Correlation Between Health Protocol with Covid-19 Cases in Workers in dr

Received 13 February 2021 Accepted 4 August 2021 Published 5 September 2021 The whole world is under the pressure of the COVID-19 outbreak, where the death toll rises, including the health workers. Action to prevent the increase in the outbreak can be applied by the health protocols. The study aims to analyze the correlation between the health protocols and COV1D19 incident on workers at RSUD dr. Zainal Umar Sadiki. The study uses a cross-sectional study design. The populations are all medical workers durum COVID-19 while the application of total sampling as the sampling obtains 40 respondents. The result shows that 90% are good, and 87,5% of health workers are not confirmed with COVID-19, and 12,5% are confirmed with COVID-19. Based on the result of the test analysis using fisher exact test with j'-value: 0,004. The conclusion is that there is a correlation between health protocols sithCOVID-19 incidents on workers at dr. Zainal Umar Sadiki regional hospital. It is suggested to health workers to always comply with the health protocols in providing services to patients with COVID-19 suspected or to those who have been confirmed with COVID-19. Keyword:


INTRODUCTION
Today's era has seen the whole world to be impacted by COVID-19 pandemic. Frontline health workers in most health facilities are no exception; the numbers of COVID-19 infection cases in health workers, particularly doctors and nurses, are increasing on a daily basis. The virus infection has caused casualties of such health workers. The Center for Disease Control and Prevention in the US, during the weekly report in April, informed that from the span of February 12 to April 9, 9,282 out of 49,370 health workers (19%) had been infected by COVID-19 virus. Meanwhile, in Indonesia, the data of COVID-19 Response Task Force reported at least 55 casualties of health workers due to COVID-19 infection (Theconversation.com, June 28, 2020).
The increasing trend of COVID-19 infected health workers actually indicates that the occupation is among the most susceptible to the virus (Liu et al., 2020). Efforts have been made by the government in preventing the widespread of the virus in the community as well as in healthcare facilities. The government, through the Ministry of Health, has conducted preventive measures to control the disease spread by implementing health protocols in all healthcare facilities, including hospitals, community health services, or health clinics. According to the Indonesian Dictionary, 'protocol' refers to the procedures that apply on a global scale.
Regarding this, the health protocol is implemented in the form of conducts of infection prevention and control. The conducts refer to the prevention guidelines of COVID-19 spread released by the Ministry of Health of the Republic of Indonesia (Ministry of Health, 2020) in the Strategies of Prevention and Control of Infection in Healthcare Facilities. The document encompasses the administration standard and control caution, as well as education and training.
The implementation of isolation caution involves standard caution and transmission caution. Standard caution comprises hand hygiene, use of personal protective equipment, respiratory hygiene, environmental hygiene, linen handling, waste management, and disinfection of patient care equipment. In the meantime, transmission caution involves the implementation of triage by filtering at the new patient entry post, isolation of patients with the systemic disorder, applying safe social distance sign with a minimum distance of 1 meter in the patient queue locations, adjusting the placement of consultation desk, check-up bed, and patients' and health workers' chair, as well as isolating suspect cases and/or confirmed virus-positive patients in an Isolation Room (Ministry of Health, 2020).
Dr. Zainal Umar Sidiki hospital is the regional government hospital of North Gorontalo regency. During the pandemic, the hospital has provided service to the general patients as well as COVID-19 suspect and confirmed-positive patients Based on the medical record data, the hospital has received 45 COVID-19 suspect patients and 40 confirmedpositive patients. From the total COVID-19 positive patients, 24 patients were the health workers that work in the hospital. They consisted of 14 doctors, seven nurses, and three midwives.
As the initial observation suggests, some of the health workers did not implement the health standard protocol, particularly regarding the standard caution and transmission caution; several procedures such as washing hands properly and proper use of personal protective equipment were not implemented optimally. The purpose of this research is to investigate the correlation between the implementation of health protocol and COVID-19 cases in health workers in Zainal Umar Sidiki regional public hospital.

Research participants
The participants of the study were 40 health workers in dr. Zainul Umar Sidiki hospital.

Research procedure
The study employed a cross-sectional design.

Data analysis
The data were collected by questionnaire and analyzed by Fisher exact test.

RESULTS AND DISCUSSION
Provided below are the analysis results regarding the implementation of health protocols and prevalence of Covid-19 by health workers at dr. Zainal Umar Sidiki Regional Public Hospital, North Gorontalo Regency (table 1): The results show that the health protocol in Dr. Zainal Umar Sidiki regional public hospital is implemented well by the health workers. As many as 36 respondents (90%) implement the health protocol properly, while four respondents (10%) did not implement a proper health protocol.
The study argues that the good practices of health protocol implementation in the hospital are mainly influenced by the availability of personal protective equipment.
Echoing this, the Regulation of Ministry of Health (Ministry of Health, 2020) in general regulates the protection of the health of an individual as the principles of COVID-19 spread prevention. Such measures involve: 1) wearing personal protective equipment in the form of a mask that covers the nose up to the chin, 2) washing hands with soap and running water properly, and 3) using hand sanitizer or alcohol-based antiseptic liquid.
Further, Pagliano&Kafil (2020) explain that the practice of washing hands or using alcohol-based antiseptic are simple yet effective to prevent the spread of pathogen and infections in healthcare facilities. This is in accordance with Ministry of Health (2020) that the prevention and control of the risks of disease spread, as based on the WHO recommendation, require to use of personal protective equipment such as mask, surgical gown, gloves, and eye protection tools (glasses or face protector) (Herron et al., 2020).
The historical record of COVID-19 check-up towards health workers in dr. Zainal Umar Sidiki hospital indicates that most cases are confirmed COVID-19 negative. A total of 35 respondents (87.5%) showed negative results, while the rest five respondents (12.5%) showed confirmed COVID-19 positive.
Such results are presumably due to the health workers' conformity towards the standard service procedure during the COVID-19 pandemic. The virus spreads through air droplets and remains on an object for several hours; therefore, extra caution from health workers is necessary to prevent the spread of COVID-19 virus. In this regard, the health workers are obliged to comply with the health protocols and apply hygiene measures in treating the patients.
The profession of health workers is highly susceptible to infection, particularly before the dynamics of COVID-19 spread are fully marked. The reported cases were the spread of SARS-CoV-2 in workplace. The facilities in healthcare service units must also comply with the standard health protocol as regulated to protect the health workers who treat the suspect or confirmed-positive COVID-19 patients. In addition to that, early recognition and isolation, including resource control for patients who might be infected, are essential to minimize the exposure of health workers towards unprotected and high-risk conditions. Such measures are of significance to protect the health workers from the infection of COVID-19 virus (Heinzerling et al., 2020).
The following table 2 displays the analysis results regarding the relationship between Health protocols and the cases of Covid-19 among the employees at dr. Zainal Umar Sidiki Regional Public Hospital, North Gorontalo Regency. As based on the results from 4 respondents that implemented poor health protocol, one respondent was confirmed COVID-19 negative, while three respondents were confirmed positive of the virus infection. Further, 34 of 36 respondents that applied proper health protocol were tested negative for the virus, while two respondents were confirmed positive.
The analysis results indicate a trend that proper implementation of health protocol is more likely to result in lower probability of COVID-19 infection. The Fisher exact test generates a p-Value of 0.004, or < 0.05. The numbers signify that there is a correlation between health protocol and COVID-19 cases in health workers in dr. Zainal Umar Sidiki regional public hospital.
The correlation is assumed to take place due to the proper implementation of health protocol by the health workers in the hospital. Regarding this, the implementation of health protocol in accordance with the standard procedures will lower the risk of exposure and infection of COVID-19. Such conducts comprise the use of personal protective equipment and hand hygiene protocol, as well as the placement of confirmed-positive patients in the isolation room. Personal protective equipment is among the most effective means to prevent the spread of COVID-19 pandemic, particularly in avoiding the exposure from the airborne virus droplets or from the droplets of the patients' body fluids. The same also applies to regular hand washing protocol. Virus can remain alive on the objects nearby the patients or object that have direct contact with the patients. The use of hand sanitation protocol using running water or an antiseptic hand rub is expected to kill the virus nearby the patient's area or that is carried by the health workers' hands.
This is in line with Chersich et al., (2020), that the risk of SARS-CoV-2 infection might be higher in the professionals working nearby the patients, such as doctors or nurses. In addition, other procedures such as non-invasive ventilation, High Flow Nasal Cannula, and mechanic ventilation can generate higher volume of aerosol; despite that, the procedures are still the main conducts. The risk of infection in health workers can be lowered by applying the proper preventive conducts in healthcare facilities, including the use of surgical gowns, gloves, masks, and glasses/face shields.
The donning and doffing of such protective equipment require extra care; in doing such procedures, adequate training and monitoring are essential. The risk of infection might be at the highest point during the early phase of the COVID-19 outbreak since most of the health workers are not used to the use of personal protective equipment.
The findings of the study are in line with Sharma, et al (2020) that discover that the standard caution must be implemented with the full acknowledgment that all individuals are susceptible to the infection of COVID-19 that might occur in healthcare facilities. In this regard, it is essential to implement the monitoring of all health workers to ensure that they practice the standard cautions such as hand sanitation, safe coughing ethics, and use of personal protective equipment

CONCLUSIONS AND RECOMMENDATION
The study concludes that: 1) the health protocol was implemented well (90%) by the health workers in dr. Zainal Umar Sidiki regional hospital in North Gorontalo regency; 2) The historical record of COVID-19 check-in dr. Zainal Umar Sidiki hospital indicates that 87.5% of the health workers were tested COVID-19 negative; 3) There is a correlation between the implementation of health protocol and COVID-19 cases in health workers in dr. Zainal Umar Sidiki hospital, in which the Fisher exact test generates p-Value of 0.004, or <0.05.
The study recommends that hospitals and other healthcare facilities apply maximum monitoring of health protocol in health workers that provide treatment to the COVID-19 suspect patients or tested-positive patients.