Risk of “On Job Non Compliance” towards Various COVID-19 Standard & Transmission Based Infection Prevention & Control Measures/Precautions among the Healthcare Workers Working in OPD Settings of Public Sector Tertiary Care Hospitals of Quetta Balochistan (Prospective Cohort Study)

Background: COVID-19 Pandemic is still circulating within the human population and proving to be a deadlier disease with a mortality rate ranging from 0.5% to 7%. Since COVID-19 is a highly transmissible disease; there is always a probability for its outward spread towards the general public and community from the hospitals and healthcare facilities where they come to seek treatment. Methodology: A prospective cohort study design was used, considering the limited available resources and time—a total of 200 healthcare workers (including doctors, nurses, para-medical staff, janitorial staff, reception staff & pharmacists) working in the OPDs of the two major public sector hospitals of Quetta were made part of this study. The study participants were selected using a simple random sampling technique and selection was made from the daily attendance register. The study participants from “Hospital-A” were first of all educated and trained on various COVID-19 IPC measures later on various COVID-19-IEC materials; written in simple Urdu language, were displayed clearly everywhere in the OPD. Similarly, handwashing stations along with hand sanitizers/soaps and surgical face masks were also made available free of cost for all the study participants of Hospital-A. Moreover the importance and effectiveness of COVID-19 IPC measures were continuously announced in the OPD gallery of Hospital-A, these announcements used simple wording in local languages (i.e., Urdu, Pashto, Balochi and Brahvi). On the other hand, in the OPD of “Hospital-B”, no such interventions were made. The study participants of both the hospitals were followed for one month and observations like which group showed more on-job noncompliance towards various COVID-19 IPC measures were recorded. The data was recorded on daily basis (from 1st May-to-31st May 2021) after observing the study participants for compliance towards using face masks, face shields, personal protective gowns, gloves, hand sanitizers, maintaining 6 feet social distancing and implanting triage at his or her OPD counter. Any study participant with daily proper practice of at least face masks, gloves, hand sanitizer and maintaining a 6 feet social distancing SOPs during duty hours at the outdoor patients department was considered to be a compliant individual if even one of these minimum required SOPs has not practiced the study participant, he/she was classified as non-compliant individual. A checklist was used to record these findings for every study participant on daily basis by trained data collectors. Lastly, all the data was analyzed using Microsoft Excel 2007 version. Results: The major findings of this study are almost in line with the set objectives, the study results are clearly showing the Risk Ratio (RR) as 0.27, indicating that the intervention group participants were only 27% as likely to develop on-job non-compliance for various COVID-19 IPC measures compare to the non-intervention group. Discussion & Conclusion: It is highly recommended that various COVID-19 specific infection prevention and control interventions like COVID-19 IPC trainings, COVID-19 IEC and BCC materials be displayed clearly everywhere in the healthcare facilities especially in the OPD department. Moreover, audio announcements made in simple wording using local languages like Urdu, Pashto, Balochi and Brahvi could really serve as constant reminder tools especially in an OPD department where every next patient in the queue could present with a different infectious bug.