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Dewi YS, et al. The Risk Factors of COVID-19 Transmission in Health Workers: A Literature
Review. Adv Nursing Patient Care Int J 2021, 4(1): 180052.
Copyright © 2021 Dewi YS, et al.
Advanced Nursing & Patient Care International Journal
ISSN: 2642-0147
Research Article Volume 4 Issue 1
The Risk Factors of COVID-19 Transmission in Health Workers: A
Literature Review
Mastifah1, Dewi YS2*, Asmoro CP2, Laksono AD3 and Kamel AD4
1Student of Faculty of Nursing UniversitasAirlangga Surabaya, Indonesia
2Faculty of Nursing UniversitasAirlangga Surabaya, Indonesia
3National Institute of Health Research and Development, Indonesia Ministry of Health, Jakarta, Indonesia
4Collage of nursing, King Saud bin Abdul Aziz University for Health Science KSAU-HS-Riyad-KSA - Maternal and New Born Health
Nursing, Faculty of Nursing, Cairo University, Egypt
*Corresponding author:
unair.ac.id
Received Date: April 11, 2021; Published Date: April 24, 2021
Abstract
purpose was to explain the risk factors for transmission and prevention of transmission of COVID-19 to health workers.
Methods: A literature review searched four databases (Scopus, Science Direct, Proquest, and PubMed) searches were conducted
in July and August 2020. The Prisma checklist guided this review. Data tabulation and narrative analysis of the study was
performed. Title, abstract, full text, and methodology were assessed for the eligibility of the studies.
Results: We found seventeen studies that matched the research criteria. The study was divided into two themes, namely risk
factors for transmission of COVID-19 to health workers (n=8) and prevention of transmission (n=3) and the study of both
(n=6). Risk factors for transmission of COVID-19 to health workers included age, improper hand washing, comorbidities, lack of
sleep quality, lack of knowledge and training, work stress, close contact or exposure to positive COVID-19 patients, lack of PPE,
workload, climate, temperature, and humidity. Whereas ways to prevent are keeping hand hygiene, physical distancing, using
facilities operations, and conducting rapid tests and PCR tests to all staff and patients.
Conclusion: It can be concluded that there are 9 risk factors for transmitting COVID-19 to health workers, and 6 ways to prevent
transmission of COVID-19 to health workers.
Keywords: COVID-19; Risk Factors; the Factor of Transmission; Prevention; Health Worker; Literature Review
Abbreviations: PPE: Protective Equipment; PPI:
Infection Prevention and Control; COPD: Chronic Obstructive
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Introduction
The COVID-19 is quickly spreading because of its human-
to-human transmission through droplets of coughs and
sneezes and aerosols. Close contact is one of the risk factors
for transmission of COVID-19 to health workers [1] another
cause of transmission of COVID-19 is the lack of availability
of personal protective equipment (PPE) or improper use and
removal of PPE [2] of the various factors of transmission of
COVID-19 to health workers, it is necessary to carry out a
literature study to resolve the risk factors for transmission of
COVID-19 and ways to prevent the transmission.
Transmission to health workers in America reached 370
people per 10,000 cases with the mortality rate for health
workers reaching 5% [3]. Case reporting on September
22nd, 2020 the number of positive cases of COVID-19
worldwide reached 30,949,804 cases with a CFR of 3.1%
of COVID-19 was 248,852 cases with a CFR of 3.9%. There
were 25,000 cases of COVID-19 among health workers
worldwide, consisting of doctors, nurses, midwives, analysts,
pharmacies, and others [4]. The Indonesian COVID-19 Task
Force reported that for every 100 deaths, around 6-8 of the
deaths were number fatalities from the health workers. Data
entered on August 1st, 2020; the number of deaths of health
workers in Indonesia due to COVID-19 was 153 cases.
The cause of transmission of COVID-19 to health workers
does not only occur when contacting positive COVID-19
patients but also occurs due to contact between colleagues
and contacts outside of hospital regulations, for instance
during lunch breaks and meetings. Also, health workers work
[5] health workers also gather without wearing masks
and remove the PPE improperly [3]. The virus entering
the respiratory tract if a person touches the face and nose
without prior washing hand [6]. The impact of COVID-19
transmission on health workers including increased anxiety,
fear of negative community stigmatization, increased
implementation of infection prevention and control (PPI) [7]
and inadequacy of health facilities and health workers that
accommodate and provide care [8]. Besides, health workers
are concerned that the infection will not be limited to their
selves but also their colleagues and family members [9].
The increase in transmission of COVID-19 to health workers
continues to increase from time to time even though
prevention efforts have been made. According to the results
of previous research conducted in South Africa, the risk
factors for transmission of COVID-19 to health workers
are age, immunity of health workers, and comorbidities
such as hypertension, diabetes mellitus, cardiovascular
disease, and chronic obstructive pulmonary disease (COPD)
[10]. Transmission of COVID-19 to health workers can be
prevented or minimized. Therefore, the author was interested
in conducting literature reviews to analyse the risk factors
for transmission of COVID-19 to health workers and prevent
or minimize transmission to protect health workers from
COVID-19 infection.
Methods
Source of Information
The author searched for articles in four databases, namely
Scopus, Science Direct, Proquest, and PubMed with the
research topic being risk factors for transmission and
prevention of COVID-19 to health workers. Article searches
were conducted from July to August 2020.
Search Term in Survey
Literature search used keywords and Boolean operators
(AND, OR NOR or AND NOT). The keywords used in the
literature search namely “Risk factors” OR “Factors” OR
“Causa *” AND “Transmission” OR “Disease transmission” OR
“Infection transmission “AND” Preventive “OR” Prevention
and control “OR” Universal precaution “AND” COVID-19 “OR”
2019-nCOV “OR” Sars Cov-2 “OR” Novel Coronavirus “AND”
Health care workers “OR” Health care professional “OR”
Medical Staff “.
Selection Criteria
Inclusion criteria were according to the PICOS framework.
Based on the results of literature searches through
publications in four databases and using keywords that have
been determined by MeSH, the authors obtained 939 journals
that matched the keywords. There were 458 duplicated
articles hence excluded from the list and the remaining 481
articles were screened and found that as many as 17 articles
matched the research objectives to be reviewed.
Results of the Search for Source Material
This literature review study included 17 journals that
passed the screening according to predetermined criteria.
research objectives, namely discussing the transmission and
prevention of transmission of COVID-2019 to health workers.
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No First Author
& Country Title Design and Sample The Result of Factor
Analysis Database
1Steensels, et
al. [19] Belgia
Hospital –Wide SARS-Cov
Antibody Screening in 3056
Staff in a Tertiary Center in
Belgium
Design: Cross-sectional
Study Sample 3065 Medical
Staff in Belgium
Close contact,
availability, Prevention
was carried out by
screening with a rapid
test
Science Direct
Q1-indexed
Journal
2Al-zoubi, et al.
[2] Jordania
Prevalence of positive
COVID-19 among
asymptomatic health care
workers who care for
patients infected with the
novel coronavirus
Design: Retrospective Study
and prevalence Sample:
370 Health care workers at
King Abdullah University
Hospital
Close contact Prevention
was carried out using a
PCR test on all staff
Scopus Q3-
indexed Journal
3Tabah, et al
[30]. Australia
Personal protective
equipment and intensive
care unit healthcare worker
safety in the COVID-19 era
Design: International
Survey dan prevalence
Sample: 2711 Health care
worker
Lack of Knowledge and
Training. Prevention can
be done by providing
education and training
Scopus Q1-
indexed Journal
4Haberman, et
al. [14] USA
COVID-19 in Patients with
Prospective Study on the
Effects of Comorbidities
and DMARDs on Clinical
Outcomes
Design: Prospective
cohortSample:103 patients
in New York
Age, autoimmune and
comorbid diseases.
Science Direct
Q1-indexed
Journal
5Barrett, et al
[1]. USA
Prevalence of SARS Cov-
2 Infection in previously
undiagnosed health care
workers at the onset of the
U.S. COVID-19epidemic
Design: Prospective
cohortSample:829 HCW in
the USA
Close contact
Science Direct
Q1-indexed
Journal
6Dioscoridi L,
et al. [15] Italy
COVID-19 exposure risk
for family members of
healthcare workers
Design: Observational Study
dan Case Report Sample:
38 Health workers and 81
Family Health workers
of PPE, exposed to many
undiagnosed cases.
Scopus Q1-
indexed Journal
7
Sikkema,
et al. [12]
Netherlands
COVID-19 in health-
care workers in three
hospitals in the south of
the Netherlands: a cross-
sectional study
Design: Cross-sectional
Study Sample: 12.022
Health workers
Close contact, foreigners
with travel history,
community contacts/
mass gatherings,
prevention can be
done by carrying out
screening for Sars Cov-2
to patients and health
workers.
PubMed Q1-
indexed Journal
8Ran, et al. [20]
China
Risk Factors of Healthcare
Worker with Corona Virus
Disease 2019
Design: Retrospective
Cohort Study Sample: 72
health workers
Lack of hand hygiene,
improper use of PPE,
excessive workload.
Prevention can be
carried out by having
a high level of hand
hygiene and reducing
working hours.
PubMed Q1-
indexed Journal
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9Wang, et al.
[8] China
Super factors associated
with the transmission of
occupational COVID-19
infection among healthcare
staff in Wuhan, China
Design: Cross-Sectional
Study Sample: 92 Health
care staff
Using the mask
improperly, touching the
cheeks, nose, and mouth
while working, wearing
incorrect or damaged
PPE, being exposed to
COVID-19 patients
Science
directQ1-
indexed Journal
10 Lahner, et al.
[13] Italy
Prevalence of Sars-Cov-2
infection in health workers
(HWs) and diagnostic
test performance: the
experience of a teaching
hospital in central Italy
Design: Cross-Sectional
Study Sample: 2.057 Health
workers in Italy
Age, exposure to Sars
Cov-2 patients, and
longer working hours
The prevention are by
reducing working hours.
Proquest Q1-
indexed Journal
11
Bhagavathula,
et al. [33]
India
Novel Coronavirus
(COVID-19) Knowledge
and Perceptions: A Survey
of Healthcare Workers in
India
Design: Cross-Sectional
Study Sample: 453 Health
workers
Low level of knowledge
and perception of
COVID-19.
PubMed Q1-
indexed Journal
12
Powell-
Jackson, et al.
[21] Tanzania
Prevention and control
compliance in Tanzanian
outpatient facilities: a
cross-sectional study with
implications for the control
of COVID-19
Design: Cross-sectional
study Sample : 734
outpatient health workers in
Tanzania
Prevention can be
carried out bythe
implementation of
standard precautions
Science direct
tQ1-indexed
Journal
13 Celebi, et al.
[16] Turkey
SARS-CoV-2 transmission
among health care workers
in a university hospital in
turkey
Design: Case-Control
StudySample:703 Health
care workers
Improper use of PPE,
failure to maintain
physical distance.
Science
directQ1-
indexed Journal
14 Schwartz, et
al. [7] Taiwan
Protecting Health Care
Workers during the
COVID-19 Coronavirus
Outbreak -Lessons from
Design: Quasi-
experimentSample:18
hospitals as a treatment
group and 33 hospitals as a
control group
The prevention is by
Control Bundling (TCB)
and physical distancing.
PubMed Q1-
indexed Journal
15 Bai, et al. [8]
China
SARS Cov-2 Infection in
Health care workers
Design: Retrospective
Study/Case Report Sample:
118 Health workers in
Wuhan China
Working night shift
(low sleep quality) and
working under pressure
(work stress), working
in a COVID-19 isolation
room.
ProquestQ1-
indexed Journal
16
Altamimi, &
Ahmed et al.
[17] Saudi
Arabia
Climate factors and
incidence of Middle East
respiratory syndrome
coronavirus
Design: Retrospective/
Cohort Study Sample: 712
cases of Mers Cov in Riyadh,
Saudi Arabia
Climate, temperature,
and humidity.
Science
DirectQ2-
indexed Journal
17
Gonzalez-
Ciccarelli, et
al. [22] USA
Surgery Cases Reducing the
transmission of COVID-19
using a continuous
negative pressure operative
maxillofacial surgery
Design: A case report
Sample: patient suffering
left maxillary sinus lesion
and positive COVID-19
Prevention can be
carried by placing
COVID-19 patients in
rooms with negative
pressure
ScopusQ4-
indexed Journal
Table 1: The Result of the Literature Search.
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These seventeen journals were divided into 2 major themes,
namely risk factors for transmission of COVID-19 and factors
for the prevention of transmission of COVID-19 to health
workers, 8 studies discussed risk factors for transmission
of COVID-19, 3 studies discussed factors for preventing
transmission and 6 studies addressed both. The results of a
literature search can be seen in Table 1.
Seventeen articles found by the author in four databases were
all published in 2020 with different study designs, namely
cross-sectional study, prevalence study, cohort study, case
report, case-control study, and quasi-experimental study.
Results
Risk Factors for Transmission of COVID-19 to
Health Workers
material, method, money, and quality factors [11]. The risk
factors that affect the transmission of COVID-19 to health
factors. The risk factors for transmitting COVID-19 to health
workers can be seen in Table 2. Based on Table 2, the risk
factors for transmitting COVID-19 to health workers are age,
lack of hand hygiene, comorbidities and autoimmune, low
sleep quality, work stress, lack PPE, climate, temperature,
and humidity, workload, and close contact and exposure to a
positive patient with COVID-19.
Author Transmission Factor
Man Material Method
Steensels, et al. [19]
2020 Age, inappropriate use of PPE
Exposure to co-workers who
are positive for COVID-19,
Weak implementation of PPI.
Al-zoubi, et al. [2]
2020 -Contact with COVID-19
patients or coworkers.
High workload, incorrect use,
and removal of PPE.
Tabah, et al. [30]
2020 Lack of knowledge and training - -
Haberman, et al. [14]
2020
Age, autoimmune and comorbid
diseases - -
Barrett, et al. [1]
2020 -Close contact with COVID-19
patients Work as a health worker.
Dioscoridi L & Carrisi
C, 2020 -Exposure to many undiagnosed
cases Lack PPE
Sikkema, et al. [15]
2020 -
Through unknown people with
travel history, contact with
communities/ mass gatherings,
nosocomial infections
-
Ran,et al. [1] 2020 Lack of hand hygiene before and
after patient contact -
Improper use of PPE, risk of
contracting the disease when
working 15 hours per day.
Wang, et al. [8] 2020
Improper use of masks, close
contact, touching cheeks, nose, and
mouth while working
Exposure to Sars Cov-2 patient Incorrect use of PPE, using
damaged PPE.
Lahner, et al. [13]
2020
Age, improper hand washing before
or after patient contact. Exposure to Sars Cov-2 patient Longer working hours.
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Bhagavathula, et al.
[33] 2020
Low level of knowledge and
perception of COVID-19 - -
Celebi, et al. [16]
2020 - -
Incorrect use of PPE when
treating patients with
COVID-19 infection and
unable to maintain physical
distancing.
Bai, et al. [8] 2020 Low quality of sleep, working
under pressure (work stress) -Workload and work in
COVID-19 isolation rooms.
Altamimi, Asmaa &
Ahmed, Anwar E, et
al. [17] 2020
-Climate, temperature, and
humidity -
Table 2: Risk Factor of Transmission of COVID-19 on Health Workers.
Age, an older people have comorbid that make them fall into
an immunocompromised condition that is very susceptible
to contracting COVID-19 [12]. Lack of hand hygiene, one of
the risk factors for being infected with COVID-19 is less than
optimal hand washing before and after contact with patients
[13]. Comorbidities and autoimmune, patients with arthritis
and taking oral glucocorticoids were more likely to be treated
for COVID-19 [14]. Low sleep quality, Health workers who
PSQI score than the PSQI for uninfected [8].
Work stress, the stress level of health workers is also a risk
factor for the transmission of COVID-19 [8]. Lack PPE, the use
of PPE is not appropriate because it has low PPE availability
[15,16]. Climate, temperature, and humidity, is associated
with increased viral activity in the Mers Cov incidence [17].
Workload, excessive or high workload results in fatigue
of the health worker [18]. Close contact and exposure to a
positive patient with COVID-19, health workers are exposed
COVID-1919and are exposed to many undiagnosed cases
[15].
Prevention Factors of Transmission of COVID-19 to
Health Workers
Prevention of transmission of COVID-19 to health workers is
the study results found by the author, these factors can be
seen in Table 3. Based on Table 3, the factors for preventing
the transmission of COVID-19 to health workers are hand
hygiene, PPE, standard precaution, physical distancing,
provision of education and training, and negative pressure
room.
Author Preventive Factor
Man Material Method
Steensels, et al. [19]
2020 Using PPE - Implementation of a rapid test on all
patients and staff.
Al-zoubi, et al. [2] 2020 Using PPE Availability of PPE Screening by carrying out a PCR test.
Tabah, et al. [30] 2020 Using PPE level 3 Availability of PPE Providing education and training on the
use of PPE, PPI training.
Sikkema, et al. [15] 2020 Using PPE level 3 - Screening of Sars Cov-2 in patients and
healthcare workers.
Ran, et al. [1] 2020 Hand hygiene -
Reducing working hours, removing health
workers with comorbid from serving
patients but working as administrative
Wang, et al. [8] 2020
Wearing a mask, keeping
physical distance, avoiding
the mass gathering
Availability of PPE -
Lahner, et al. [13] 2020 - - Decreasing the working hours.
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Jackson, et al. [19] 2020 Hand hygiene Using hand gloves
Implementation of PPI or standard
precautions, disinfection of equipment,
sewage treatment.
Schwartz, et al. [7] 2020 Self-isolation
and Physical distancing.
Gonzalez-Ciccarelli, et al.
[22] 2020 -Negative pressure
room -
Table 3: Factors for Preventing the Transmission of COVID-19 to Health Workers.
Hand Hygiene, maintain hand hygiene by washing hands
frequently and not touching the nose, mouth, and eyes before
washing hands, covering mouth when sneezing or coughing
[18,19]. Adhere to hand hygiene and the use of gloves [20].
PPE, one of the steps to prevent infection transmission is to
provide and wear PPE [2,21]. Standard precaution, perform
high touch point disinfection throughout the hospital at least
3 times a day, wearing PPE according to the procedure to be
performed [21]. Disinfection of reusable equipment, sewage
treatment [20].
Physical Distancing, provide health services without direct
contact with patients [7]. Provision of education and training;
educate health workers about how to care for COVID-19
patients, about hand hygiene, how to put on and take off the
correct PPE and the types of PPE used [2]. Negative pressure
room, the negative pressure chamber will clean the aerosol
particles of the room with negative pressure circulating 33
cubic feet will remove 99.999% of 0.1 μm particles or larger
[22].
Discussion
Risk Factors for Transmission of COVID-19 to
Health Workers
Based on the results of the review of articles conducted by
the author, it was found that the human factors that affected
the transmission of COVID-19 to health workers are age, lack
of hand hygiene, low quality of sleep, and stress. Age affects
the transmission of COVID-19 to health workers [13,14]. The
infection progresses faster in older age due to decreased
endurance, for instance, due to comorbidities [23]. The
difference in the morbidity of infectious disease in various
education, and population migration [24,25]. Following this
statement, age affects the transmission of COVID-19. The
impact of COVID-19 on people of older age with comorbid
and autoimmune symptoms is a more severe condition and
a greater risk of death. Health facility management should
understand the age structure and comorbid status of their
health workers, to obtain the data of health workers included
in the vulnerable group during the pandemic.
Most of the research states that hand hygiene is a factor
affecting the transmission of COVID-19 to health workers.
This is expressed in their respective researches [13,19].
Based on the results of the study, it is shown that the
transmission of disease through the hands orally can be
prevented by washing hands using soap and running water
before or after carrying out activities.
The low sleep quality of health workers leads to a greater
risk of being infected with COVID-19 [8]. Sleep quality can
be described by the length of sleep and the complaints felt
during sleep or after waking up [26]. Sleep quality was
assessed using the PSQI [8]. The study did not include data on
the immunity and health status of respondents, therefore it is
necessary to conduct research. Furthermore the stress level
of health workers is also a risk factor for the transmission
reaction in the face of a threat and pressure [27]. Based on
the results of the review of the article, it is stated that the high
positive for COVID-19 is due to the stigmatization that health
workers are carriers of the virus, therefore optimal support
is needed from the management of health facilities, the
community, as well as family.
Based on the results of the review of the article, material
factors that affect the transmission of COVID-19 are exposure
to COVID-19 patients, the environment, temperature, climate,
and humidity. The environment referred to in the research
is the patient care room and the community environment.
The environment that is suspected of contributing to the
transmission of COVID-19 includes temperature in the air, air
pollution, particulates, humidity, and weather [17]. The family
environment is a factor in the transmission of COVID-19, if
one of the family members is infected, other family members
may also be infected [28]. Based on the results of the review
of the article, the authors state that health workers are
already proper in wearing and removing PPE following the
SOP and existing protocols, but health workers are at risk of
infection or exposure in the family environment or outside
health facilities because they do not wear PPE.
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Method factors that affect the transmission of COVID-19 are
the lack of PPE availability and workload. Based on research
conducted by Valdivia-Granda & Richt (2020) that states
many doctors contracted COVID-19 due to errors in using
PPE. But this is not entirely proven, indicated by the presence
of health workers infected with COVID-19 from their family
environment, and the problem of lack of PPE. Some health
workers also wear substitutes that have the same function
as PPE, such as raincoats and face shields from plastic covers
[29].
The workload is related to working hours and activities
carried out [11]. Based on the results of the study, it can be
stated that the workload of health workers increases during
the pandemic because they have to wear PPE, comply with
positive for COVID-19. Deemed monotonous, using PPE and
blurry vision for long periods can be stressful. Based on
this statement, it was found that the increasing workload
of health workers is due to their duties to provide care to
the patient and to protect themselves from exposure to
COVID-19. The consideration of working hours and workload
is very important as an effort to prevent transmission to
health workers.
Factors to Prevent Transmission of COVID-19 to
Health Workers
Based on the results of the review of the article, the factors
preventing the transmission of COVID-19 in terms of
human factors are hand hygiene and physical distancing.
Hand hygiene is one way to break the chain of disease
transmission [24]. Health workers can bring the virus home
and infect the family or spread the virus to the restroom for
study, it is important to not wear jewellery such as rings and
bracelets because the possibility becomes a living spot for
microorganisms, therefore hand hygiene procedures can be
carried out optimally.
Material factors that can prevent the transmission of
COVID-19 are the use of PPE, placing patients in negative
(TCB). The use of PPE is important in efforts to prevent
transmission. Personal protective equipment commonly
used by health workers consists of surgical masks, white or
green cotton gowns, headgear, protective goggles, gloves,
and disposable protective gowns, for low-risk patients
[2,12,21,30]. The use of gloves is highly recommended to
prevent transmission by touch [31]. Based on the results of
the analysis, it can be shown that PPE at health facilities is
readily available and health workers already understand the
importance of its use.
The room used in the care of patients with COVID-19 must
have special standards such as negative pressure and open
to free air [22]. Method factors in preventing COVID19 are
changes in health facilities operations, implementation of
PPI or standard precautions, implementation of rapid tests
and mass PCR tests, and providing education and training to
health workers. The government has made various efforts
to prevent the transmission of COVID-19 by providing PPE
according to standards, implementing infection prevention
and control, providing training to health workers on how
to provide care to COVID-19 patients, clean hands, use and
remove the PPE and types of PPE used, implementation of
rapid and PCR tests on health workers with close contact with
also has made policies on the health and protection of health
workers. Health workers that experience illness may take
sick leave. Working time is set with a maximum of 40 hours a
week with a daily work time of 7-8 hours and not exceeding
12 hours. There should be a monitoring of the health aspects
with comorbidities and special conditions. Finally, there is
banning for visitors and watchmen for COVID-19 patients
[32].
Knowledge plays a role in the transmission and prevention of
COVID-19 [30,33]. The knowledge expressed in the research
includes knowledge of transmission, proper and correct
use of PPE, and negative perceptions of COVID-19. Health
workers that handle COVID-19 only rely on the experience of
handling patients with infectious diseases by using PPE and
washing hands as a preventive measure [30]. Based on the
results of the review of articles, there is a need to increase
the knowledge of health workers by conducting education
and training related to COVID-19 through an online system.
The COVID-19 pandemic has resulted in changes in the
use of PPE. COVID-19 is a new disease for which until now
there has been no detailed explanation regarding the most
effective mechanisms and handling. This situation affects
the knowledge of health workers therefore it is necessary to
train all staff, not only health workers about hand hygiene
and the use of PPE. Based on the results of the review of
the articles found by the author, the factor that shows the
greatest urgency for the transmission of COVID-19 to health
workers is due to exposure or close contact with positive
COVID-19 patients outside of health facilities in which health
workers do not wear PPE.
Study Limitation
The limitation associated with this review is the potential for
publication bias because the studies included only limited
to those found by the author, therefore it was lacking factors
studied and other factors were not found by the authors.
Besides, the studies conducted not in all countries with most
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of them were from countries that discovered the virus much
earlier, namely in Wuhan, China and in a country with a high
aspects related to policies for preventing the transmission of
COVID-19 to health workers need to be considered for the
application of interventions in health facilities and much
more research is needed to determine the most appropriate
steps in efforts to prevent COVID-19 transmission [34].
Conclusion
The risk factors for transmission of COVID-19 to health
workers namely age, comorbidities, autoimmune, lack of
hand hygiene, and lack of PPE availability, close contact or
exposure to patients positive for COVID-19, sleep quality,
lack of knowledge and training, stress, workload, climate,
temperature, and humidity. The factors for preventing
the transmission of COVID-19 to health workers are hand
control bundling, implementing PPI or standard precautions,
providing education and training, changing health facilities
operations, and implementing rapid tests and PCR tests on
all health facilities staff and patient and placing the patient in
a negative pressure room.
Based on the conclusion, two things can be suggested:
• For health workers to better comply with health
protocols, increase immunity by consuming nutritious
foods, vegetables, and fruit, have adequate rest, and
perform regular exercise
• For the government and management of health
facilities, it is important to provide PPE according to the
implementation standards for infection prevention and
control, provide training to health workers, reducing
workload by reducing working hours, providing vaccines
to health workers with to close contact with COVID-19
patients, and conducting PCR tests on all staff working
in health facilities.
Acknowledgment
The authors would like to thank the Faculty of Nursing,
Universitas Airlangga Surabaya, for allowing the reworking
articles.
The authors alone are responsible for the views expressed
in this publication, and they do not necessarily represent the
views, decisions or policies of their institutions.
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