STUDENT PROJECT

COVID-19 PREVENTION APPLICATION IN HEALTH INDUSTRY

(HOSPITAL)

Rosabel Eugene Priyatna [1902511115]

Bagus Indra Nagastya [1902511032]
Claudia Felicia Limanda [1902511058]
Vicky Samantha [1902511079]
Putri Agnes Monica [1902511100]
Nia Nurliandari [1902511131]
Widya Herawaty Widiyoga [1902511175]
Bella Trisha Agung Saraswati [1902511152]
Nareswara Pawestri [1902511135]
Cokorda Istri Intan Dalem Sukawati [1902511231]
Richard Timothy Elkurnia [1902511006]
Amanda Viani Maria Sitepu [1902511111]
Kezia Crystadinra Gavrilla [1802511160]

SGD B1

FACULTY OF MEDICINE
UDAYANA UNIVERSITY
2022
 STUDENT PROJECT
COVID-19 PREVENTION APPLICATION IN HEALTH INDUSTRY
(HOSPITAL)

Rosabel Eugene Priyatna [1902511115]

Bagus Indra Nagastya [1902511032]
Claudia Felicia Limanda [1902511058]
Vicky Samantha [1902511079]
Putri Agnes Monica [1902511100]
Nia Nurliandari [1902511131]
Widya Herawaty Widiyoga [1902511175]
Bella Trisha Agung Saraswati [1902511152]
Nareswara Pawestri [1902511135]
Cokorda Istri Intan Dalem Sukawati [1902511231]
Richard Timothy Elkurnia [1902511006]
Amanda Viani Maria Sitepu [1902511111]
Kezia Crystadinra Gavrilla [1802511160]

SGD B1

FACULTY OF MEDICINE
UDAYANA UNIVERSITY
2022

i
 FOREWORD

First of all, we would like to express our gratitude to the Almighty God, that
this Student Project can be finished on time to be submitted as an assignment given
by Dr.dr.Made Agus Hendrayana,M.Ked as the head in this Special Topic 3 Block.
This Student Project is based on the topic ‘Covid-19 Prevention Application in
Health Industry (Hospital)’.
We make this Student Project by doing literature review, using all kind of
resources and literature available from online sources. We would also like to
express our deepest gratitude to our facilitator, dr. Ni Putu Oktaviani Rinika
Pranitasari, Sp.THT-KL, who have given us guidance and knowledge to do this
Student Project properly with less mishaps.
Lastly, we noticed that this Student Project is far from perfect and we as the
writer hopes to get suggestions and critics that will be useful for our next project.
We are very hopeful that this Student Project would give the readers new
knowledge and information that can be useful in daily life. In addition, we hope that
this Student Project can improve the quality of life by learning about this topic.
Thank You.

Denpasar, September 10th 2022

Writers Team

ii
 TABLE OF CONTENTS

COVER .......................................................................................................... i
FOREWORD ................................................................................................. ii
TABLE OF CONTENTS .............................................................................. iii
CHAPTER 1: INTRODUCTION
1.1. Background ..................................................................................... 1
1.2. Problem Identifications ................................................................... 2
1.3. Purposes .......................................................................................... 2
1.4. Benefit ............................................................................................ 2
CHAPTER 2: CONTENTS
2.1. Principles for Preventing Infections in Health Workers .................. 3
2.2. Detection of COVID-19 Infections in Health Workers
to Prevent Future Transmission ....................................................... 5
2.3. Handling Health Workers Exposure and Infection to
COVID-19 ....................................................................................... 8
2.4. Sustainable Hospital Management in Preventing
COVID-19 Since Pandemic............................................................. 10
2.5. COVID-19 Vaccine in Indonesia .................................................... 11
CHAPTER 3: SUMMARY................................................................................. 13
REFERENCE ...................................................................................................... 14

iii
 CHAPTER 1
INTRODUCTION

1.1 Background
Coronavirus Disease 2019 (COVID-19) is a case of pneumonia and was first
reported in Wuhan, Hubei Province. At that time, within a month, this infectious
disease spread to various other provinces in China, Thailand, and several other
countries until within a few months, it had spread throughout the world.1
Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which is the
newest type of coronavirus that has never been previously identified in humans. In
Indonesia itself, the spread of COVID-19 has reached all provinces in Indonesia
with the number of cases and/or the number of deaths increasing every day. This
certainly causes an impact on the political, economic, socio-cultural, defense and
security aspects, education and public welfare in Indonesia.1
Therefore, the Indonesian government issued a Decree of the Minister of
Health of the Republic of Indonesia Number HK.01.07/Menkes/413/2020
concerning Guidelines for the Prevention and Control of Coronavirus Disease 2019
(COVID-19), which explained that in minimizing the risk of exposure to the SARS-
CoV-2 To health and non-health workers, patients and visitors in health care
facilities, high attention is needed to the principles of risk prevention and control as
follows:1
a. Implement isolation precautions for all patients
b. Implement administrative control
c. Conduct education and training
Infection prevention and control strategies in Health Service Facilities are
also explained that can be achieved by implementing several things, namely the
application of isolation precautions in the form of improving hand hygiene, the use
of PPE, the use of cough and sneezing etiquette, maintaining environmental
cleanliness, waste management, and disinfection of treatment equipment. Then
administrative control in the form of applying a minimum distance of 1 meter,
organizing PPE logistics so that it is used properly. Lastly, by conducting education
and training, in the form of education related to the chain of infection, isolation

1
precautions, PPE, occupational safety and health (K3) as well as socialization and
education to the public about COVID-19.1

1.2 Problems Identification

Based on the descriptions above, the problem can be formulated as follows:
1. What is/are the principles for preventing infections in health workers?
2. How to detect COVID-19 infections in health workers to prevent future
transmission?
3. How to handling health workers exposure and infections to COVID-
19?
4. What is the sustainable management hospital in preventing COVID-19
since pandemic?

1.3 Purposes
The purpose of this paper is to explain:
1. To understand the principles for preventing infections in health
workers.
2. To understand how to detect COVID-19 infections in health workers to
prevent future transmission.
3. To understand how to handling health workers exposure and infections
to COVID-19.
4. To understand the sustainable management hospital in preventing
COVID-19 since pandemic.

1.4 Benefit
Providing the authors further understanding about COVID-19 Prevention
Application in Health Industry.

2
 CHAPTER 2
CONTENTS

2.1 Principles for Preventing Infections in Health Workers

Health workers are people who interact directly with patients. During the
pandemic, both health workers and patients need to adhere to several protocols to
prevent the spread and wider transmission of the disease. As a precaution,
especially for health workers, WHO has mentioned several important elements that
must be considered, which is risk assessment, hand hygiene, personal protective
equipment, respiratory hygiene and cough etiquette, environment and
environmental cleaning, injection safety, and waste management.

2.1.1 Risk Assessment

All health workers must be equipped with knowledge about what they will
face. The goal for health workers is to know the initial conditions of the field they
will face and finally be able to make more optimal preparations. The knowledge,
for example, can be a question about who will be handled, how to handle it based
on the existing levels, also how to control and finally implement what has been
learned based on the assessment.2,3

2.1.2 Hand Hygiene

Health workers are expected to always wash their hands before and after
touching the patient, before performing aseptic procedures, before and after
touching the patient's body fluids, and after touching the patient's surroundings.4

Figure 2.1 Five moments for hand hygiene.5

3
2.1.3 Personal Protective Equipment (PPE)
Health workers must know the various types of health-protective equipment
that will be used before taking action. The selection of PPE can be known from the
risk assessment carried out before taking action.3

Figure 2.2 Mode of transmission, when to use and matched types of PPE.6

2.1.4 Respiratory Hygiene and Cough Etiquette

Health workers must do and educate people around about proper cough
etiquette. In addition, health workers must also be cautious to the surrounding. If
there is a person with respiratory symptoms it would be best to direct that person at
least 1 meter away from healthy people.7

2.1.5 Environment and Environmental Cleaning

Health workers must be able to keep their work environment clean and
hygienic. Health workers also have to maintain the cleanliness of the equipment
used in every action.8,9

2.1.6 Safe Injection and Sharps Injury Prevention

Before starting to inject, health workers must ensure that the work
environment is safe (low risk of contamination from blood, body fluids, and
splashes). Health workers should also use sterile and safe PPE. All equipment that
will be use in the injection process must be ensured that it is sterile. After
completion of the injection, the needle should be disposed of in a sharps
container.10,11

4
2.1.7 Waste Management
Health workers must be able to sort out the waste generated after the action.
Especially for waste containing blood, body fluids, secretions, and excretions,
laboratory waste is classified as infectious waste. Health workers are expected to
minimize waste generated from health facilities.12

Figure 2.3 Share, types, and applications of plastics in the medical device
industry.13

2.2 Detection of COVID-19 Infections in Health Workers to Prevent Future

Transmission
Early detection of covid-19 infection within health workers can be achieved
by syndromic monitoring and/or laboratory testing, and this is an important
prevention method to prevent further COVID-19 transmission to patients, between
health workers and across health-care settings. These including:

5
2.2.1 Syndromic monitoring of health workers for COVID-19 symptoms should
be performed prior to entry
Based on available evidence, WHO advises health workers should be
screened for clinical manifestations of COVID-19, including fever or chills, cough,
myalgia or arthralgia, fatigue, anosmia, extreme tiredness, and also headache. This
should include:
1) Passive surveillance: health workers report symptoms to the occupational
health professionals or another appointed staff in the facility before the shift
start, during or after their shift.
2) Active surveillance: creating private procedure to ensure that health workers
are examined for COVID-19 symptoms on arrival for their shift.
Passive surveillance may be done when there is limited resources, but active
surveillance should be considered if the human resources permit it.

2.2.2 Testing strategies for health workers for detection of SARS-CoV-2

infections should be implemented
In order to prevent further COVID-19 transmission, WHO recommends that
health workers should be prioritized for testing, regardless whether they are and/or
were contact with confirmed case to protect themselves and to reduce the risk of
nosocomial transmission.
WHO recommends RT-PCR and antigen-based for the diagnosis of SARS
CoV-2. The testing strategies should be:
1) Testing health workers following exposure to COVID-19 confirmed
cases
2) Health workers in health care facilities who are in contact with
suspected and/or confirmed cases should consult and be tested for
SARS-CoV2.14,15,16

6
 Figure 2.4 RT-PCR schematic illustration for COVID 19 diagnostic test.17

2.2.3 Routine testing of health workers for COVID-19 surveillance

Health workers have tasks with a high risk of direct contact with individuals
who are known to be or suspected to be infected with the SARS-CoV-2 virus or
with items or surfaces that may be contaminated.18 Routine testing for health
workers needs to be carried out regularly so that the hospital can prevent the
transmission of COVID-19 from health workers to patients. Usually this routine
test is held every 2 weeks by the RT-PCR method. Routine tests is for all health
workers with high-risk tasks and have agreed to the informed consent of routine
testing. The following variables should be considered when determining the
necessity for routine testing using a risk-based approach:16
1) The transmission's intensity in the environment of the health facilities,
for example, when that Community-wide spread or severe outbreaks of
COVID-19.
2) The ability of the facility and laboratories to carry out the testing,
including the availability of the appropriate human and financial
resources, testing supplies, and laboratory space.

7
 3) The percentage of patients who tested positive for admission to the
institution or being exposed to SARS-CoV2 by health professionals.
4) Percentage of health workers positive with Covid-19.
5) The percentage of workers who are unwell but not yet diagnosed during
quarantine as contacts for COVID-19, making it unable to provide
sufficient safe staffing ratios.

2.2.4 Testing health workers in long-term care facilities

The frequency of testing for health workers will be based on the level of
transmission inside a building and in the surroundings. Example in the long term
care with all transmission scenario like sporadic cases or cluster transmission, the
health workers will be tested with this indication:16
1) Health workers with symptoms of Covid-19.
2) Health workers with history contact of a SARSCoV-2 case.
3) When a resident or staff person is found to have SARSCoV-2, all
medical professionals must be tested.
4) Whenever possible, routine testing of healthcare professionals is a
must.

Table 2.1 Possible approach to monitor COVID-19 transmission in health

workers.16

2.3 Handling Health Workers Exposure and Infections to COVID-19

COVID-19 is an infection that spreads easily through droplets. In the
hospital health workers are at risk getting the infection by direct interaction with
COVID-19 patients. Ministry of health of Indonesia publish a guidance as
Keputusan Menteri Kesehatan Republik Indonesia Nomor

8
HK.01.07/MENKES/230/2021 about a regulation of hospital or emergency hospital
during the Corona Virus Disease 2019 (Covid-19) to protect both patients and
health workers in hospital from Covid-19 exposure in Indonesia. This guidance
provides a standard of a hospital in order to be safe from covid-19, regulation of
job of the workers, equipment that are needed, and guidance for the patients.19
WHO in order to optimize PPE use by health workers released a guidance
for the fourth edition of Rational use of Personal Protective Equipment ((PPE) for
COVID-19 and considerations during severe shortages interim guidance. The
guidance includes operational advice for the use of PPE. Health workers are
required to wear Personal PPE to prevent exposure and infection of Covid-19. This
equipment include medical/ surgical mask, respirator N95, face shield, examination
gloves, surgical gloves, disposable medical gown, medical coverall, heavy duty
apron, waterproof boats, and shoe cover. The regulations of health protection
equipment base on health workers transmission risk to the Covid-19. Other than
that WHO guidance also recommend all health workers and caregiver to receive
adequate training in preventing Covid-19 Infection.20
If health workers report unprotected COVID-19 exposure and fail to screen
the syndrome on arrival or develop symptoms during their shift, policies and
procedures should be in place that outlines the steps to be taken, which include:
1) Direct healthcare professionals to immediately stop working, then
advise them to put on a medical mask if they aren't already doing so,
report to their occupational health and safety (OHS) officer, and isolate
themselves.16
2) Where resources allow, OHS Officers must arrange a meeting with the
health worker to undertake an assessment and obtain a history of their
exposure. Alternatively, they must ask the worker to fill out and submit
the WHO Risk Assessment and Management of Exposure of Health
Care Workers in the Context of COVID-19 form.16,21
3) OHS Officers should classify a risk for a health worker who has had an
unprotected exposure based on the risk assessment tool and establish
the necessary management, including the health worker's capability to
return to work.16
4) OHS should get in touch with local public health authorities to inform
them about healthcare professionals who report exposures from both

9
 work-related and non-work-related sources and to set up the proper
follow-up and monitoring.16,21
5) In accordance with OHS Acts, the occupational sickness should be
notified.16
6) Workforce shortage mitigation strategies need to be in place.16

2.4 Sustainable Hospital Management in Preventing COVID-19 Since

Pandemic
Health services during the COVID-19 pandemic will be very different from
the situation before COVID-19. Hospitals need to prepare stricter safety procedures
where the Infection Prevention and Control (IPC) protocol is followed according to
standards. The patient admission procedure will also be undergoing changes
including universal use of masks, stricter regulations of screening procedures,
visiting schedule arrangements, restrictions for patient's visitor/accompaniment,
and even separate services for COVID-19 and non-COVID-19 patients.22
The main principle of hospital management during the COVID-19
pandemic to adjust the routine services are:
1) Make the division and arrangement of COVID-19 risk zones and
restrictions on access to the hospital.
2) Utilization of information technology for service innovation health
such as:
a. Registration system by phone or online to limit the number of
people in the hospital at the same time. On the application list
online, patients can also be asked to fill out a self-study COVID-
19 to simplify and shorten the process screening when visiting the
hospital.
b. Telemedicine services to reduce the number of people who is in the
hospital.
c. Electronic medical record.
d. Payment system online / via electronic money.
3) Develop a “drug dispencing” system in which patients who have
received telemedicine services do not need to come to the hospital just
to take medicine. Hospital can develop drug delivery services or

10
 cooperate with other service providers to deliver medicine to the
patient.19
Others factors that can be controlled in preventing COVID-19 transmission
in hospital are patient placement, Personal Protective Equipment (PPE), and
visitations. Patient placements are regulated by placing suspected or confirmed
SARS-COV-2-infected patients in a single-person room with a dedicated bathroom.
These patients will be monitored within the facility by dedicated healthcare
provider. The mobilization and transportation of the patient is also limited outside
of the room. In regulating Personal Protective Equipment, every healthcare provider
must use a NIOSH-approved N95 or equivalent or higher-level PPE such as gown,
gloves, respirator, and eye protections. Hospital can also regulate visitation by
encouraging the limitation of in-person visitation while the patients are still in the
infectious state. Every visitor must be instructed to maintain hand hygiene, the
usage of PPE, and the limitation of touched surfaces before entering patient’s room.
Visitors also only can visit the patient’s room and are encouraged to leave the
facility as soon as possible to minimize the duration of COVID-19 transmission in
hospital.23

2.5 COVID-19 Vaccine in Indonesia

Indonesia carries out the COVID-19 vaccination as part of its strategy to
deal with the COVID-19 pandemic. The massive COVID-19 vaccination effort
carried out by the government of the Republic of Indonesia is a positive step in
suppressing the growth rate of the pandemic. The development of a COVID-19
vaccine is still being carried out by several world research institutions. In the
development of a new vaccine, it will take at least 12 to 18 months for the vaccine
to be produced. After all stages can be passed with significant results, then the next
stage is the “Approval Stage”, which is a review by the government in each country.
Indonesia, with the most COVID-19 cases in Southeast Asia, participated in clinical
trials of the COVID-19 vaccine for several types of vaccines. In January 2021, one
of the strategies carried out by the government was the free vaccines, in accordance
with the Peraturan Menteri Kesehatan RI No. 10 Tahun 2021 concerning the
Implementation of Vaccinations in the Context of Combating the Corona Virus
Disease 2019 (COVID-19) Pandemic, for all people. In the beginning of practice,
through the Peraturan Menteri Kesehatan RI No. 84 Tahun 2020, health workers

11
became the first group to get vaccinated as the front line to deal with the
pandemic.24 The targets for the first stage of the Covid-19 vaccination are health
workers, health assistants, support staff and students who are undergoing medical
professional education who are on duty in health care facilities. The implementation
time of the first phase of the vaccine is from January to April 2021.25

12
 CHAPTER 3
SUMMARY

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which is the
newest type of coronavirus that has never been previously identified in humans. It
is an infection that spreads easily through droplets. In the hospital health workers
are at risk getting the infection by direct interaction with COVID-19 patients.
Principles for preventing infections in health workers are risk assessment, hand
hygiene, PPE, respiratory hygiene and cough etiquette, environment and
environmental cleaning, safe injection and sharps injury prevention, and lastly
waste management. Early detection of COVID-19 infection within health workers
can be achieved by syndromic monitoring and/or laboratory testing. In order to
prevent further COVID-19 transmission, WHO recommends that health workers
should be prioritized for testing, regardless whether they are and/or were in contact
with confirmed cases to protect themselves and to reduce the risk of nosocomial
transmission. The frequency of testing for health workers will be based on the level
of transmission inside a building and in the surroundings. Ministry of health of
Indonesia publish a guidance as Keputusan Menteri Kesehatan Republik Indonesia
Nomor HK.01.07/MENKES/230/2021 about a regulation of hospital or emergency
hospital during the Corona Virus Disease 2019 (Covid-19) to protect both patients
and health workers in hospital from Covid-19 exposure in Indonesia. Health
services during the COVID-19 pandemic will be very different from the situation
before COVID-19. Hospitals need to prepare stricter safety procedures where the
Infection Prevention and Control (IPC) protocol is followed according to standards.

13
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