Protecting Healthcare workers from COVID19 transmission in 20 Indonesian hospitals

Indonesia is one of the world's fastest-growing COVID-19 caseloads since March 2020. Daily case increased sharply in Nov-Dec 2020 and during the second wave at-mid 2021 when hospitals across the country reached their surge capacity. COVID-19 claimed lives of 1,691 Indonesian healthcare worker since March 2020. Direct infection to healthcare workers were linked to a lack of personal protective equipment (PPE), low awareness of virus transmission in health facilities, and poor practice in the use of PPE, handwashing, and medical masks, and low efficacy of vaccine. Beside the distribution of PPEs, fit tests, and Oxygen concentrators to health facilities, we conducted a cascade training on COVID19 Infection Prevention and Controls (IPC) in 20 hospitals representing West, central and Eastern Indonesia. The subjects include the selection & correct use of PPEs, handwashing prior, during and after contacts with patients and body materials, handling corps and waste management. Two serial assessments were conducted using WHO adapted tools. Ninety percent hospitals improved IPC practices in 6 aspects from 65% in 1st assessment to 79% in 2nd assessment. IPC managerial practices increased 63 to 81%, screening and triage capacity increased 63 to 77%, Implementation of standard precaution and transmission base precaution 72 to 82%, Administrative practices by 62 to 78% and environmental and engineering 58 to 73%. Understanding on COVID19 IPC among hospitals workers also increased 54% to 91%. COVID19 deaths among workers decreased significantly after intervention, leaving some transmission outside hospital setting.