Assessment Of Health Care Workers Compliance On Covid19 Protocols At Specialist Hospital Bauchi
Abstract
Compliance with infection prevention and control (IPC) protocols is critical in minimizing the risk of coronavirus disease (COVID-19) infection among healthcare workers. However, data on IPC compliance among healthcare workers in COVID-19 treatment centers are unknown in Bauchi state. This study aims to assess IPC compliance among healthcare workers in Nigeria’s COVID-19 treatment centers. The study was a secondary analysis of data, which was initially collected to determine the level of risk of COVID-19 virus infection among healthcare workers in Nigeria. Quantitative data were conveniently collected using the WHO COVID-19 risk assessment tool. We analyzed the data using descriptive statistics and logistic regression analyses. We observed that IPC compliance during healthcare interactions was 88.4% for hand hygiene and 90.6% for Personal Protective Equipment (PPE) usage; IPC compliance while performing aerosol-generating procedures (AGPs), was 97.5% for hand hygiene and 97.5% for PPE usage. For PPE usage during healthcare interactions, lower compliance was seen among healthcare workers who were separated/divorced/widowed (OR: 0.08; 95% CI: 0.01–0.43), those with secondary level qualifications (OR 0.08; 95% CI 0.01–0.43), non-clinical staff (OR 0.16 95% CI 0.07–0.35), cleaners (OR: 0.16; 95% CI: 0.05–0.52), pharmacists (OR: 0.07; 95% CI: 0.01–0.49) and among healthcare workers who reported of insufficiency of PPEs (OR: 0.33; 95% CI: 0.14–0.77). Generally, healthcare workers’ infection prevention and control compliance were high, but this compliance differs across the different groups of health professionals in the treatment centers. Ensuring an adequate supply of IPC logistics coupled with behavior change interventions and paying particular attention to nonclinical staff is critical in minimizing the risk of COVID-19 transmission in the treatment centers.
TABLE OF CONTENTS
ABSTRACT
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study
1.2 Statement of the Problem
1.3 Objectives of the Study
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Limitations of the Study
CHAPTER TWO: LITERATURE REVIEW
2.1 Overview of Coronavirus
2.2 The virus, its origins and evolution
2.3 Epidemiology
2.3.1 Incubation Period
2.3.2 Infectious Period
2.4 Etiology
2.5 Signs and symptoms
2.6 Complications
2.7 Treatment
2.7.1 Antiviral
2.7.2 Anti-Inflammatory
2.8 Anatomy of a coronavirus
CHAPTER THREE: MATERIALS AND METHODS
3.1 Research design
3.2 Sources of Data
3.3 Population of the study
3.4 Sample size determination
3.5 Instrumentation
3.6 Content of the study tool
3.7 Reliability
3.8 Validity
3.9 Method of Data Collection
3.10 Data analysis
3.11 Ethical considerations
CHAPTER FOUR: RESULTS AND DISCUSSION
4.1 Results
4.2 Discussion
CHAPTER FIVE: CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion
5.2 Recommendations
REFERENCES
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Health related infections are the major problems of public health in many nations of the world, which ultimately cause an increase in the morbidity, mortality, and additional costs in health care settings (Mauldin et al 2010; Defez et al, 2008 and Llata et al, 2009). Ensuring hand hygiene is therefore one of the basic means preventing the spread of such infections. In 1983, Semmelweis highlighted that cleansing of contaminated hands with antiseptic products before and after contact with patients may reduce health related infections (Semmelweis I. 1988). Thereafter, Centre for Disease Control and Prevention published the first formal guidelines on hand washing practices in hospitals (Garner JS, Favero MS. 1986), followed by guidelines from the Association for Professionals in Infection Control and Epidemiology (APIC) (Larson et al, 1995).
Corona viruses are common viruses that most people get sometime in their life and may also infect animals. Human coronaviruses (hCoV) which has been globally trending for over a month now usually causes upper respiratory tract illnesses. Severe Acute Respiratory Syndrome (SARS-CoV) that occurred way back in 2003 served as a reminder to this newly emerging zoonotic coronaviruses which has the potential to transmit from person to person and to cause severe human illnesses. Novel coronavirus (nCoV), described as Middle East Respiratory Syndrome coronavirus (MERS-CoV), is a particular strain different from any other known hCoV with a possibility of zoonotic transmission. However, Centre for Disease Control and Prevention (2019) revealed that investigations was carried out to figure out the reservoir and source of infection, route of transmission to humans, symptoms, prevention, severity and clinical effects with gradually increasing number of reported cases on daily basis.
There has been a rapid international response following the news of this new virus from Wuhan, China on the 12th of February 2020 which has now spread to every nook and cranny of the world. An interim case definition was developed rapidly by WHO to ensure that a systematic approach is followed for appropriate identification and investigation of suspected cases. The body has also made arrangement for disbursing huge amount of money for the prevention and cure of this pandemic disease now known as COVID-19 to the high risk affected nations of the world.
Understanding the knowledge, attitudes, and perception of health workers on transmission and prevention of COVID-19 is essential to bring forth a sustained change in behaviors of individuals and institutions and to improve such practices when designing interventions. This is why health workers and the government are clamouring for hand hygiene. This can be achieved by frequently washing of the hands. Several factors are involved in hand hygiene behavior such as attitude, perceived social norm, perceived behavioral control, perceived risk for infection, hand hygiene practices, perceived role model, perceived knowledge, and motivation (Larson et al, 2000). Despite the number of published studies on hand hygiene, many questions concerning attitudes and knowledge of health care workers (HCWs) remain unanswered. This is particularly true in primary care settings where the volume of patients and complexities of cultural, institutional, and health policy factors can influence the practice of hand washing. Various studies have confirmed an inverse relation between intensity of patient care and adherence to hand hygiene practice (Pittet et al, 2004; Harbarth et al, 2001 and Arenas et al, 2005). Additionally, the current burden of the spreading Middle East respiratory syndrome coronavirus (MERS-CoV) implied an action to review our basic strategies in hand hygiene practice. In a descriptive study (47 cases), MERS-CoV was found to be associated with substantial mortality in admitted patients who have medical co morbidities. This brings about adequate infection control measures among health workers, for example, hand hygiene. Hence, knowledge, attitudes, and perception of hand hygiene will continue to be a major concern and are important to examine to bridge the theory practice gap.
The discovery of this new virus mandates it for China to demonstrate to rest of the world how vigilant and prepared they are to prevent the global spread of a new infection and protect both global health and the wellbeing of their own peoples. The countries of the region need to be vigilant and put in place enhanced public health surveillance plan for identifying suspected cases using WHO’s recommended case definition and investigation protocol ((Cao J, Tu W, Cheng W, Yu L, Liu Y, Hu X, et al. 2020)
. The US, UK, Germany, Italy and even Nigeria are currently battling with COVID-19 pandemic. It has taken a great concern at the governmental and public levels as it led to a number of human infections and deaths. Since February 12, to March 26, 2020; the total number of infected cases with COVID-19, as reported by worldometers, reached 478,446 of global cases of which 21,524 cases have died and a total of global recovery stands at 115,668.
Healthcare workers play a critical role in fighting the COVID-19 pandemic and are at greater risk of COVID-19 virus infection in the line of duty (Kim R. et al. 2020)
. For instance, data from recent studies showed healthcare workers are more likely to be exposed to SARS-COV-2 (WHO, 2020)
and are, therefore, at higher risk of COVID-19 infection than the general community [10]. Hence, the impact of the COVID-19 pandemic on healthcare workers has been enormous (Kim R. et al. 2020).
However, prevention remains the best weapon for protecting healthcare workers against the COVID-19 pandemic (Verbeek and Rajamaki 2020).
. Therefore, adherence to infection prevention and control protocols is critical at minimizing healthcare workers exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Verbeek and Rajamaki 2020). Indeed, correct and consistent compliance with IPC protocols is effective in minimizing the risk of COVID-19 infection (WHO, 2020).
Compliance with IPC protocols is facilitated by training of healthcare workers on IPC, provision of IPC materials and regular audit of IPC practices (Verbeek and Rajamaki 2020).
Generally, IPC strategies in response to highly infectious diseases, such as COVID-19, should include early recognition, physical distancing, source control, taking precautions and appropriate use of PPEs, restriction of movement, environmental cleaning and disinfection as well as support for healthcare workers (Verbeek and Rajamaki 2020).
COVID-19 infection among frontline healthcare workers put patients, other healthcare workers and the general community at risk of infection. Minimizing exposure of healthcare workers to the SARS-CoV-2 is the best option for protecting frontline healthcare workers from COVID-19 infection, and this is best done through healthcare worker adherence with IPC protocols as well as inoculating against the SARS-COV-2 [Al-Ahdal et al., 2020]. Therefore, an understanding of IPC compliance among healthcare workers managing COVID-19 patients is essential for preventing the spread of COVID-19 infections among healthcare workers, reducing secondary transmission in the treatment centers and updating IPC policies in Nigeria.
We need to better understand the public health implication of emergence of this new respiratory virus from China to understand the exposure risks. The current situation in Nigeria needs to be carefully monitored by our health workers as there is a fear from increased number of human infections and deaths recording on daily basis. Till now, no COVID-19 cases have been confirmed in some states in Nigeria, however, in south western part of Nigeria, as at 26th of March, 2020, Lagos State has recorded 32 cases, while Ogun has recorded 3, Ekiti, Osunand Bauchi (the case study for this research work) has recorded 1 case each. Thus, the concern over the possibility of an outbreak in Bauchi State should not be taken lightly. The problem of COVID-19 pandemic becomes more complicated in absence of any prophylactic vaccines, curative treatment and lack of experience in control measures (Al-Ahdal et al., 2020). It is against this backdrop that the study sets to examine the compliance of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of Specialist hospital Bauchi as a case study.
1.2 Statement of the Problem
Once again, the world is currently experiencing a global viral COVID-19 pandemic. As of March 26, 2020 confirmed cases of coronavirus disease (COVID-19) has been reported to be 478,446 and 21,524 deaths had been reported in more than 30 countries of the world. The majority of cases as at the time of writing have been from China which is closely followed by Italy, US, UK, Germany and Spain. Most countries in the world have made efforts to halt transmission through shutting down transport, quarantining entire cities, regular washing of the hand with soap and sanitizer and enforcing the use of face masks. International flights have been cancelled in Nigeria and other African nations have been following suites and affected cruise ships quarantined. This has been having effects on the economy of the world.
The effects of COVID-19 pandemic outbreak to the economy of the world will surely be discussed in its aftermath. The initial response in China to contain the virus has been applauded by WHO and considered much improved compared with its response to the 2003 SARS-CoV epidemic. Internationally, we have seen rapid generation and sharing of knowledge to the benefit of the outbreak response, but also counterproductive actions by some countries, including limiting trade and shutting of borders, to its detriment. With the increasing frequency of zoonotic spillovers leading to human infections and transmission, it is apparent that pandemic preparedness has become a priority for the global health agenda. It is on this claim that this study aims to examine the compliance of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of Specialist hospital Bauchi as a case study.
1.3 Objectives of the Study
The objective of this study is to examine the compliance of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of Specialist hospital Bauchi as a case study. However, the specific objectives are:
Health Care Workers Compliance on Covid19 Protocols
- To understand the compliance of health workers to the Covid19 Protocols in Bauchi State
- To determine the strategies used by health workers in the State to stop the general spread COVID-19
- To study the effects of COVID-19 on the economic status of the world
- To establish the symptoms of COVID-19 and the steps to take when these symptoms occur
1.4 Research Questions
The following questions were generated during the course of this study:
- What are the compliance of health workers to the Covid19 Protocols in Bauchi State?
- What are the strategies used by health workers in the State to stop the general spread COVID-19?
- What are the effects of COVID-19 on the economic status of the world?
- What are the symptoms of COVID-19 and the steps to take when these symptoms occur?
1.5 Significance of the Study
Theoretically, this study stands to provide additional knowledge to the body of existing literature on the spread this pandemic disease to the world and of particular reference to Nigeria. The result of this study will serve as good base or guide for future reference and it will also encourage further research on the importance of staying healthy. Furthermore, this study will provide relevant information on the reasons for the spread of this disease from China to the rest of the world.
Practically, the findings of this study will reveal the reasons for regular health check up for the benefit of staying healthy at all times. The result from this research will also help health workers to design relevant, persuasive health messages that will help change the people’s attitude on the utilization of hospitals and create more awareness on the situation of health care services in the country. This study will be of great significant to the medical professionals who have defaulted in carrying out their duties to their patients
1.6 Scope of the Study
This study focuses mainly on the compliance of health workers on transmission and prevention of COVID-19 of health workers in the outpatient department of Specialist hospital Bauchi. It will therefore, be carried out among the students and health workers in the outpatient department of Specialist hospital Bauchi.
1.7 Limitations of the Study
The time frame was not enough for the researcher to delve into the issue as comprehensively as would have been desired. This also informed the decision to focus on one department so the time would be invested in identifying and evaluating all possible aspects of the subject matter so as to make the study as comprehensive as possible. The use of a case study arguably has many limitations, however it allows for a level of research that was commensurate with the nature of results expected.
1.8 Organization of the Study
The study comprises of five chapters. Chapter one consists of the background to the study, statement of the problem, purpose of the study, objectives, research questions, significance, limitation of the study, delimitation of the study and organization of the study. Chapter two comprises of literature review theoretical and conceptual frameworks. Chapter three deals with research methodology, covering research sampling, procedures, research instruments and their validity and reliability, procedures for data collection and data analysis. Chapter four comprises of findings and discussions which were generated by the study. Chapter five presents summary, conclusions and recommendations.
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