Keywords
Dear Editor,
At the time of submission of the article, Iran continues to have the highest morbidity and mortality due to coronavirus disease 2019 (COVID-19) among the Eastern Mediterranean Region countries (1). Moreover, the magnitude of the problem among Iranian healthcare workers is worrying so that during the COVID-19 pandemic, many were infected and some died, most of them were physicians and nurses (2). The estimated infection fatality rate for COVID-19 in Iran ranged from 1.4% to 2.2% (3). This means that following public health protocols, which have been written with regard to World Health Organization's (WHO) prevention guidelines, is very important (4). Lack of full compliance with COVID-19-related health protocols could be mainly due to the limited availability of personal protective equipment (PPE) and inadequate supervision over the implementation of COVID-19 prevention protocols (5, 6). The following are examples of non-compliance or partial compliance with COVID-19-related health protocols while medical services to patients are provided; It must be mentioned that the non-compliance increase the risk of the novel coronavirus infection in many medical centers:
Wearing a face mask for a long time, re-use a mask and wearing face masks improperly such as not changing disposable masks may lead to a false sense of security;
Manipulation of a face mask with contaminated hands and subsequently increasing potential risk of self-contamination;
Putting a mask on contaminated surfaces when washing the face and wearing the same mask again;
Some personnel use just a pair of gloves in order to provide medical services for confirmed and suspected COVID-19 cases (or also patients with other respiratory diseases) which leads into a further spread of the virus;
Some personnel do not use safety glasses and do not fully observe their personal protective equipment (PPE); particularly the possibility of this behavior increases among healthcare workers with the prolonged hospital stay;
Taking off personal protective clothes when using the toilet and bathroom, and wearing the same clothes partly due to not observing health protocols;
Given the large number of hospitalized patients with COVID-19, employing nursing personnel without sufficient mental preparation in the coronavirus isolation ward may face challenges to achieving good results in their professional performance from various aspects. For example, lack of skilled personnel may lead to inefficient use of the intensive care unit facilities such as a ventilator, and endotracheal tube for intubation, while, using these facilities efficiently is so important in managing the critical COVID-19 patients who are suffering from breathing complications.
In parallel with the increased number of COVID-19 cases in Iran, and as Iran is entering its third phase of its COVID-19 epidemic, sticking to advice and guidance is highly necessary and disregarding the organizational behavior that guarantees full compliance with health protocols by the healthcare workers will deepen the crisis. In the current situation, full observance of health protocols by healthcare providers is the main key to break COVID-19 transmission chain. The government should take some measures to ensure that all of the medical personnel follow protocols strictly in order to protects personnel’s health and supports national health systems.
References
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1.
World Health Organization. WHO coronavirus disease (COVID-19) dashboard. 2020, [cited 2020 Aug 12]. Available from: https://covid19.who.int/.
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2.
Gharebaghi R, Heidary F. COVID-19 and Iran: Swimming with hands tied!. Swiss Med Wkly. 2020;150:w20242. [PubMed ID: 32255497]. https://doi.org/10.4414/smw.2020.20242.
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3.
Sharifi H, Jahani Y, Mirzazadeh A, Ahmadi Gohari M, Nakhaeizadeh M, Shokoohi M, et al. Estimating COVID-19-related infections, deaths, and hospitalizations in iran under different physical distancing and isolation scenarios. Int J Health Policy Manage. 2020. https://doi.org/10.34172/ijhpm.2020.134.
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4.
World Health Organization. Coronavirus disease (COVID-19) pandemic. 2020, [cited 2020 Aug12]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
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5.
Karamouzian M, Johnson C, Kerr T. Public health messaging and harm reduction in the time of COVID-19. Lancet Psychiatry. 2020;7(5):390-1. [PubMed ID: 32353270]. [PubMed Central ID: PMC7185931]. https://doi.org/10.1016/S2215-0366(20)30144-9.
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6.
Karamouzian M, Madani N. COVID-19 response in the Middle East and north Africa: Challenges and paths forward. Lancet Glob Health. 2020;8(7):e886-7. [PubMed ID: 32416767]. [PubMed Central ID: PMC7255278]. https://doi.org/10.1016/S2214-109X(20)30233-3.