Lessons Learned from COVID-19 for Future Pandemics: Infection Prevention in Health Care Workers.

Dear Editor, Since the beginning of the pandemic in late December 2019 in Wuhan, China, and the rapid spread of the coronavirus disease 2019 (COVID-19) virus, until May 31, 2022, there were 6.9 million reported deaths and 17.2 million estimated deaths from COVID-19.1 Due to the unique genetic structure of coronaviruses, as well as their ability to reproduce and easily spread, the emergence of COVID-19 has not been unexpected for virologists. Based on the information collected to-date on COVID-19, due to the complex structure of the virus, high risk of inter-human transmission, presence of asymptomatic or mildly-symptomatic carriers, and progression of the condition to respiratory distress and 5-10% mortality, the occurrence of COVID-19 pandemic can be defined as a kind of perfect storm.2 The COVID-19 pandemic, in addition to its negative economic, social, political implications, has posed many challenges for the healthcare sector: dramatic increase of the need for medical staff, the cost of personal prevention and protection equipment, cost of diagnosing and treating patients, need for more intensive care unit and ventilated beds, and in the mortality rate in the community.3 Nurses, as the largest group of medical staff, spend more time with patients than other health care workers (HCWs). For many emerging diseases, there is no standard treatment, and nurses have the key role in the supportive care of the patients infected with emerging diseas.2 In the critical situation of emerging diseases, all social organs, even close relatives and the patient’s family, distance themselves from the patient, and it is the duty of the medical staff to take care of the patient despite the dangers that exist for them. 50% of those who died in the severe acute respiratory syndrome (SARS) epidemic were HCWs who became infected in hospital through caring of the infected patients.4 The prevalence of hospitalization among HCWs was 15.1% and mortality rate was 1.5 %.5 According to the Executive Director of the International Council of Nurses (ICN), “The fact that the number of nurses who died during the epidemic is similar to the number of people who died during World War I Is a giver. We have been calling for standard and systematic data collection on infection and deaths of HCWs, but the fact that we do not yet have accurate statistics is a major scandal”6 as the actual statistics are about 60% higher than reported.7 It is estimated that the rate of virus transmission within hospitals from patients to HCWs is about 29%.8 According to the Deputy Minister of Nursing of the Ministry of Health of Iran, more than 200 000 nurses are working in wards where patients with coronavirus have been hospitalized; since the outbreak of corona in Iran, more than 125 000 nurses have been infected with COVID-19.9 The COVID-19 pandemic makes it even more important to talk about the safety of all HCWs. As a result, maintaining the health and safety of staff is a key principle in promoting patient safety.10 Focusing on the safety of patients should not cause neglect of the safety of HCWs. This article tried to highlight the importance of implementation of new and flexible infection prevention methods based on the characteristics of the disease agent. This letter was written with the aim of prevention of infection in HCWs to infectious diseases, maintaining human resources, increasing nurses’ work efficiency, increasing the quality of care and patient safety, and using health care capacity for education, psychological support, and prevention. Therefore, based on the opinion of experts and the evidence obtained from the review of literature and considering the potentials available in Iran, the following options were proposed to be considered at the next possible pandemics. Letter to Editor