Prevention, Control and Safety of Health Care Providers during COVID-19: A Review Study

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Considering the high prevalence of COVID-19 infection in the world and its high mortality rate, this epidemic can be tackled to some extent through infection control in the general population and promoting the safety of health centers. This study aims to scrutinize the literature in terms of measures adopted for infection control and safety of healthcare workers in health centers during COVID-19. Methods: We searched key words related to the study namely, “prevention and control”, “safety”, “coronavirus”, “COVID-19”, and “health personnel” in PubMed, Web of Science, ScienceDirect, Scopus databases, Google Scholar, and also in Persian data bases such as SID, Magiran, Irandoc, and Iran Medex using AND/OR functions. To select the documents, the titles of the retrieved studies were first evaluated for relevance; then, the abstracts and full texts of the papers with relevant titles were inspected. Results: Out of 136 retrieved studies, 10 were relevant and their data were analyzed. Four of the articles highlighted the importance of prevention, three enunciated the importance control and three of them related to care providers’ safety. The results showed that the COVID-19 epidemic has affected the healthcare providers’ health; however, it is possible to prevent a catastrophe through strategic planning, prevention and control measures. Conclusions: Considering the importance of the healthcare workers’ health, it is necessary to implement COVID-19 prevention and control management principles according to scientific evidence. Health Economics & Outcomes Research Health Policy Prevention and control Safety Coronavirus COVID-19 Health Personnel Figures Figure 1 Background An outbreak of a new virus (SARS-CoV-2) started in Wuhan, China in December 2019 and spread to the rest of the world very quickly. The new coronavirus, which belongs to the betacoronavirus family, causes COVID-19 characterized by fever, coughs, and shortness of breath [ 1 ]. The spread of the coronavirus in China followed by its global spread has affected health systems, economy, and human societies across the world [ 2 ]. Although many people in different professions are exposed to coronavirus, healthcare workers that care for COVID-19 patients are at higher risk of infection due to their close contacts with the patients [ 3 ]. The world health organization (WHO) has recommended that healthcare workers adopt certain control and prevention measures to minimize the risk of infection transmission; however, many of them have been infected with COVID-19 [ 4 ], which is due to shortage of personal protection equipment and lack of training for infection prevention and control [ 3 ]. Moreover, it has been reported that nurses were infected with COVID-19 through respiratory droplets produced by coughs despite using protective equipment [ 5 ]. The situation even become worse with Coinfection of COVID-19 with other infections and lack of respiratory symptoms in many patients at the time of referring to health centers [ 6 , 7 ]. Furthermore, lack of personal protection equipment, high workload, ineffective infection control systems, and even direct verbal insults from patients like using offensive words or coughing deliberately on them, which may be due to high levels of stress, economic pressure, and the critical situation of the society, have increased the vulnerability of the healthcare providers. Therefore, it is necessary to provide extra support for healthcare personnel [ 8 ]. Considering the lack of a definitive treatment for COVID-19 and the risk of disease transmission in the incubation period, infection prevention and control are of utmost importance for global health. Since no study has comprehensively reviewed the safety of healthcare workers during this period, this study aims to sort out different preventive measures and proper management plans to achieve infection prevention and control in health centers. Methods This review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol. We reviewed the articles published in February to September 2020 about COVID-19 prevention, control, and healthcare workers’ safety. No time filter was applied for the literature search. We searched key words related to the study namely, “prevention and control”, “safety”, “coronavirus”, “COVID-19”, and “health personnel” in PubMed, Web of Science, ScienceDirect, Scopus databases, Google Scholar, and also in Persian data bases such as SID, Magiran, Irandoc, and Iran Medex using AND/OR functions. Subsequently, we collected all articles relevant to control and safety of health workers and collected their full texts. Then, the full texts of the papers (excluding the authors’ name to prevent any bias) were presented to two researchers that were experts in review studies. Both researchers independently reviewed each article and stated their reasons for accepting or rejecting the paper. Any disagreement was resolved through consultation with a third reviewer. The inclusion criteria were the articles that investigated prevention, control, and health workers’ safety during COVID-19 and presented the required data for prevention, control, and health workers’ safety. Finally, out of 136 retrieved studies, 10 matched the criteria and selected for analysis (see Fig. 1 .) Results Four of the articles highlighted the importance of prevention [ 7 – 10 – 11 – 12 ], three enunciated the importance control [ 14 – 15 – 16 ], and three of them related to care providers’ safety [ 17 – 18 – 20 ] (see Table 1 ). Table 1 Characteristics of the studies included in the analysis Study Setting Healthcare Workers Outcomes J.Tao 2020[ 7 ] 15 February 2020 China Dermatology departments Although their hospital is in an infected center, no infected patients have been detected in their departments, owing to heightened surveillance Xiuqing Ma 2020[ 10 ] West China Hospital, Wenjiang Hospital all departments and personnel The control of epidemic prevention in the subdivision area was effective and effective emergency plans should be formulated from the very beginning. Safety control measures should be taken decisively. Only in this way can the infection be controlled to the minimum. Yang CJ 2020[ 11 ] Kaohsiung Municipal Ta-Tung hospital (KMTTH) in Kaohsiung, Taiwan all hospital staffs, included doctors, nurses, pharmacists, radiologists, cleaners etc Community hospitals play an important role in the health system in Taiwan, which provide the basic medical needs for general population with limited human and equipment resources compared to medical centers. WHO 2020[ 12 ] Worldwide This guidance is intended for health care workers (HCWs), health care managers It has been adapted from WHO’s Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome Kilic AU2020[ 14 ] An operation center in Ankara within the General Directorate of Public Health. Healthcare workers Many factors may be contributed to the emergence and spread of previous outbreaks. Zixing Huang2020[ 15 ] people suspected or confirmed to be infected with COVID-19 Radiology department Strategic planning and adequate protections can help protect patients and staff against a highly infectious disease while maintaining function at a high-volume capacity. Bloomer MJ2020[ 16 ] Australian survey Nurses working in the intensive care unit ICU nurses play a key role in managing end-of-life care. This not only includes ongoing clinical care for the dying patient, but caring for and supporting families Anup Agarwal2020 [ 17 ] an evidence-based plan according to the needs and infrastructure Infectious disease department, engineering and nursing department, and departments of microbiology and virology High-quality clinical care not only helps in limiting the loss of lives from the onslaught of the contagions, but also interrupts the transmission by excluding the infective patients from the general population. Yogesh G2020[ 18 ] a cross-sectional hospital-based survey 40 healthcare workers When infected, they need to be taken out of work force to prevent infection to colleagues and patients, which puts a severe strain on their teams. Chekol W2020[ 20 ] A systematic review All personnel working in the operating room All health care personnel should wear personal protective equipment based on the class of patients during surgery. Elective procedures should be postponed to save and mobilize resources for the protection and management of the pandemic disease. Prevention Epidemic diseases after the initial outbreak in hospitals may lead to outbreaks among patients and health care workers. It may even spread to the local community if visitors become infected, leading to increase patient mortality and medical costs in the community which could be prevented by protection measures [ 9 ]. The study by Tao et al. aimed to highlight the need for protective measures and recommend proper emergency management programs to prevent and control nosocomial infections (COVID-19) in China. They realized that at the Union Hospital, the amount of knowledge and information among healthcare providers about protective equipment in various medical departments, including dermatology, is very low. Therefore, management protocols were set up to prevent and control the disease, including the establishment of multilayer triage from the entrance of the hospital to the entrance of the wards. In addition, measures were taken for dermatologists and hair specialists to work with nurses at dermatology triage stations to evaluate patients if necessary. Moreover, the use of online counseling for patients with mild and non-emergency symptoms to prevent unnecessary referrals was prescribed [ 7 ]. Another prevention study was conducted in Wenjiang Hosptial in China to ensure the effective implementation of new coronavirus prevention and control measures. A three-layer control and prevention system was implemented: (A) prevention and primary control at the main entrance of the hospital, (B) monitoring and evaluation at the emergency entrance and (C) supervision at the entrance of each ward. At each entrance, professional nurses and security staff were responsible for closely monitoring the temperature, biographies of possible sources of the virus, identifying staff, and recording staff entry and exit. In other words, in each entrance, suspicious patients were carefully examined and in case of infection, the necessary isolation and treatment measures were performed. In addition, each unit was inspected at least three times a week for the effectiveness of the protective measures of different employees in the workplace [ 10 ]. In the same vein, the study by Chin et al. in Taiwan stressed the need for protection and preventive measures for healthcare workers during Coronavirus COVID-19. During the pandemic, health care workers demanded to receive more equipment, which means that it is important to protect health care workers. This is because of the fact that health care providers interact closely with vulnerable patients that may lead to anxiety and lack of willingness to work. The results of the study showed that psychological support of health care providers, availability of equipment, facilities to break the community-hospital infection cycle, and use of public health standards are of great importance [ 11 ]. Finally, the study by Muh et al., examined the consequences of prevention and control in 2020, concluded that protecting health care providers from patients in hospitals should be of prime importance. This is because many patients have unusual manifestations of the disease or are waiting for a definite diagnosis, which can be dangerous for health care providers. Therefore, the use of disinfectants and protection equipment to control the transfer cycle of the disease in hospitals are very important [ 12 ] Control To control epidemics, some priorities should be considered such as controlling an epidemic in its early stages, strengthening knowledge about prevention and control, and ensuring full attention to the implementation of prevention and control strategies [ 13 ]. In a study by Kilic et al. in Turkey, to control the coronavirus epidemic, measures were taken to control the infection. The most important of which is hand hygiene and proper use of personal protective equipment by healthcare providers. In so doing, relevant instructions, including the definition of suspected and definite cases and preventive and control measures for the transmission of the disease in all medical centers were immediately developed and notified to health care professionals [ 14 ]. In the same line, Huang et al., study in the radiology department of West Hospital in China, revealed more than 3,000 patients with suspected or definite COVID-19 were referred for imaging procedures in less than 50 days. In the end, none of the radiology staffs was infected with the virus following engineering measures (triage and zoning, low-dose chest CT protocol, and standard precautions in radiology). Therefore, strategic planning and adequate protection and control measures can help protect patients and staff against highly infectious disease while maintaining high performance [ 15 ]. The same results were also reported in Melissa et al. study of infection control in healthcare providers. They concluded that by providing infection prevention and control measures for emergency care workers, they can take care of the patients as best as they can although the implementation of these guidelines require a unified approach [ 16 ] Safety Dealing with Coronavirus 2019 (COVID-19) and its outbreak require fully equipped and dedicated health facilities for patient management. Meanwhile, health and environmental care workers must have the necessary safety to provide services to patients [ 17 ]. Yogesh et al. conducted a cross-sectional and hospital-based survey from April 2020 to June 2020 to examine workplace safety and mental health of health care workers. They concluded that health care workers who are at the forefront of dealing with Coronavirus disease are at increased risk of developing COVID-19 infections.. When contaminated, health workers and patients need to rest to prevent infection, which puts pressure on their health systems. Thus, paying attention to the safety of the mental health workplace is very important for health care providers [ 18 ]. By the same token, Tongji at Wuhan Hospital in China conducted a study on effective safety management measures in the field of nursing during COVID-19 disease epidemic. They concluded by formulating solutions for nurses' safety: (A) forming an epidemic leadership team as a responsible system for designing emergency plans, (B) selecting experienced nurses as head nurses in different wards, (C) rotating nursing staff and observing the arrangement and composition of new and old staff in wards, (D) highlighting the role of nurse managers in the front line as a model and instructor to create a sense of responsibility and improve the nurses’ morale and (E) providing adequate materials and equipment for nurses at the forefront of exposure to coronavirus. Likewise, Chekol et al. study designed to assess the safety of operating room staff that are part of service personnel. They concluded that all health care personnel should use personal protective equipment based on the type of patients’ surgery. Besides, selective operations should be delayed and emergency procedures like burns, cesarean operation, malignant neoplasia, and traumatic injury should be performed using personal protective equipment [ 20 ] Discussion COVID-19 manifests with a range of mild to severe symptoms; a major problem is that similar to common cold, patients with mild symptoms may not seek treatment, which may result in lack of diagnosis, increased chance of infection, and virus cycle expansion [ 2 ]. On the other hand, virus transmission is possible during the incubation period, which may last up to 14 days [ 7 ]. Tao et al showed that since the COVID-19 outbreak, the governments have implemented strict prevention and control measures; however, infected patients may still be missed in the asymptomatic incubation period. The study in China showed that 77.5% of the infected health professionals worked in general wards, indicating the high transmissibility of the disease even in general wards. Further, the coinfection of COVID-19 disease with other infections may even intensify the problem [ 8 ]. In the same line, Lotfinejad et al found that health care providers is at the forefront of the fight against coronavirus. The growing rate of coronavirus transmission in hospitals has increased global demand for more effective prevention and control across healthcare settings. Experienced nurses can avoid infections with appropriate hand hygiene compliance and use of protective equipment. However, it is crucial to have adequate numbers of nursing staff and access to protective equipment to ensure the safety and quality of care [ 2 ]. To this end, experienced nurses can prevent infection by maintaining proper hygiene and using protective equipment. To ensure the safety and quality of care, it is essential to have a sufficient number of nursing staff and access to equipment [ 1 ]. In the study by Liu, they also mentioned that one of the most important challenges in responding to the coronavirus is human resource management and personal protective equipment [ 19 ]. A key step in controlling the corona virus is hand washing, which has been repeatedly recommended by the WHO. The WHO has also advised health workers to cover their noses and mouths with a cloth or elbow when coughing or sneezing, and to provide masks for patients with suspected infections [ 1 ]. The Centers for Disease Control and Prevention (CDC) and the WHO have also published lessons from China that protect health care providers and the proper use of masks according to protocols to protect health care providers from the coronavirus [ 21 ]. Thus, these studies are consistent with the present study emphasizing that during the epidemic of COVID-19, prevention and safety of employees who are the front line of service providers is of great importance. Fascinatingly, a study by Gibson et al. in the United States found that the Pre-hospital emergency staff received no benefits in connection with COVID-19 disease. More importantly, 60 percent of mission staff does emergency work without an N95 mask, and 18 percent use only one N95 mask for a week or more on emergency missions. However, according to the WHO, it is important to maintain appropriate preventive measures not only when caring for patients but also in close contact with colleagues. The results of the study illustrated that the United States, as a leading country in the field of emergency medical services (EMS), is facing a serious problem and crisis. At present, treating coronavirus patients in the emergency centers are in accordance with the instructions of the CDC [ 3 , 22 ]. Another important issue that should be mentioned is the use of experienced trained staff in COVID-19 to form a team to develop disease prevention and control programs, integrate processes, and continually improve management principles in disease prevention and control based on scientific evidence. Based on Huang et al. study, this group should provide a daily report on the updated status of suspected and definitively infected patients and analyze their condition and inform the specialists in the intensive care unit and radiology to assess whether the patient needs further examination and treatment. These medical communications can be web-based. Moreover, isolation, reporting and transfer of suspected patients should be done following policies and processes to control local infection and involve the general public. The above measures of the management group will stabilize the order in the wards and greatly reduce the duration of exposure to the patient and the risk of infection [ 7 , 15 ]. Finally, the study conducted by Belingheri et al in 2020 with the aim of preventing and controlling health in unhealthy environments concluded that there is no recommendation and protective equipment for personal protective equipment for people in unhygienic environments. Nevertheless, to prevent the spread of droplets, they should use masks, observe social distancing, clean and disinfect dirty surfaces, and prevent overcrowding at work [ 23 ]. Conclusions Personal protective equipment for health care workers will improve services and improve the quality of staff care for patients. Thus, prominent protective measures and appropriate emergency management plans are recommended to prevent and control infection and the safety of health care workers. It should be noted that most of the current studies investigated the prevention and emergency control of hospital pediatrics and the evaluation of patients with COVID-19 in the radiology department and unsanitary environments. Therefore, future studies should inclusively focus on the safety of health care providers in hospital environment. List of Abbreviations WHO : World Health Organization, CDC : Centers for Disease Control and Prevention, PPE: personal protective equipment . Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Competing interests The authors declare that they have no competing interests Funding Not applicable Authors' contributions SM, and GM conceptualized and designed the study. FBS carried out the study, analyzed and interpreted the data, and wrote the first manuscript. MR gave intellectual feedback, redrafted and finalized the manuscript. All authors read and approved the final manuscript. Availability of data and materials Not applicable References Lotfinejad N, Peters A, Pittet D. Hand hygiene and the novel coronavirus pandemic: The role of healthcare workers. Journal of Hospital Infection. 2020. Peters A, Vetter P, Guitart C, Lotfinejad N, Pittet D. Understanding the emerging coronavirus: what it means for health security and infection prevention. Journal of Hospital Infection. 2020. Belingheri M, Paladino M, Riva M. Beyond the assistance: additional exposure situations to COVID-19 for healthcare workers. Journal of Hospital Infection. 2020. Coronavirus disease (COVID-19) outbreak situation. World Health Organization. (accessed 2020 Apr 26). Chen C, Zhao B. Makeshift hospitals for COVID-19 patients: where health-care workers and patients need sufficient ventilation for more protection. Journal of Hospital Infection. 2020. Joob B, Wiwanitkit V. COVID-19 in medical personnel: observation from Thailand. The Journal of Hospital Infection. 2020. Tao J, Song Z, Yang L, Huang C, Feng A, Man X. Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department. British Journal of Dermatology. 2020. Joob B, Wiwanitkit V. Traumatization in medical staff helping with COVID-19 control. Brain, Behavior, and Immunity. 2020. Zhang Y-H, Leung NHL, Cowling BJ, Yang Z-F. Role of viral bioaerosols in nosocomial infections and measures for prevention and control. Journal of Aerosol Science. 2018;117:200-11. Qing MX, Li S, Yu S, Ouyang Y, Zeng L, Li X, et al. Emergency management of the prevention and control of novel coronavirus pneumonia in specialized branches of hospital. Academic Emergency Medicine. 2020. Yang C-J, Chen T-C, Chen Y-H. The preventive strategies of community hospital in the battle of fighting pandemic COVID-19 in Taiwan. Journal of Microbiology, Immunology, and Infection. 2020;53(3):381. World Health O. Infection prevention and control during health care when COVID-19 is suspected: interim guidance, 19 March 2020. World Health Organization; 2020. Wu H, Zhang Q, Wu H, Tian F, Cui B, Qi Z, et al. Tackling COVID-19: Insights from the Qinghai Province plague prevention and control (PPC) model. Biosafety and Health. 2020. Kilic AU, Kara F, Alp E, Doganay M. New threat: 2019 novel Coronavirus infection and infection control perspective in Turkey. Northern Clinics of İstanbul. 2020;7(2):95. Huang Z, Zhao S, Li Z, Chen W, Zhao L, Deng L, et al. The Battle Against Coronavirus Disease 2019 (COVID-19): Emergency Management and Infection Control in a Radiology Department. Journal of the American College of Radiology. 2020. Bloomer MJ, Bouchoucha S. Australian College of Critical Care Nurses and Australasian College for Infection Prevention and Control position statement on facilitating next-of-kin presence for patients dying from coronavirus disease 2019 (COVID-19) in the intensive care unit. Australian Critical Care. Agarwal A, Nagi N, Chatterjee P, Sarkar S, Mourya D, Sahay RR, et al. Guidance for building a dedicated health facility to contain the spread of the 2019 novel coronavirus outbreak. Indian Journal of Medical Research. 2020;151(2):177. Dabholkar YG, Sagane BA, Dabholkar TY, Divity S. COVID-19 infection in health care professionals: Risks, work-safety and psychological issues. Indian Journal of Otolaryngology and Head & Neck Surgery. 2020;72(4):468-73. Liu Y, Wang H, Chen J, Zhang X, Yue X, Ke J, et al. Emergency management of nursing human resources and supplies to respond to coronavirus disease 2019 epidemic. International Journal of Nursing Sciences. 2020. Chekol WB, Melesse DY. Operating room team safety and perioperative anesthetic management of patients with suspected or confirmed novel corona virus in resource limited settings: A systematic review. Trends in Anaesthesia and Critical Care. 2020. Lynch C, Mahida N, Oppenheim B, Gray J. Washing our hands of the problem. Journal of Hospital Infection. 2020. Gibson CV, Ventura CA, Collier GD. An investigation on Emergency Medical Services resource capacity and competency amid COVID-19 in the United States. Belingheri M, Paladino ME, Riva MA. COVID-19: Health prevention and control in non-healthcare settings. Occupational Medicine. 2020;70(2):82-3. Supplementary Files PRISMA2009checklist.doc Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-108680","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":4787532,"identity":"91b245a1-f111-40f8-9bc5-139b610391a1","order_by":0,"name":"Shandiz Moslehi","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shandiz","middleName":"","lastName":"Moslehi","suffix":""},{"id":4787533,"identity":"4ed4d822-ff3d-4d70-a009-3fa08d6951d3","order_by":1,"name":"Gholamreza Masoumi","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gholamreza","middleName":"","lastName":"Masoumi","suffix":""},{"id":4787534,"identity":"4e2a27a2-b922-4555-ac55-4502885c062b","order_by":2,"name":"Morteza Rostamian","email":"","orcid":"https://orcid.org/0000-0002-3639-8474","institution":"Gonabad University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Morteza","middleName":"","lastName":"Rostamian","suffix":""},{"id":4787535,"identity":"66c3ae4c-f1f8-41ee-8c33-46c15523fdc2","order_by":3,"name":"Fahimeh Barghi Shirazi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIie3RvwqCQBzA8QPhXH5w6wXRMxwIVjT4Kk5NV3ODyEXglnOP0eTsITnp7h40NBWCo3QnDU1qW9B9hzs47gP3ByGT6QezBaBUzUDIQc90OkggfZPJKfc1gVGkiwnOuoVhQkqZ7YJwylBR36tgAcjOLudeQre+LHIMc+uYrHiuDgbrddVHPApMCgywFGXicKwIBbeXACkUaRVM+c3h7RiCOJP7iGliXTfRGEI1iX39yK61iSngobuogzlP0YSe+sprzZtwRuws7yWfYdqNY7frrMc3u00mk+l/egFe6UVUzaHyvAAAAABJRU5ErkJggg==","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Fahimeh","middleName":"Barghi","lastName":"Shirazi","suffix":""}],"badges":[],"createdAt":"2020-11-15 13:41:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-108680/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-108680/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":3670665,"identity":"23fada2e-7643-4fb2-a237-e121fe0b8e95","added_by":"auto","created_at":"2020-11-18 17:09:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52195,"visible":true,"origin":"","legend":"PRISMA study flow diagram","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-108680/v1/7e279317c0ca829b5b71ae06.png"},{"id":13615778,"identity":"bcba3d42-54b3-45d5-8df1-f94fbe046430","added_by":"auto","created_at":"2021-09-17 06:46:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":309593,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-108680/v1/5afca38a-4649-40ad-a787-ec7a60d3483c.pdf"},{"id":3670666,"identity":"9903f375-1070-428d-81ae-e2f535e04d9c","added_by":"auto","created_at":"2020-11-18 17:09:19","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":115712,"visible":true,"origin":"","legend":"","description":"","filename":"PRISMA2009checklist.doc","url":"https://assets-eu.researchsquare.com/files/rs-108680/v1/937caecd1381ab9b0b643284.doc"}],"financialInterests":"","formattedTitle":"Prevention, Control and Safety of Health Care Providers during COVID-19: A Review Study","fulltext":[{"header":"Background","content":" \u003cp\u003eAn outbreak of a new virus (SARS-CoV-2) started in Wuhan, China in December 2019 and spread to the rest of the world very quickly. The new coronavirus, which belongs to the betacoronavirus family, causes COVID-19 characterized by fever, coughs, and shortness of breath [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The spread of the coronavirus in China followed by its global spread has affected health systems, economy, and human societies across the world [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although many people in different professions are exposed to coronavirus, healthcare workers that care for COVID-19 patients are at higher risk of infection due to their close contacts with the patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe world health organization (WHO) has recommended that healthcare workers adopt certain control and prevention measures to minimize the risk of infection transmission; however, many of them have been infected with COVID-19 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], which is due to shortage of personal protection equipment and lack of training for infection prevention and control [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, it has been reported that nurses were infected with COVID-19 through respiratory droplets produced by coughs despite using protective equipment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The situation even become worse with Coinfection of COVID-19 with other infections and lack of respiratory symptoms in many patients at the time of referring to health centers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, lack of personal protection equipment, high workload, ineffective infection control systems, and even direct verbal insults from patients like using offensive words or coughing deliberately on them, which may be due to high levels of stress, economic pressure, and the critical situation of the society, have increased the vulnerability of the healthcare providers. Therefore, it is necessary to provide extra support for healthcare personnel [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsidering the lack of a definitive treatment for COVID-19 and the risk of disease transmission in the incubation period, infection prevention and control are of utmost importance for global health. Since no study has comprehensively reviewed the safety of healthcare workers during this period, this study aims to sort out different preventive measures and proper management plans to achieve infection prevention and control in health centers.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eThis review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol. We reviewed the articles published in February to September 2020 about COVID-19 prevention, control, and healthcare workers\u0026rsquo; safety. No time filter was applied for the literature search. We searched key words related to the study namely, \u0026ldquo;prevention and control\u0026rdquo;, \u0026ldquo;safety\u0026rdquo;, \u0026ldquo;coronavirus\u0026rdquo;, \u0026ldquo;COVID-19\u0026rdquo;, and \u0026ldquo;health personnel\u0026rdquo; in PubMed, Web of Science, ScienceDirect, Scopus databases, Google Scholar, and also in Persian data bases such as SID, Magiran, Irandoc, and Iran Medex using AND/OR functions. Subsequently, we collected all articles relevant to control and safety of health workers and collected their full texts. Then, the full texts of the papers (excluding the authors\u0026rsquo; name to prevent any bias) were presented to two researchers that were experts in review studies. Both researchers independently reviewed each article and stated their reasons for accepting or rejecting the paper. Any disagreement was resolved through consultation with a third reviewer. The inclusion criteria were the articles that investigated prevention, control, and health workers\u0026rsquo; safety during COVID-19 and presented the required data for prevention, control, and health workers\u0026rsquo; safety. Finally, out of 136 retrieved studies, 10 matched the criteria and selected for analysis (see Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.)\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFour of the articles highlighted the importance of prevention [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e], three enunciated the importance control [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e], and three of them related to care providers\u0026rsquo; safety [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e] (see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of the studies included in the analysis\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStudy\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHealthcare Workers\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJ.Tao 2020[\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 February 2020 China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDermatology departments\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlthough their hospital is in an infected center, no infected patients have been detected in their departments, owing to heightened surveillance\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eXiuqing Ma\u0026nbsp;2020[\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWest China Hospital, Wenjiang Hospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eall departments and personnel\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThe control of epidemic prevention in the subdivision area was effective and effective emergency plans should be formulated from the very beginning. Safety control measures should be taken decisively. Only in this way can the infection be controlled to the minimum.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYang CJ 2020[\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKaohsiung Municipal Ta-Tung hospital (KMTTH) in Kaohsiung, Taiwan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eall hospital staffs, included doctors, nurses, pharmacists, radiologists, cleaners etc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCommunity hospitals play an important role in the health system in Taiwan, which provide the basic medical needs for general population with limited human and equipment resources compared to medical centers.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWHO 2020[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWorldwide\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThis guidance is intended for health care workers (HCWs), health care managers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIt has been adapted from WHO\u0026rsquo;s Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKilic AU2020[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAn operation center in Ankara within the General Directorate of Public Health.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealthcare workers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMany factors may be contributed to the emergence and spread of previous outbreaks.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eZixing Huang2020[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003epeople suspected or confirmed to be infected with COVID-19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRadiology department\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStrategic planning and adequate protections can help protect patients and staff against a highly infectious disease while maintaining function at a high-volume capacity.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBloomer MJ2020[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAustralian survey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNurses working in the intensive care unit\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICU nurses play a key role in managing end-of-life care. This not only includes ongoing clinical care for the dying patient, but caring for and supporting families\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnup Agarwal2020 [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ean evidence-based plan according to the needs and infrastructure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfectious disease department, engineering and nursing department, and departments of microbiology and virology\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh-quality clinical care not only helps in limiting the loss of lives from the onslaught of the contagions, but also interrupts the transmission by excluding the infective patients from the general population.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYogesh G2020[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ea cross-sectional hospital-based survey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40 healthcare workers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhen infected, they need to be taken out of work force to prevent infection to colleagues and patients, which puts a severe strain on their teams.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChekol W2020[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eA systematic review\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAll personnel working in the operating room\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAll health care personnel should wear personal protective equipment based on the class of patients during surgery. Elective procedures should be postponed to save and mobilize resources for the protection and management of the pandemic disease.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e\u0026nbsp;\u003c/h2\u003e\n\u003ch2\u003ePrevention\u003c/h2\u003e\n\u003cp\u003eEpidemic diseases after the initial outbreak in hospitals may lead to outbreaks among patients and health care workers. It may even spread to the local community if visitors become infected, leading to increase patient mortality and medical costs in the community which could be prevented by protection measures [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe study by Tao et al. aimed to highlight the need for protective measures and recommend proper emergency management programs to prevent and control nosocomial infections (COVID-19) in China. They realized that at the Union Hospital, the amount of knowledge and information among healthcare providers about protective equipment in various medical departments, including dermatology, is very low. Therefore, management protocols were set up to prevent and control the disease, including the establishment of multilayer triage from the entrance of the hospital to the entrance of the wards. In addition, measures were taken for dermatologists and hair specialists to work with nurses at dermatology triage stations to evaluate patients if necessary. Moreover, the use of online counseling for patients with mild and non-emergency symptoms to prevent unnecessary referrals was prescribed [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAnother prevention study was conducted in Wenjiang Hosptial in China to ensure the effective implementation of new coronavirus prevention and control measures. A three-layer control and prevention system was implemented: (A) prevention and primary control at the main entrance of the hospital, (B) monitoring and evaluation at the emergency entrance and (C) supervision at the entrance of each ward. At each entrance, professional nurses and security staff were responsible for closely monitoring the temperature, biographies of possible sources of the virus, identifying staff, and recording staff entry and exit. In other words, in each entrance, suspicious patients were carefully examined and in case of infection, the necessary isolation and treatment measures were performed. In addition, each unit was inspected at least three times a week for the effectiveness of the protective measures of different employees in the workplace [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eIn the same vein, the study by Chin et al. in Taiwan stressed the need for protection and preventive measures for healthcare workers during Coronavirus COVID-19. During the pandemic, health care workers demanded to receive more equipment, which means that it is important to protect health care workers. This is because of the fact that health care providers interact closely with vulnerable patients that may lead to anxiety and lack of willingness to work. The results of the study showed that psychological support of health care providers, availability of equipment, facilities to break the community-hospital infection cycle, and use of public health standards are of great importance [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eFinally, the study by Muh et al., examined the consequences of prevention and control in 2020, concluded that protecting health care providers from patients in hospitals should be of prime importance. This is because many patients have unusual manifestations of the disease or are waiting for a definite diagnosis, which can be dangerous for health care providers. Therefore, the use of disinfectants and protection equipment to control the transfer cycle of the disease in hospitals are very important [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n\u003ch2\u003eControl\u003c/h2\u003e\n\u003cp\u003eTo control epidemics, some priorities should be considered such as controlling an epidemic in its early stages, strengthening knowledge about prevention and control, and ensuring full attention to the implementation of prevention and control strategies [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eIn a study by Kilic et al. in Turkey, to control the coronavirus epidemic, measures were taken to control the infection. The most important of which is hand hygiene and proper use of personal protective equipment by healthcare providers. In so doing, relevant instructions, including the definition of suspected and definite cases and preventive and control measures for the transmission of the disease in all medical centers were immediately developed and notified to health care professionals [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eIn the same line, Huang et al., study in the radiology department of West Hospital in China, revealed more than 3,000 patients with suspected or definite COVID-19 were referred for imaging procedures in less than 50 days. In the end, none of the radiology staffs was infected with the virus following engineering measures (triage and zoning, low-dose chest CT protocol, and standard precautions in radiology). Therefore, strategic planning and adequate protection and control measures can help protect patients and staff against highly infectious disease while maintaining high performance [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. The same results were also reported in Melissa et al. study of infection control in healthcare providers. They concluded that by providing infection prevention and control measures for emergency care workers, they can take care of the patients as best as they can although the implementation of these guidelines require a unified approach [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n\u003ch2\u003eSafety\u003c/h2\u003e\n\u003cp\u003eDealing with Coronavirus 2019 (COVID-19) and its outbreak require fully equipped and dedicated health facilities for patient management. Meanwhile, health and environmental care workers must have the necessary safety to provide services to patients [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eYogesh et al. conducted a cross-sectional and hospital-based survey from April 2020 to June 2020 to examine workplace safety and mental health of health care workers. They concluded that health care workers who are at the forefront of dealing with Coronavirus disease are at increased risk of developing COVID-19 infections.. When contaminated, health workers and patients need to rest to prevent infection, which puts pressure on their health systems. Thus, paying attention to the safety of the mental health workplace is very important for health care providers [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eBy the same token, Tongji at Wuhan Hospital in China conducted a study on effective safety management measures in the field of nursing during COVID-19 disease epidemic. They concluded by formulating solutions for nurses' safety: (A) forming an epidemic leadership team as a responsible system for designing emergency plans, (B) selecting experienced nurses as head nurses in different wards, (C) rotating nursing staff and observing the arrangement and composition of new and old staff in wards, (D) highlighting the role of nurse managers in the front line as a model and instructor to create a sense of responsibility and improve the nurses\u0026rsquo; morale and (E) providing adequate materials and equipment for nurses at the forefront of exposure to coronavirus.\u003c/p\u003e\n\u003cp\u003eLikewise, Chekol et al. study designed to assess the safety of operating room staff that are part of service personnel. They concluded that all health care personnel should use personal protective equipment based on the type of patients\u0026rsquo; surgery. Besides, selective operations should be delayed and emergency procedures like burns, cesarean operation, malignant neoplasia, and traumatic injury should be performed using personal protective equipment [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":" \u003cp\u003eCOVID-19 manifests with a range of mild to severe symptoms; a major problem is that similar to common cold, patients with mild symptoms may not seek treatment, which may result in lack of diagnosis, increased chance of infection, and virus cycle expansion [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. On the other hand, virus transmission is possible during the incubation period, which may last up to 14 days [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Tao et al showed that since the COVID-19 outbreak, the governments have implemented strict prevention and control measures; however, infected patients may still be missed in the asymptomatic incubation period. The study in China showed that 77.5% of the infected health professionals worked in general wards, indicating the high transmissibility of the disease even in general wards. Further, the coinfection of COVID-19 disease with other infections may even intensify the problem [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the same line, Lotfinejad et al found that health care providers is at the forefront of the fight against coronavirus. The growing rate of coronavirus transmission in hospitals has increased global demand for more effective prevention and control across healthcare settings. Experienced nurses can avoid infections with appropriate hand hygiene compliance and use of protective equipment. However, it is crucial to have adequate numbers of nursing staff and access to protective equipment to ensure the safety and quality of care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. To this end, experienced nurses can prevent infection by maintaining proper hygiene and using protective equipment. To ensure the safety and quality of care, it is essential to have a sufficient number of nursing staff and access to equipment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the study by Liu, they also mentioned that one of the most important challenges in responding to the coronavirus is human resource management and personal protective equipment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA key step in controlling the corona virus is hand washing, which has been repeatedly recommended by the WHO. The WHO has also advised health workers to cover their noses and mouths with a cloth or elbow when coughing or sneezing, and to provide masks for patients with suspected infections [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The Centers for Disease Control and Prevention (CDC) and the WHO have also published lessons from China that protect health care providers and the proper use of masks according to protocols to protect health care providers from the coronavirus [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Thus, these studies are consistent with the present study emphasizing that during the epidemic of COVID-19, prevention and safety of employees who are the front line of service providers is of great importance.\u003c/p\u003e \u003cp\u003eFascinatingly, a study by Gibson et al. in the United States found that the Pre-hospital emergency staff received no benefits in connection with COVID-19 disease. More importantly, 60 percent of mission staff does emergency work without an N95 mask, and 18 percent use only one N95 mask for a week or more on emergency missions. However, according to the WHO, it is important to maintain appropriate preventive measures not only when caring for patients but also in close contact with colleagues. The results of the study illustrated that the United States, as a leading country in the field of emergency medical services (EMS), is facing a serious problem and crisis. At present, treating coronavirus patients in the emergency centers are in accordance with the instructions of the CDC [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother important issue that should be mentioned is the use of experienced trained staff in COVID-19 to form a team to develop disease prevention and control programs, integrate processes, and continually improve management principles in disease prevention and control based on scientific evidence. Based on Huang et al. study, this group should provide a daily report on the updated status of suspected and definitively infected patients and analyze their condition and inform the specialists in the intensive care unit and radiology to assess whether the patient needs further examination and treatment. These medical communications can be web-based. Moreover, isolation, reporting and transfer of suspected patients should be done following policies and processes to control local infection and involve the general public. The above measures of the management group will stabilize the order in the wards and greatly reduce the duration of exposure to the patient and the risk of infection [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFinally, the study conducted by Belingheri et al in 2020 with the aim of preventing and controlling health in unhealthy environments concluded that there is no recommendation and protective equipment for personal protective equipment for people in unhygienic environments. Nevertheless, to prevent the spread of droplets, they should use masks, observe social distancing, clean and disinfect dirty surfaces, and prevent overcrowding at work [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003ePersonal protective equipment for health care workers will improve services and improve the quality of staff care for patients. Thus, prominent protective measures and appropriate emergency management plans are recommended to prevent and control infection and the safety of health care workers.\u003c/p\u003e \u003cp\u003eIt should be noted that most of the current studies investigated the prevention and emergency control of hospital pediatrics and the evaluation of patients with COVID-19 in the radiology department and unsanitary environments. Therefore, future studies should inclusively focus on the safety of health care providers in hospital environment.\u003c/p\u003e "},{"header":"List of Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e: World Health Organization, \u003cstrong\u003eCDC\u003c/strong\u003e: Centers for Disease Control and Prevention, \u0026nbsp;PPE: personal protective equipment .\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAuthors' contributions\u003c/h2\u003e\n\u003cp\u003eSM, and GM conceptualized and designed the study. FBS carried out the study, analyzed and interpreted the data, and wrote the first manuscript. MR gave intellectual feedback, redrafted and finalized the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLotfinejad N, Peters A, Pittet D. Hand hygiene and the novel coronavirus pandemic: The role of healthcare workers. Journal of Hospital Infection. 2020.\u003c/li\u003e\n\u003cli\u003ePeters A, Vetter P, Guitart C, Lotfinejad N, Pittet D. Understanding the emerging coronavirus: what it means for health security and infection prevention. Journal of Hospital Infection. 2020.\u003c/li\u003e\n\u003cli\u003eBelingheri M, Paladino M, Riva M. Beyond the assistance: additional exposure situations to COVID-19 for healthcare workers. Journal of Hospital Infection. 2020.\u003c/li\u003e\n\u003cli\u003eCoronavirus disease (COVID-19) outbreak situation. World Health Organization. (accessed 2020 Apr 26).\u003c/li\u003e\n\u003cli\u003eChen C, Zhao B. Makeshift hospitals for COVID-19 patients: where health-care workers and patients need sufficient ventilation for more protection. Journal of Hospital Infection. 2020.\u003c/li\u003e\n\u003cli\u003eJoob B, Wiwanitkit V. COVID-19 in medical personnel: observation from Thailand. The Journal of Hospital Infection. 2020.\u003c/li\u003e\n\u003cli\u003eTao J, Song Z, Yang L, Huang C, Feng A, Man X. Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department. British Journal of Dermatology. 2020.\u003c/li\u003e\n\u003cli\u003eJoob B, Wiwanitkit V. Traumatization in medical staff helping with COVID-19 control. Brain, Behavior, and Immunity. 2020.\u003c/li\u003e\n\u003cli\u003eZhang Y-H, Leung NHL, Cowling BJ, Yang Z-F. Role of viral bioaerosols in nosocomial infections and measures for prevention and control. Journal of Aerosol Science. 2018;117:200-11.\u003c/li\u003e\n\u003cli\u003eQing MX, Li S, Yu S, Ouyang Y, Zeng L, Li X, et al. Emergency management of the prevention and control of novel coronavirus pneumonia in specialized branches of hospital. Academic Emergency Medicine. 2020.\u003c/li\u003e\n\u003cli\u003eYang C-J, Chen T-C, Chen Y-H. The preventive strategies of community hospital in the battle of fighting pandemic COVID-19 in Taiwan. Journal of Microbiology, Immunology, and Infection. 2020;53(3):381.\u003c/li\u003e\n\u003cli\u003eWorld Health O. Infection prevention and control during health care when COVID-19 is suspected: interim guidance, 19 March 2020. World Health Organization; 2020.\u003c/li\u003e\n\u003cli\u003eWu H, Zhang Q, Wu H, Tian F, Cui B, Qi Z, et al. Tackling COVID-19: Insights from the Qinghai Province plague prevention and control (PPC) model. Biosafety and Health. 2020.\u003c/li\u003e\n\u003cli\u003eKilic AU, Kara F, Alp E, Doganay M. New threat: 2019 novel Coronavirus infection and infection control perspective in Turkey. Northern Clinics of İstanbul. 2020;7(2):95.\u003c/li\u003e\n\u003cli\u003eHuang Z, Zhao S, Li Z, Chen W, Zhao L, Deng L, et al. The Battle Against Coronavirus Disease 2019 (COVID-19): Emergency Management and Infection Control in a Radiology Department. Journal of the American College of Radiology. 2020.\u003c/li\u003e\n\u003cli\u003eBloomer MJ, Bouchoucha S. Australian College of Critical Care Nurses\u0026amp;#xa0;and Australasian College for Infection Prevention and Control position statement on facilitating next-of-kin presence for patients dying from coronavirus disease 2019 (COVID-19) in the intensive care unit. Australian Critical Care.\u003c/li\u003e\n\u003cli\u003eAgarwal A, Nagi N, Chatterjee P, Sarkar S, Mourya D, Sahay RR, et al. Guidance for building a dedicated health facility to contain the spread of the 2019 novel coronavirus outbreak. Indian Journal of Medical Research. 2020;151(2):177.\u003c/li\u003e\n\u003cli\u003eDabholkar YG, Sagane BA, Dabholkar TY, Divity S. COVID-19 infection in health care professionals: Risks, work-safety and psychological issues. Indian Journal of Otolaryngology and Head \u0026amp; Neck Surgery. 2020;72(4):468-73.\u003c/li\u003e\n\u003cli\u003eLiu Y, Wang H, Chen J, Zhang X, Yue X, Ke J, et al. Emergency management of nursing human resources and supplies to respond to coronavirus disease 2019 epidemic. International Journal of Nursing Sciences. 2020.\u003c/li\u003e\n\u003cli\u003eChekol WB, Melesse DY. Operating room team safety and perioperative anesthetic management of patients with suspected or confirmed novel corona virus in resource limited settings: A systematic review. Trends in Anaesthesia and Critical Care. 2020.\u003c/li\u003e\n\u003cli\u003eLynch C, Mahida N, Oppenheim B, Gray J. Washing our hands of the problem. Journal of Hospital Infection. 2020.\u003c/li\u003e\n\u003cli\u003eGibson CV, Ventura CA, Collier GD. An investigation on Emergency Medical Services resource capacity and competency amid COVID-19 in the United States.\u003c/li\u003e\n\u003cli\u003eBelingheri M, Paladino ME, Riva MA. COVID-19: Health prevention and control in non-healthcare settings. Occupational Medicine. 2020;70(2):82-3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prevention and control, Safety, Coronavirus, COVID-19, Health Personnel","lastPublishedDoi":"10.21203/rs.3.rs-108680/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-108680/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eInfection\u003cstrong\u003e \u003c/strong\u003eprevention, control, and health workers’ safety in the face of biological agents are among the vital issues in healthcare systems across the world. Considering the high prevalence of COVID-19 infection in the world and its high mortality rate, this epidemic can be tackled to some extent through infection control in the general population and promoting the safety of health centers. This study aims to scrutinize the literature in terms of measures adopted for infection control and safety of healthcare workers in health centers during COVID-19.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e \u0026nbsp;We searched key words related to the study namely, “prevention and control”, “safety”, “coronavirus”, “COVID-19”, and “health personnel” in PubMed, Web of Science, ScienceDirect, Scopus databases, Google Scholar, and also in Persian data bases such as SID, Magiran, Irandoc, and Iran Medex using AND/OR functions. To select the documents, the titles of the retrieved studies were first evaluated for relevance; then, the abstracts and full texts of the papers with relevant titles were inspected. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Out of 136 retrieved studies, 10 were relevant and their data were analyzed. Four of the articles highlighted the importance of prevention, three enunciated the importance control and three of them related to care providers’ safety. The results showed that the COVID-19 epidemic has affected the healthcare providers’ health; however, it is possible to prevent a catastrophe through strategic planning, prevention and control measures.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Considering the importance of the healthcare workers’ health, it is necessary to implement COVID-19 prevention and control management principles according to scientific evidence.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Prevention, Control and Safety of Health Care Providers during COVID-19: A Review Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-11-18 17:09:17","doi":"10.21203/rs.3.rs-108680/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"26492653-cd2e-454b-866d-a5d32024d641","owner":[],"postedDate":"November 18th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":1119881,"name":"Health Economics \u0026 Outcomes Research"},{"id":1119882,"name":"Health Policy"}],"tags":[],"updatedAt":"2021-06-25T20:18:37+00:00","versionOfRecord":[],"versionCreatedAt":"2020-11-18 17:09:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-108680","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-108680","identity":"rs-108680","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}