COVID-19 is caused by infection with severe acute coronavirus 2 (SARS-CoV-2) [1]. This virus spread pandemic affecting 188 countries [2]. Apart from hospital preparedness, it is essential to ensure frontline Health Care Workers (HCWs) are prepared too, considering all possible scenarios. HCWs like nurses, Accredited Social Health Activists (ASHA) and several others can potentially play a role in COVID-19 prevention and control [3]. Current evidence suggests that the virus that causes COVID-19 is transmitted between people through close contact, infected surface contact and by droplets. The virus spreads mainly from person-to-person through respiratory droplets produced when an infected person coughs or sneezes (within about 6 feet). These droplets could land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. People most at risk of acquiring the disease are those who are in contact with or care for patients with COVID-19. Additionally, other routes of transmission of SARS-CoV-2 by fomites transmission which might have predisposed to the rapid spread globally. SARS-CoV-2 has been detected in the gastric mucosa, stool, urine and saliva [4]. Healthcare professionals have been confronted with several pressing challenges since the onset of outbreak.  The first outbreak of corona takes place in Wuhan city in December 2019 [5]. The total number of confirmed cases has reached globally to above 50 lacks as of 21 May, 2020 and above 3.26 lacks people died till date [6]. Health workers are at the front line of the COVID-19 outbreak response due to this they are more pron to exposed to hazards that put them at risk of infection according to International Council of Nurses (ICN) at least 90,000 health workers infected with COVID-19 and the disease has killed more than 260 nurses, till date 8 May, 2020. Coronavirus infections continue to grow and as they do, health workers are getting ill. In some countries up to 10% of health workers are being infected by coronavirus said, Dr. Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director General. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma and physical and psychological violence [7]. Protection of healthcare workers should be a keep at the top priority every day, especially but not exclusively during recurring viral epidemics. This article highlighted the rights to protection of health workers, including the specific measures needed to protect occupational safety and health [8]. Protection of HCWs is of paramount importance.

Strategic approaches for prevention of spread of SARS- CoV-2 in Health Care Workers (HCWs):

Provide Standard Precautions for All Health Care Workers

Standard precautions include hand and respiratory hygiene, use of appropriate Personal Protective Equipment (PPE) according to a risk assessment, injection safety practices, safe waste management, proper linens, environmental cleaning and sterilization of patient-care equipment.

Ensure that the following respiratory hygiene measures are used:

• Ensure that all health care workers cover their whole body while handling infected or suspected patients and always cover nose, mouth and palms with a mask while cleaning premises

• Offer a medical mask N95 to health care workers while they are in suspected COVID-19 public areas. Apart from the general public, persons with respiratory symptoms or those caring for COVID-19 patients at home should receive medical mask [9]. Wearing medical masks when they are not indicated may cause unnecessary cost and a procurement burden and create a false sense of security that can lead to the neglect of other essential preventive measures

• Perform hand hygiene after contact with respiratory secretions. All health care workers should apply hand hygiene approach before touching a patient, before any clean or aseptic procedure is performed, after exposure to body fluid, after touching a patient and after touching a patient’s surroundings

• Hand hygiene is of fundamental importance. Hands should be cleaned frequently with soap and water, alcohol-based hand rub (containing 70 % alcohol are preferred) or other materials that are known to inactivate the virus. The COVID-19 virus is susceptible to killing by 60 to 70 % alcohol [10]. Do not rub mouth and nose with fingers hand

• The SARS-CoV-2 virus lives longest on plastics and steel surfaces for up to 72 hours to 5 days. So that in the infected areas cleaning of visibly dirty surfaces followed by sanitization with 0.5% hydrogen peroxide or 1% sodium hypochlorite is a best practice measure of prevention of COVID-19 virus in HCWs [11]. It is also recommended that if HCWs comes in contact with these infected objects must be clean their hands and avoid to touching from these infected objects, when comes in contact then use hand sanitizer containing at least 70% alcohol. Hand hygiene with alcohol-based products should be effective

Ensuring Early Detection, Triage and Source Control Measures

Clinical triage includes a system for assessing all patients at admission, allowing for early recognition of possible COVID-19 and immediate isolation of patients with suspected disease in an area separate from other patients (source control). Develop an inventory of resources that could be used to develop training manuals, guidance and IEC (information, education and communication) related to COVID-19 for HCWs. To facilitate the early identification of cases of suspected COVID-19, health care facilities should encourage HCWs to have a high level of clinical suspicion and establish a well-equipped triage station at the entrance to the facility, supported by trained staff.

Increased Access to Personal Protective Equipment

Contact and droplet precautions are in addition to using standard precautions. All HCWs should use contact and droplet precautions before entering the room of suspected or confirmed COVID-19 patients. Health care workers should use PPE which contains protective cloths, respirators, eye protection, gloves and gowns, aprons should also be used if gowns are not fluid resistant specifically, for aerosol-generating procedures (e.g. tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy [12].  COVID-19 is also transmitted in the form of droplet nuclei 5 μm or less, through respiratory route [13]. So that the Centres for Disease Control and Prevention currently recommend the use of N95 respirators for healthcare workers exposed to COVID-19 patients. N95 respirators a having 95% efficiency for filtering particulates. WHO said; “We owe a huge debt to our frontline health workers” and they asked for nothing more than the training and the protective gear to do their jobs.

Environmental Control

These controls address the basic infrastructure of the health care facility and aim to ensure adequate ventilation in all areas in the health care facility [14], as well as adequate environmental cleaning [15]. Deforestation and forest fires, which transgress the natural habitat of avian mostly bats which act as a source and reservoir of COVID-19 in human. Bats play important role in in minimizing population of insects, pests and other arthropods which destroys agriculture farming so that many countries farmers use bats. These viruses have emerged in animal or avian reservoirs for ages, precipitous introduction into the human host due to human encroachment into forest areas. Most of these viruses emerged in winter season as higher temperature destroying the existence of this virus. In polluted environment virus’s sheds with different gases like SO₂, CO₂, NO₂ and with the help of vapour form droplet and inters in human lungs through respiratory route and infect HCWs and other people. To protect patients and health workers we need to protect environment.

Application of Strong Surveillance and Monitoring Systems

Establishing a surveillance process for acute respiratory infections potentially caused by COVID-19 virus among HCWs. Future surveillance systems must also be in place to help prevent the spread of infection at hospitals. Monitoring HCWs compliance with standard precautions and providing mechanisms for improvement as needed [16]. To disruption in supply-chain, logistics and supportive supervision has been noted in all previous pandemics and this has impacted routine service delivery by HCWs. As such, this might be expected for COVID-19 too. For effective surveillance and monitoring, support of government to be necessary to provide clear advice on which activities are to continue and which might be postponed. Guidelines for conducting additional activities are required along with training for community sensitisation, awareness and risk communication for COVID-19.

Training Health Workers to Recognize Respiratory Diseases

Some infections in healthcare workers have occurred in wards that don’t typically deal with infectious diseases, such as long-term care wards or wards for elderly individuals. All healthcare workers must be well educated on transmission and vulnerability of COVID-19 disease and protect themselves against the virus. There must be provided a range of interactive trainings on its proper management and what types of safety measures to be taken during handling of virus [17].

Moral Support of Health Care Workers

Many health care workers are giving their duties with long shifts without break due to this they got physically and mentally health effect like exhaustion stresses and suffers from many abnormalities. So that proper rest and support should be necessary to health workers. Provide psychosocial support to HCW during quarantine or throughout the duration of illness if HCW is confirmed to have COVID-19 [18]. Death or disease of fellow health workers and the consequent economic hardships to their families led to stress and overload. Like the general public and owing to disruption of supply chain and logistics they continued to struggle to get their own supplies. Providing non-performance-based incentives, additional transport allowance, child-care support were found to be enablers in the process along with awards and recognition to maintain motivation. Understanding that every health system is vulnerable is key to finding any existing gaps and ensuring the protection of both health workers and the public at large [19]. Any system could have gaps and we should have the humility to see to what extent our system is prepared and how can we improve it for the future.”

Management of HCWs Exposed to COVID-19 Virus

• Stop all health care interactions with patients for a period of 14 days after the last day of exposure to a confirmed COVID-19 patient and quarantine for 14 days in a designated setting

• Self-monitor temperature and respiratory symptoms daily for 14 days after the last day of exposure to a COVID-19 patient. HCWs should call the health care facility if they develop any symptoms suggestive of COVID-19 and practice respiratory etiquette at all times

• Provide review of Infection Prevention and Control (IPC) training for all health care facility staff, including HCWs at high risk for infection after 14-day quarantine period

• Provide compensation for the period of quarantine and for the duration of illness (if not on a monthly salary) or contract extension for duration of quarantine/illness

• In most of situations HCWS accomplished denigrate, isolation and had been socially ostracised. During previous pandemics, many health workers were not being allowed to use the village well for their water, asked to leave their rented accommodation and not being allowed to use taxis. Health workers often isolate from their families to protect them from infection to respond to their call for duty

• Common coping strategies of HCWs included renewed purpose in continuing to serve their community or country, peer and family support (in some cases) and religion

Protecting health care workers from exposure and infection with Coronavirus Disease 2019 (COVID-19) is depend on the type of work being performed and also risk of exposure including potential for interaction with people of suspected and confirmed COVID-19 and environmental contamination of the work place. Employers should adapt infection control strategies based on a thorough hazard assessment, using appropriate combinations of engineering and administrative controls, safe work practices and Personal Protective Equipment (PPE) to prevent health worker exposures.

Conflict of Interest

The authors declare that they have no conflict of interests with any financial organisation regarding the material discussed in the manuscript.

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