COVID-19: Key Elements for Optimal Protection of Healthcare Workers

By Nouf Moh’d Khalifeh, MD | Published 4/4/2020 0


Photo source: iStock

In December 2019 a new outbreak of acute respiratory disease emerged in China.1 The causing pathogen was identified to be of the coronavirus family and named as the 2019 novel coronavirus (2019-nCoV).2

On March 11, 2020, the World Health Organization (WHO) declared the outbreak a pandemic. According to the Johns Hopkins Coronavirus Resource Center, there are now more than a million cases and almost 60,00 deaths worldwide.3 The numbers are changing rapidly, so be sure to consult the Resource Center for updates.

In the face of all the uncertainties regarding the treatment, vaccine, and presenting symptoms, person to person transmission through droplets or contact was confirmed, which sets the frontline healthcare workers at high risk of acquiring the disease.2

Identifying the Reasons

The drastic increases in caseloads along with the buildup of misinformation and anxiety have resulted in intense pressure on healthcare systems.4 Healthcare workers are more vulnerable to be infected while combating the disease and nosocomial infection may take place.5

During the severe acute respiratory syndrome (SARS) epidemic, more than 1,700 healthcare workers were infected which accounted for 21% of the cases.6 On the other hand, until February 24, 2020, more than 33,00 healthcare workers in China were infected with (2019-nCoV), with 22 (0.6%) deaths.7

Moreover,  in Italy, 20% of the responding healthcare workers were confirmed to be infected.8 Given this, it is important to take prompt action to prepare healthcare workers to face the coming challenges. There are numerous reasons that led to a high number of infected healthcare workers during the coronavirus disease 2019 (COVID-19) outbreak.

  • First, atypical presentation of infected individuals and lack of recognition of cases while they are highly contagious and the insufficient awareness of personal protective measures among healthcare workers.5 
  • Second, the workload, lack of adequate rest and nutrition, and longtime exposure to infected patients increased the likelihood of healthcare workers to become infected.7 
  • Third, the increased demand for personal protective equipment (PPE) led to a shortage of supply in tertiary hospitals which increased the risk further.5,7 
  • Fourth, due to the sudden emergence of this outbreak emergency, healthcare workers didn’t have enough time to be trained properly on the proper use of PPE and infection prevention and control policies.5,7,9 
  • Fifth, inadequate supervision and guidance on using PPE augmented the risk of infection among healthcare workers.7 Given this, it is important to take prompt action to prepare healthcare workers to face the coming challenges, especially in low and middle-income countries.7,9   

COVID-19 key elements for optimal protection of healthcare workers

By reviewing the previous experience of many hospitals and the policies they followed to protect healthcare workers from encountering the 2019-nCoV infection and to prevent nosocomial infection, recommendations can be summarized into four main categories:

  • Healthcare workers

Healthcare workers should be able to promptly identify suspected cases based on their presenting symptoms, travel history, and exposures. They should actions, such as confirmatory testing, and precautions accordingly.2,10

Infection prevention measures should include the proper knowledge of personal protective equipment (PPE) including how to put them on and take them off appropriately.2 The recommended PPE to be used include: fluid-resistant gown, gloves, eye protection, full face shield, fit-tested N95 respirator, head cover, and impermeable shoes that can be disinfected.4,11–13 However, disposable shoe covers are not recommended as they may increase the risk of self-contamination while taking them off.12,13

In addition, extra precautions should be taken when conducting high-risk aerosol-generating procedures as for example bag-mask ventilation, endotracheal intubation, and endoscopy.2,13,14

Such procedures are intended to be done in an airborne infection isolation room and healthcare personnel should take full airborne precautions.13,14 Powered air-purifying respirators (PAPRs) are 2.5 fold more protective than N95 respirators and may be more comfortable for prolonged resuscitation.12,13 Double gloving and hand hygiene are very essential in reducing the risk of infection.12

On the other hand, a hierarchal structure should be established among healthcare staff with a view to engage and empower each member to participate and respond efficiently.4  All healthcare personnel should follow the evidence-based guidelines in treating pneumonia, acute respiratory distress, and sepsis taking into account the new guidelines that evolve continuously as more information about COVID-19 is revealed.15

Related Content:  Healthcare Workers Say They’ll Be Fired If They Wear Their Own Masks

  • Healthcare facilities

Healthcare workers are the first line of defense in combating any pandemic and they constitute a fundamental part of all healthcare systems. Based on the foregoing, the paramount mission of healthcare facilities is to provide optimal protection and support to all healthcare staff.

All secondary and tertiary healthcare facilities should establish emergency policies and protocols for triaging and isolating suspected cases with airborne precautions.4,13,15 Each hospital should evaluate the intensive care unit bed capacity and mechanical ventilation supply and the ability to be augmented if needed.13,15

On another front, training, and education of healthcare workers deserves further attention, emergency infection control team should be established to train all the staff on infection prevention measures and triage strategies.12,16 Furthermore, a systematic risk-based approach should be implemented to select PPE according to the emerging infectious disease.12

The emergency team should monitor the process of donning and doffing of PPE among all healthcare workers.4,12 The eagle-eyed observer is a novel infection control measure that can be applied to follow the medical workers in the isolation ward and evaluate the personal protection and infection control procedure.4,17

The psychological support and protection is crucial and should not be neglected, frequent disclosure of information and communication with healthcare staff can ease anxiety and boost their confidence.4,13,18

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  • Regulatory and policy-making

The healthcare leaders and the government should establish an emergency response team to review the health policies and organize all the human, financial, and physical resources to optimize decision making.4,10,13

Moreover, they should contact PPE suppliers to maximize their production and supply to all healthcare facilities.15,19 Specific hospitals should be assigned to admit all COVID-19 patients to isolate them efficiently.13 On the other hand, clear communication with the public to raise awareness about infection control measures can lower the risk of acquiring the infection.13,15 

  • Community and society

The cooperation of society is essential to combat and control any pandemic. The community should follow all the instructions provided by their local health authorities to diminish the extent of the disease spread and to drop off the peak of the epidemic curve.15

The most important interventions are the rapid isolation of suspected cases and social distancing. 13,15 Following those measures will decrease the demand for hospitals and healthcare workers.

In conclusion, proper preparation and effective communication and collaboration between all sectors including the governmental and public community will enhance the efficiency in confronting this disease.



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  1. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA – J Am Med Assoc. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585
  2. Wu Y, Chen C, Chan Y. The outbreak of COVID-19. An overview. J Chinese Med Assoc. 2020:1. doi:10.1097/jcma.0000000000000270  
  4. Bearman G, Pryor R, Albert H, et al. Novel coronavirus and hospital infection prevention: Preparing for the impromptu speech. Infect Control Hosp Epidemiol. 2020:1-2. doi:10.1017/ice.2020.55
  5. Zhou P, Huang Z, Xiao Y, Huang X, Fan X-G. Protecting Chinese Healthcare Workers While Combating the 2019 Novel Coronavirus. Infect Control Hosp Epidemiol. 2020:1-4. doi:10.1017/ice.2020.60
  6. Sepkowitz KA, Eisenberg L. Occupational deaths among healthcare workers. Emerg Infect Dis. 2005. doi:10.3201/eid1107.041038
  7. Wang J, Zhou M, Liu F. Exploring the reasons for healthcare workers infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect. 2020;2019. doi:10.1016/j.jhin.2020.03.002
  8. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet. 2020;2:10-13. doi:10.1016/s0140-6736(20)30627-9
  9. Peters A, Vetter P, Guitart C, Lotfinejad N, Pittet D. Understanding the emerging coronavirus: what it means for health security and infection prevention. J Hosp Infect. 2020. doi:10.1016/j.jhin.2020.02.023
  10. Lee I, Wang C, Lin M, Kung C, Lan K, Lee T. Effective strategies to prevent coronavirus disease-2019 (COVID-19) outbreak in hospital. J Hosp Infect. 2020;2019. doi:10.1016/j.jhin.2020.02.022
  11. Wang X, Pan Z, Cheng Z. Association between 2019-nCoV transmission and N95 respirator use. J Hosp Infect. 2020:2020.02.18.20021881. doi:10.1016/j.jhin.2020.02.021
  12. Jones RM, Bleasdale SC, Maita D, Brosseau LM. American Journal of Infection Control Major Article A systematic risk-based strategy to select personal protective equipment for infectious diseases. AJIC Am J Infect Control. 2020;48(1):46-51. doi:10.1016/j.ajic.2019.06.023
  13. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus ( 2019-nCoV ) patients ` tes a ` l ’ intention des e ´ quipes de soins intensifs et Directives concre ´ siologie prenant soin de patients atteints du coronav. Can J Anesth Can d’anesthésie. 2020. doi:10.1007/s12630-020-01591-x
  14. Cheung JC-H, Ho LT, Cheng JV, Cham EYK, Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. Lancet Respir Med. 2020;2600(20):30084. doi:10.1016/S2213-2600(20)30084-9
  15. Adalja AA, Toner E, Inglesby T V. Priorities for the US Health Community Responding to COVID-19. JAMA – J Am Med Assoc. 2020;21202(December 2019):2019-2020. doi:10.1001/jama.2020.3413
  16. Ent H, Covid- A, Ent A. Letter to the Editor Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. 2020;(xxxx):2019-2020. doi:10.1016/j.jhin.2020.02.018
  17. Peng J, Ren N, Wang M, Zhang G. Practical experiences and suggestions on the eagle-eyed observer, a novel promising role for controlling nosocomial infection of the COVID-19 outbreak. J Hosp Infect. 2020. doi:10.1016/j.jhin.2020.02.020
  18. Imai H. Trust is a key factor in the willingness of health professionals to work during the COVID‐19 outbreak: Experience from the H1N1 pandemic in Japan 2009. Psychiatry Clin Neurosci. 2020;(February):2020. doi:10.1111/pcn.12995
  19. Ji Y, Ma Z, Peppelenbosch MP, Pan Q. Correspondence Potential association. Lancet Glob Heal. 2020;8(4):e480. doi:10.1016/S2214-109X(20)30068-1

Nouf Moh’d Khalifeh, MD

Nouf Moh’d Khalifeh, MD is a Master student in healthcare innovation at Arizona State University (ASU).

In 2019 She received a Bachelor in Medicine from the University of Jordan. During undergraduate studies, she focused on developing her clinical research skills and participated in many studies in different fields.

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