years and all except one werefemales. 50% of the affected were doctors and 50% staff nurse, reflecting the equal importance of IPC adherence among the different classes of HCW. 4(67%) of the affected HCW were working in the ICU, s and 2(33%) in the ward. This may be attributed to the emergency situations the HCW had to face in the ICU which may have caused failure in their IPC practices, weighing patient life as more important than one's own. All of the 6 HCW were categorised by the Risk assessment Committee as high-risk contacts, depending on the distance maintained, the duration of contact and also the PPE used. Two out of six HCW gave history of multiple contacts with other COVID 19 positive Doctors and Nurses. Two had history of contact with COVID 19 patients and two of them couldn't account for the possible contacts. An epidemiologic study focusing on self-reported IPC behaviours before and after COVID-19 was conducted among HCWs in Wuhan city, Hubei Province and Ganzhou city, Jiangxi Province at the early stage of pandemic outbreak. The results suggested that the self-reported IPC behaviours of HCWs significantly improved after COVID-19 outbreak. HCWs who were in the affected area and in high-risk department reported IPC behaviour better. 9 This is in accordance with our study which suggests very high compliance level of the HCW to IPC resulting in the very few numbers being affected by the virus. According to another study conducted by Mary Eyram Ashinyo and Stephen Dajaan Dubik et al. in Ghana Healthcare workers' compliance with IPC protocols in different COVID19 treatment centers was high. 10 Ensuring an adequate supply of IPC logistics coupled with behaviour change interventions and paying special attention to nonclinical staff is critical for minimizing the risk of COVID-19 transmission in the treatment centres.

CONCLUSION
Out of 1049 HCW who had contact with COVID 19 patients only 6 HCW were found to be positive i.e., less than one percentage of exposed. This implies the impact that the IPC training had on the HCW which made them ensure their own safety and prevent the nosocomial spread of SARS CoV 2 within the hospital. Those who turned positive where actually high-risk primary contacts because of the unknown exposures they had to patients in dire emergencies as in the ICU settings and also contact with friends and family who had similar unknown exposures elsewhere.