Health and Safety Status of Health Professionals and Associated Factors During Covid-19 Pandemic in Public Hospitals, Addis Ababa, Ethiopia

doi:10.21203/rs.3.rs-1434319/v1

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Research Article

Health and Safety Status of Health Professionals and Associated Factors During Covid-19 Pandemic in Public Hospitals, Addis Ababa, Ethiopia

https://doi.org/10.21203/rs.3.rs-1434319/v1

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Introduction:

Healthcare professionals around the world are at risk of contracting an infectious disease. The Corona Virus Disease 19 epidemic has had a profound effect, especially on hospitals and health workers. However, at the national level in Ethiopia, there is a lack of data on the current state of health and safety of health care professionals. Therefore, the purpose of this study was to determine the state of health and safety and the associated characteristics of health professionals in public hospitals during the COVID-19 epidemic.

Objective

The purpose of this study was to determine the occupational health and safety of health professionals and associated factors, at selected public hospitals in Addis Ababa during the Corona Virus Disease 19 pandemic.

Methodology:

An institutional based cross-sectional study was conducted From January 1 to January 30, 2022, for 360 participants. A simple random technique was used to select study participants. Data were collected using self-administered questioners and entered into Epi info version 3.1 before being exported to SPSS Software (version 23) for analysis. Logistic regression was used to identify significant variables and control confounding factor. The strength of the association was measured using an adjusted odds ratio with a 95 percent confidence interval at a 5% level of significance. A P-value < 0.05 indicated a significant relationship between factors.

Result

Out of a total of 360 study participants, 73.6% (95%Confidence Interval [CI] = 68.9–78.3) had good occupational health and safety status. Work experiences(Adjusted Odds Ratio [AOR] = 1.8, 95%Confidence Interval[CI] = 1.12–3.2), Availability of Proper facemasks to wear during patient contact (Adjusted Odds Ratio [AOR] = 3, 95%Confidence Interval[CI]: 1.7–5.2), the presence of cleaning and disinfection agents (Adjusted Odds Ratio [AOR] = 2, 95%Confidence Interval[CI] = 1.11–3.7), availability of water and hand washing facilities (Adjusted Odds Ratio [AOR] = 2, 95%Confidence Interval[CI] = 1.1–3.4), training on health and safety (Adjusted Odds Ratio [AOR] = 1.8, 95%Confidence Interval[CI] = 1.13–3.2) were significantly associated with occupational health and safety status of health professionals. Conclusion: The findings indicated that occupational health safety status was generally good in the study area. However, the availability of personal protective equipment, availability of water and hand washing facilities, availability of cleaning and disinfectants, and the provision of health and safety training for health professionals still need to be improved because lack of these predictors decrease occupational health and safety status of health professionals and increase the risk of infections at work place.

occupational health and safety

infection prevention

COVID-19

healthcare professional

Healthcare professionals (HCPs) around the world are at risk of contracting infectious diseases during work[1]. COVID-19 has underlined this concern, particularly in the early stages of the pandemic, when many health care facilities lack personal protective equipment (PPE)[2]. HCPs continue to offer patient care in various situations around the world, even if they are afraid of becoming infected and infecting their family, friends, patients, and coworkers [3–5].

Because African countries, including Ethiopia, have limited health care facilities and lack individual protection equipment to prevent the pandemic, the stress of COVID 19 risks for health professionals in Africa is significant[2, 6]. SARS-CoV-2 infection is more likely in healthcare workers that work close to proximity to patients, such as ophthalmologists and dentists [7].

While people are encouraged to stay at home to prevent the diseases from spreading, healthcare workers must keep working even though of the fact that their lengthy shifts expose them to infection. Many hospitals report mental and physical stress, as well as difficulty handling so many sick patients, an increase in mortality in general, and the deaths of their colleagues[5, 8, 9]

Little is said about the occupational health and safety of health professionals in Ethiopia, particularly in Addis Ababa. The busiest hospitals in the country are Saint Paul's Hospital Millennium Medical College and Ras Desta Memorial Hospital, which both act as referral hospitals. The occupational health and safety of health professionals, OHS risks, control measures, and safety practices of health professionals should be assessed during this COVID 19 pandemic in selected public hospitals, Addis Ababa, Ethiopia.

As a result, the goal of this study was to determine occupational health and safety status and associated factors in selected public hospitals, during COVID 19 Pandemic.

4.1. Study Design and Period

An institutional based cross-sectional study was undertaken from January 1 to January 30, 2022.

4.2. Study Setting

The study settings were Ras Desta Memorial Hospital and Saint Paul’s Hospital Millennium Medical College, which are Public Referral Hospitals found in Addis Ababa, Ethiopia. Therefore the research was carried out among health professionals in selected Hospitals

The Ras Desta Damtew Memorial Hospital found under the Addis Ababa City Administration, and the hospital currently features a medical facility that provides health care services to both inpatients and outpatients. Currently, the hospital employs roughly 560 people, with 425 of them being health professionals, including 226 nurses, 88 doctors, and 5 pharmacists.

Saint Paul’s Hospital Millennium Medical College is an Addis Ababa-based referral hospital run by the Ethiopian Federal Ministry of Health. Saint Paul’s Hospital Millennium Medical College is a teaching health institution as well as a health care provider. The hospital currently has 932 beds and treats 2310 new and 4065 return patients per month on average. It has 2045 health professionals.

4.1. Source of Population

Source of population were all health professionals working at Ras Desta Memorial Hospital and Saint Paul's Hospitals Millennium Medical College in Addis Ababa during data collection.

4.2. Study Population

Study participants were health professionals who were selected by using a simple random sampling technique based on the proportion of each hospital's owner.

4.3. Inclusion and Exclusion Criteria

4.3.1. Inclusion Criteria

During the data collection period, health professionals working at Ras Desta Memorial Hospital and Saint Paul's Hospitals Millennium Medical College were included.

4.3.2. Exclusion Criteria

Health professionals on annual leave as well as those who did not wish to take part in the study were also excluded.

4.4. Sample Size Determination and Sampling procedure

4.4.1. Sample Size Determination

The sample size was derived using a single population proportion formula and a 51 percent proportion of health professional occupational health and safety practice taken from a previous study [4]. Considering 95% confidence interval and 5% marginal error with a 10% non- response rate, the calculated sample size was 384.

If the total population of both hospitals is less than 10, 000, correction formula will be considered.

Correction formula=\(\frac{n}{1+\frac{n}{N}}\) where n=sample size and N=Total health workers of the two hospitals. Therefore, the smallest sample size needed was calculated by using correction formula \(\frac{{n}}{1+\frac{{n}}{{N}}}\)= \(\frac{384}{1+\frac{384}{2470}}\)=332.By adding 10% non-response rate required sample size will be 366.

To determine the sample size for each hospital, we multiplied the number of health professionals employed by the total sample size and divide by the total number of health professionals employed by the two hospitals. i.e:N₁ = Number of health professional from Ras Desta Hospital = 425, n₁ will be 63.And N₂ = Number of health professional from Saint Paul Hospital = 2045, and n₂ will be 303, (where N_T= 2470).

4.2.1. Dependent variables

Occupational health safety status of the health professionals

4.2.2. Independent variables

The independent variables were: Age, sex, educational level, religion, monthly income, job experience, marital status, profession, family size, working section; Accessibility of supplies, such as PPE, like gloves, masks, eyes/face shield, gown, water and hand washing facilities, policy and procedures for infection prevention, Reducing the number of individuals who enter the room, minimizing the number of individuals who are present in the room, isolating suspected cases separately, and using engineering control to keep healthcare employees away from customers, COVID 19 vaccine availability, accessibility of cleaning and disinfection agents.

4.3. Operational Definitions

Occupational Health and Safety

Occupational safety and health, according to WHO (1995), is defined as "activity designed to safeguard and maintain the health and safety of health care professionals by eliminating occupational factors and conditions that are detrimental to their health and safety at HCF. It is complete physical, mental, and social well-being, of health professionals[10].

Participants' OHS status issues were assessed in this study using 16 questions (health and safety practices questions), each with an equal weighting. Each participant has received a maximum of 16 points and a minimum of 0 points. Finally, the results of each question were divided into two categories based on their OHS status. In this study the participant’s OHS issues were assessed 16 questions and assessment items ranged from 0–16, and a score of ≥ 13 was reported as good OHS, and a score of < 13 indicated as poor OHS status of health professionals during COVID-19 as Ozturk,et.al; shibiru S. et. al; and Saqlain M.et.al categorization [11–13].

4.4. Data collection procedures (Instrument, personnel, data quality control)

Structured self-administered and interviewer administered questionnaires were used to collect data. Various works of literature were adapted and modified to create the data collection tools[3, 4]. The questionnaire was written in English and then translated into Amharic and back to English to ensure uniformity. For data collection and supervision, three environmental health specialists were chosen: two for data collection and one for supervision. Data collectors and supervisors received one day of training on the study's objectives, the contents of the questionnaire, confidentiality, respondents' rights, and the way to collect data. A pretest of the data collection instrument was undertaken in 10% of the sample in Zawuditu hospital. Data collectors and supervisors discussed the questionnaire to determine the reliability of the data collection instruments and conclusions, and the tool was updated for any inconsistencies or ambiguity before actual data collection. A simple random sampling strategy was used to pick study participants from each public hospital.

4.5. Data processing and analysis

Data were collected, checked for completeness, coded, cleaned, and entered into EP-info software before being transferred to SPSS version 23 for data cleaning and analysis. Frequency tables, cross-tabulations, and proportions were produced as descriptive statistics. Before starting the regression analysis, the Hosmer-Lemeshow goodness of fit test was used to ensure that the model was fit. To discover variables associated with HCPs' OHS, Bivariable, and multivariable logistic regression analyses were used. To control the confounding impact and assess the relationship between the predictors and the outcome (OHS status) of health professionals, all variables with a p-value of < 0.2 in the Bivariable analysis were included in the multivariable model. Significant components in the multivariable model were variables with a p-value of < 0.05. The odds ratio with a 95% CI was used to describe associations between study variables and outcome factors

1) Socio-demographic of study participants

A total of 360 people took part in the study, with a response rate of 98.4%. Males made up 54.7% of study participants, while females made up 45.3%. Those between the ages of 18–30 years constituted the majority, 219 (60.8%) and only 139 (38.1%) were between age 31–40 years. Almost all of the study participants (65.3%) had more than five years of job experience, and the majority of them (70%) had a bachelor's degree, a master's degree and above (21.1%). In terms of the study participants' occupations, the majorities (35.1%) were nurses and (31.4%) were doctors (Table 1).

Table 1

Socio-Demographic Characteristic and OHS status of Health Professionals at Ras Dasta Memorial Hospital and Saint Paul’s Hospitals Millennium Medical College, AA, (n = 360)
Variables	Category	OHS Status of health professionals
		Poor Practice	Good Practice	Total
		Freq. (%)	Freq. (%)	Freq. (%)
Age	18–30 >31	67 (70.5) 28 (29.5)	154 (58) 111 (42)	211 (58.6) 139 (41.4)
Sex	Female Male	46 (48.4) 49 (51.6)	117 (44.2) 148 (55.8)	163 (45.3) 197 (54.7)
Religion	Orthodox Protestant Muslim Others	55 (57.9) 18 (18.9) 18 (18.9) 4 (4.3)	151 (57) 50 (18.9) 59 (22.3) 5 (1.8)	206 (57.2) 68 (18.9) 77 (21.4) 9 (2.5)
Educational level	Diploma BSc Degree Masters and above	3 (3.2) 76 (80) 16 (16.8)	11(4.2) 194 (73.2) 60 (22.6)	14 (3.9) 270 (75) 76 (21.1)
Work experience	< 5years > 5years	43 (45.2) 52(54.8)	82 (31) 183(69)	125 (34.3) 235 (65.7)
Profession	HO Labratorists Pharmacists Mid wives Nurse MD	3 (3.2) 9 (9.5) 9 (9.5) 16 (16.8) 28 (29.5) 30 (31.6)	9 (3.4) 8 (3.2) 13 (4.9) 54 (20.4) 98 (37) 83 (31.4)	12 (3.3) 17 (4.7) 22 (6.1) 70 (19.4) 126 (35) 113 (31.4)
Working hours/d	< 8hrs ≥ 8hrs	49 (51.6) 46 (48.4)	130 (49.1) 135 (50.9)	179 (49.7) 181 (50.3)
Monthly income	< 5000birr 5000-10,000birr > 10,000birr	18 (18.9) 58 (61.1) 19 (0.2)	44 (16.6) 169 (63.8) 52 (19.6)	62 (17.2) 227 (63.1) 71 (19.7)
Work Section	Laboratory Drug store ICU Surgical Wards pediatric OPD Gynecology Emergency Medical wards	9 (9.5) 9 (9.5) 0 8 (9.3) 2 (3) 12 (12.6) 22 (23) 20 (21.1) 13 (12.3)	8 (3) 13 (4.9) 17 (6.4) 15 (5.7) 26 (9.8) 20 (7.5) 52 (19.6) 63 (23.8) 51(19.2)	17 (4.7) 22 (6.1) 17 (4.7) 23 (6.4) 28 (7.8) 32 (8.9) 74 (20.6) 83 (23.1) 64 (17.8)
Marital status	Single Married	41 (43.2) 54 (56.8)	91 (34.3) 174 (65.7)	132 (36.7) 228 (63.3)
Family size	< 3 ≥ 3	68 (70.8) 27 (29.2)	224 (84.5) 41 (15.5)	292 (81.1) 68 (18.9)

2) Engineering control, Administrative control and Availability of PPE

Regarding the availability of PPE, most health professionals (80.6%) had availability of face masks, (79.2%) of them had availability of cleaning and disinfectants, and (41.7%) of health professionals had not enough gloves in their working section.

Regarding engineering and administrative control, most of the study participants (81%) of them had said there was engineering control like (ventilation, isolation, and enough spaces between patient and health provider), especially at triage area and 78% of study participants had said there was a policy and procedure for COVID-19 prevention in their hospitals. Only 69% of study participants had got health and safety training regarding COVID 19 prevention (Table 2).

Table 2: Availability of PPE, Administrative and engineering in selected public hospitals, Addis Ababa, Ethiopia (n=360)

Variable	Category	OHS status
Variable		Poor	Good	Total (%)
Availability of PPE		Frequency	Frequency
Availability of proper face mask to wear during patient contact?	No	30	40	70 (19.4)
	Yes	35	225	290 (80.6)
Availability of enough gloves in your room?	No	50	100	150 (41.7)
Availability of enough gloves in your room?	Yes	45	165	210 (58.3)
Availability of eye/face protection (eg, goggles, face shield)?	No	71	152	223 (62)
	Yes	24	113	137 (38)
Availability of cleaning and disinfectants agents around your working area?	No	33	42	75 (20.8)
	Yes	62	223	285 (79.2)
Availability of water and hand washing facility in your working room?	No	39	60	99 (27.5)
	Yes	56	205	261 (72.5)
Administrative and engineering control
Do you restrict the number of personnel entering the room of a patient?	No	10	10	20 (5.6)
	Yes	85	255	340 (44.4)
Do you minimize the number of staff present when performing aerosol-generating procedures?	No	41	75	116 (32.2)
	Yes	54	190	244 (67.3)
Is it possible isolating suspected cases separately to help prevent transmission?	No	47	104	151 (42)
	Yes	48	161	209 (58)
Is their engineering control to shield healthcare workers from patients, especially at triage area	No	27	41	68 (19)
	Yes	68	224	291 (81)
Does your organization have a policy and procedure for COVID-19 prevention?	No	25	54	79 (22)
	Yes	70	211	281 (78)
Training on health and safety to prevent COVID-19?	No Yes	39 56	73 192	112 (31) 284 (69)
Do you vaccinated with COVID 19 Vaccination?	No Yes	2 93	5 260	7 (2) 353 (98)

3) Health and safety practices of health professionals

Table 3 showed that from the total 360 participants, 73.6% (95% CI: 68.9–78.3) had good OHS status and 26.4% (95% CI: 21.7– 31.1) of them had poor OHS status in this continued COVID-19 Pandemics Regarding to health and safety practices of health professionals those who had performed hand hygiene after removing PPE (88.3%), those who had performed cleaning and disinfection procedures (87.2%) and who performed hand hygiene after patient contact (86.1%) had the highest good OHS status. On the other hand health professionals those who maintained their social distance (52.5%) during this COVID 19 pandemic had lowest OHS status.

Table 3: Health and safety practices of Health Professionals during the COVID-19 Pandemicin selected public hospitals, Addis Ababa, Ethiopia(n=360)

Health and safety practices of health professionals

Category

OHS status

Poor

Good

Total

Freq.(%)

Do you wear gloves when you have contact with patients?

No Yes

27 (28.4)

68 (71.6)

58 (21.9)

207 (79.1)

85 (23.6)

275 (76.4)

Do you wear a proper face mask when you are serving the client?

No Yes

31(32.6)

64 (67.4)

33 (12.5)

232 (87.5)

64 (17.8)

296 (82.2)

Do you clean and disinfect reusable instruments after each client?

No Yes

42 (44.2)

53 (55.8)

37 (14)

228 (86)

79 (22)

281 (78)

Do you wash your hand appropriately with water before wearing PPE?

No Yes

40 (42)

55 (58)

47 (17.7)

218 (82.3)

87 (24.2)

273 (75.8)

Do you perform hand hygiene before contact with the patient?

No Yes

32 (32.9)

63 ((67.1)

49 (18.5)

216 (81.5)

81(22.5)

279 (77.5)

Do you perform hand hygiene after contact with the patient?

No Yes

40 (42)

55 (58)

10 (3.8)

255 (96.2)

50 (13.9)

310 (86.1)

Do you perform hand hygiene after removing PPE (eg, gloves, gown, and facemask)?

No Yes

27 (28.4)

68 (71.6)

15 (5.7)

250 (94.3)

42 (11.7)

318 (88.3)

Do you use an alcohol-based hand rub after patient contact (if water is not available in the room)?

No Yes

52 (55.2)

43 (44.8)

48 (18.2)

217 (81.8)

100 (27.8)

260 (72.2)

Do you change gloves when indicated and performed hand hygiene?

No Yes

28 (28.8)

67 (71.2)

35 (13.2)

230 (86.8)

63 (17.5)

297 (82.5)

Do you wash your hands before and after performing a procedure?

No Yes

46 (48.4)

49 (51.6)

23 (8.7)

242 (91.3)

69 (19.2)

291 (80.8)

Do you perform routine cleaning and disinfection procedures?

No Yes

32 (32.9)

63 (67.1)

14 (5.2)

251 (94.8)

46 (12.8)

314 (87.2)

Do you differentiate PPE wearing area from PPE removing area?

No Yes

57 (60)

38 (40)

45 (17)

220 (83)

102 (28.3)

258 (71.7)

Do you handle waste and other potentially infectious materials properly?

No Yes

55 (58)

40 (42)

30 (11.3)

235 (89.7)

85 (23.6)

275 (76.4)

Do you avoid touching your faces, eyes, noses, and mouth before disinfection?

No Yes

49 (51.6)

46 (48.4)

34 (12.8)

231(87.2)

83 (23)

277 (77)

Have you been tested for COVID-19?

No Yes

47 (48.8)

48 (51.2)

87 (32.8)

178 (67.2)

134 (37.2)

226 (62.8)

Do you maintain social distance during the COVID-19 outbreak?

No Yes

65 (68.4)

30 (31.6)

126 (47.5)

139 (52.5)

191(53.1)

269 (46.9)

Total status of OHS of health professionals

Good status

265 (73.6%)

Poor status

95 (26.4%)

4) Factors Associated with Occupational Health and Safety status of Health Professionals

In the Bivariable analysis, different independent variables were tested for the presence of association with occupational health and safety of health professionals. As a result of age, work experiences, working section, presence of enough gloves in the working room, having disinfectant, having accessible hand washing facilities, restriction of some personnel entering into the patient room, minimizing the number of staff during aerosol procedures, the possibility of isolation suspected cases, engineering control at triage area, and policy and procedures to prevent COVID19, and health and safety training had an association with OHS status of health professionals at p < 0.2, and these variables were taken to multivariable analysis.

In multivariable analysis work experiences, availability of face mask, availability of cleaning and disinfectants, availability of water and hand washing accessibility, health and safety training had a significant association with the OHS status of healthcare professionals at p < 0.05

Table 4 showed that healthcare professionals who had more than five years of work experience were about 2 times more likely to have good OHS status than their counterparts (AOR = 1.8, 95% CI: 1.12–3.2).

Availability of PPE (face masks) need to worn during patient contact in the hospitals increases OHS status of healthcare professionals by 3 times (AOR = 3, 95% CI: 1.7–5.2). Or health professionals who had availability of facemasks were 3 times more likely had good OHS status than health professionals who hadn’t availability of face masks

Availability of PPE (face masks) that need to be worn during patient contact in the hospitals increases the OHS status of healthcare professionals by 3 times (AOR = 3, 95% CI: 1.7–5.2). Or health professionals who had availability of facemasks were 3 times more likely to have good OHS status than health professionals who hadn’t availability of face masks

The other important is cleaning and disinfectant agents which are very important concepts in health care facilities. These agents are one of the control methods of infectious disease transmission. Cleaning and disinfection with these agents among HP and patients is a critical component of safe healthcare delivery in all healthcare settings[14]. According to this study availability of cleaning and disinfection agents in the working section increases the OHS status of HP by 2 times (AOR = 2, 95% CI: 1.11–3.7). In other words, the lack of disinfectants in the hospitals decreases the health and safety status of health professionals by 2 times.

Healthcare professionals who had water and hand washing accessibility in their hospitals were 2 times more likely to have good occupational health and safety than those who didn’t have (AOR = 2, 95% CI: 1.1–3.4). This showed that lack of water and hand washing accessibility in hospitals reduces the OHS status of healthcare professionals by 2 times.

Health professionals who had taken orientation, or training on health and safety to prevent COVID-19 were almost 2 times more likely to have good OHS status than the counterpart (AOR = 1.8, 95%CI: 1.13–3.2). Health and safety training is very important in the healthcare setting to prevent infectious diseases so this study revealed that lack of health and safety training for health professionals decreases the OHS status of health professionals by almost 2 times (AOR = 1.8, 95%CI: 1.13–3.2).

Table 4

Factors Associated with Health and Safety among Health Professionals in selected public hospitals, Addis Ababa, Ethiopia (n = 360)
Variables	Characteristics	Osh status		Crude OR(95% CI), P-value	AOR(95% CI), p-value
Variables	Characteristics	Poor	Good
Age	18–30 > 31	67 28	154 111	1 1.8 (1.1, 3), 0.02	----
Work experiences	< 5yrs > 5yrs	43 52	82 183	1 1.9 (1.1, 2.8), 0.024	1 1.8 (1.12, 3.2), 0.012
Working section	Laboratory Drug store ICU S.Wards pediatric OPD Gyne Emergency M.wards	9 9 0 8 2 12 22 20 13	8 13 17 15 26 20 52 63 51	1 1.6(0.4, 5.8), 0.4 1.5(0.3, 5.2), 0.5 2(0.6, 7.6), 0.25 4(1.4, 12), 0.052 1.9(0.6, 6.7), 0.3 2.7(0.9, 7.8), 0.075 3.5(1.2, 10), 0.03 4.4(1.4, 13), 0.01	1 0.69(0.23,4.1), 0.96 1.25(0.93,5.23), 0.99 1.84(0.46,7.42), 0.39 3.76(0.98,24), 0.071 1.6(0.44,5.98), 0.46 2.4(0.75,7.88), 0.14 2.42(0.75,7.92), 0.14 2.9(0.84,9.8), 0.09
Availability of Enough gloves in your room?	No Yes	67 28	148 117	1 1.89(1.15,3.13), 0.013	1 1.22(0.66,2.27), 0.52
Availability of face mask to wear during patient contact?	No Yes	30 35	40 225	1 5(2.5, 9.3), 0.008	1 3(1.7, 5), 0.014
Disinfectants around working area?	No yes	32 62	42 223	1 2.55(1.49,4.35), 0.001	1 2(1.11, 3.7), 0.02
Water and Hand washing accessibility	No yes	39 56	60 205	1 2.4(1.4, 3.9), 0.001	1 2 (1.1, 3.4), 0.022
Restriction of personal enter into patient room	No yes	10 85	10 255	1 3(1.2, 7.5), 0.018	1 1.6(0.54,4.8), 0.39
minimize the number of staff during aerosol-generating	No yes	41 54	75 190	1 2(1.2, 32), 0.088	1 1.3(0.64,2.7), 0.46
Engineering control to shield HCP from patients,	No Yes	27 68	41 224	1 2.2(1.2, 3.8), 0.076	1 1.3(0.64,2.63), 0.46
Policy and procedure for infection prevention?	No Yes	25 70	54 211	1 3 (1.2,7.4), 0.018	1 0.7(0.33,1.52), 0.37
Training on health and safety?	No Yes	39 56	73 192	1 2 (1.1, 3.2), 0.015	1 1.8 (1.13, 3.2), 0.031

This study aimed to determine occupational health and safety status and its associated factors among health professionals during this COVID 19 pandemic at SPHMMC and Ras Desta Memorial Hospitals, Addis Ababa, Ethiopia. In this study, we found that among the total 360 participants 265 (73.6%) of them had good OHS status and 95 (26.4%) of them had poor OHS status. Regarding association factors; work experiences, availability of PPE, availability of disinfectants, availability of water and hand washing facilities, and availability of training on health and safety had a significant association with the OHS status of healthcare professionals at P < 0.05.

Scientific assessments on health and safety of HCP are necessary in this continued COVID-19 pandemic to take suitable measures and maintain their health and safety and save their life from this fatal pandemic. Therefore, this study showed that more than half of study participants 73.6% (95% CI: 68.9–78.3) of health professionals had good occupational health and safety, while 26.4% (95% CI: 21.7– 31.1) health professionals had poor occupational safety and health status. This finding revealed that there were improvements in the OHS status of health professionals when compared to the other study conducted in Oromia, Turkey, and Pakistan at the early stage of the COVID 19 pandemic[4, 12, 13]. This difference might be due to variations in the study setting, socio-cultural difference, availability of PPE and sanitizer at early stage of COVID 19 pandemics and current status to prevent COVID-19 infections of health professionals.

Regarding the availability of PPE (face coverings), HCFs should provide HCPs with appropriate medical face coverings to wear during patient care when performing aerosol-generating procedures according to the WHO and CDC IPC[15, 16]. This study revealed that the availability of face masks increases the OHS status of HCP by 3 times (AOR = 3, 95%CI: 1.7–5.2). This indicated that the shortage of facemask in the hospitals decreases the OHS of HCP during this continued COVID 19 pandemic. This study was similar to a study conducted in Italy and the UK which stated that most health professionals had availability of proper medical facemasks and those who had availability of proper medical masks had low risks of COVID 19 and another infection and their health and safety status was good [5, 26]. This study also showed improvement when compared with other studies conducted during the early stage of the COVID 19 Pandemic when there was a shortage of PPE[11]. The difference might be due to the availability of PPE increased especially facemasks, awareness, and training on the potential use of face masks and IPC use in this continued pandemic.

Occupational health risks from patients to HCPs usually follow contamination of the HCPs’ hands after touching either patients or fomites, therefore, availability of waters and hand washing facilities for hand hygiene is considered as the most important prevention measure for healthcare-associated infections including COVID 19 [21–23]. This study finding highlighted the importance of water availability and hand washing facilities in the studied hospitals. Availability of water and hand washing facilities in the working section increases the OHS status of HCP by 2 times (AOR = 2, 95% CI: 1.1–3.4) which is highly consistent with other research[14, 26]. WHO and CDC COVID 19 Infection Control guidelines recommended that healthcare facilities should provide HCPs with access to a safe, continuous water supply at all outlets and access to the necessary facilities to perform hand washing [16, 25].

Availability of disinfection and cleaning agents are essential for ensuring that medical, surgical instruments and working environments do not transmit infectious diseases to patients and healthcare professionals[27]. This study was also revealed that the availability of cleaning and disinfection agents had a significant association with occupational health and safety status of health professionals, HCP those who had availability of cleaning and disinfection agents were 2 times more likely to have good OHS status than their counterparts (AOR = 2, 95% CI: 1.1, 3.7). This finding indicated that lack of cleaning and disinfection agents in the working sections decreases occupational health and safety status of health professionals by 2 times.

According to WHO, Occupational Safety and Health Convention (No. 155) and Recommendation (No. 164): rights, roles, and responsibilities, health professionals and their representatives have the right to receive adequate information and training on occupational health and safety to prevent health and safety hazards in health care facilities[28]. In this study training on health and safety had also an association with the occupational health and safety status of HCP. Training on health and safety for health workers increases the occupational health and safety status of HP by almost 2 times (AOR = 1.8, 95%CI: 1.13–3.2). This study was also similar to a study conducted in Colombia which stated that health and safety about patient care was essential to reduce HP exposure during this continued Pandemic[29].

Strength And Limitation Of The Study

The strength of this study was that applying a mixed approach to both self-administered and interviewer-administered questionnaires to reduce data bias during data collection.

Limitation

The main limitation of this study was limited literature regarding the health and safety of health professionals during this COVID 19 pandemic

Health professionals are at the frontline in response to the COVID-19 outbreak, which makes them vulnerable to a higher risk of infection. Therefore, this study found that health professionals' safety was good, but, availability of PPE, availability of water and hand washing facilities, availability of cleaning and disinfectants, and provision of health and safety training for HCP still need to be improved because lack of these predictors decrease occupational health and safety status of health professionals and increase the risk of infections. Thus, the findings of this study may be helpful to hospital leaders to adopt proper occupational health and safety measures for health professionals to reduce infection of the COVID 19 pandemic.

CDC:Center for Diseases Control and Prevention; CI: Confidence Interval; COVID 19:Corona Virus Disease 2019; EFMoH: EthiopianFederal Ministry of Health; HCF:Health Care Facility; HCP: Healthcare Professional; ILO: International Labor Organization; IPC: Infection Prevention and Control;

OHS: Occupational Health and Safety; OR: Odds Ratio; PPE: Personal Protective Equipment; SPHMMC: Saint Paul’s Hospital Millennium Medical College; SPSS: Statistical Package for Social Science; WHO: World Health Organization

Ethics approval and consent to participate

Ethical clearance was obtained from theInstitutional Review Board of Saint Paul's Hospital Millennium Medical College,(permit number: PM23/478). Letters of support were received from this College. The objective of the study was oriented to the hospital leaders and the study subjects. The study was conducted according to the Declaration of Helsinki. Before collecting the data, written informed consent was obtained from each participant. All datacollected from the respondents was secured in confidential

Consent for publication

Not applicable

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

There is no competing financial interests exist and that no conflict of interest exists

Funding

There was no fund for this project

Author Contributions

BGdeveloped the original idea and he was principal investigator of the project. He developed the protocol, collected, analyzed, reported data and prepared manuscript for publication. BA had played great roles(Methodology design, objectives and formulation of research question) from starting to final report writing regarding to this project.

Acknowledgements

Frist and foremost, we wish to express our deepest gratitude to the almighty of God for his all-time blessing of grace and protection through our daily activities. Next, we would like to express our heartfelt gratefulness to SPHMMC's School of Public Health for granting this project. We would also thank individuals who supported us in this research development.

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No competing interests reported.

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Health and Safety Status of Health Professionals and Associated Factors During Covid-19 Pandemic in Public Hospitals, Addis Ababa, Ethiopia

Status:

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Abstract

Introduction:

Objective

Methodology:

Result

Introduction

Methods And Materials

4.1. Study Design and Period

4.2. Study Setting

4.1. Source of Population

4.2. Study Population

4.3. Inclusion and Exclusion Criteria

4.3.1. Inclusion Criteria

4.3.2. Exclusion Criteria

4.4. Sample Size Determination and Sampling procedure

4.4.1. Sample Size Determination

4.2.1. Dependent variables

4.2.2. Independent variables

4.3. Operational Definitions

Occupational Health and Safety

4.4. Data collection procedures (Instrument, personnel, data quality control)

4.5. Data processing and analysis

Result

1) Socio-demographic of study participants

2) Engineering control, Administrative control and Availability of PPE

3) Health and safety practices of health professionals

4) Factors Associated with Occupational Health and Safety status of Health Professionals

Discussion

Strength And Limitation Of The Study

Limitation

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

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