Compliance with the Implementation of Health Protocols During the COVID-19 Pandemic for Employees in Hospitals

ABSTRACT


Corona Virus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute
Respiratory Syndrome Coronavirus 2 (SARSCoV-2). SARS-CoV-2 is a new type of coronavirus that has never been identified before in humans. WHO has designated COVID-19 as a pandemic [1]. The increase in cases proceeded quite quickly, spreading to different countries quickly. As of July 9, 2020, WHO reported 11,84,226 confirmed cases with 545,481 deaths worldwide (Case Fatality Rate /CFR 4.6%). Indonesia declared its first case on March 2, 2020. Chances are increasing and spreading rapidly throughout the territory of Indonesia. As of July 9, 2020, the Ministry of Health reported 70,736 confirmed cases of COVID-19 with 3,417 deaths (CFR 4.8%) (Ministry of Health RI, 2020). The Ministry of Health of the Republic of Indonesia is part of the task force for the acceleration of handling COVID-19. It issued Ministerial Decree concerning Health Protocols for the Community in Public Places and Facilities in the context of preventing COVID-19 Control [2]. Health protocols, in general, must contain individual health protection: using masks, washing hands regularly using soap and running water or using antiseptic fluids, maintaining distance, and increasing endurance by applying the protocol.
Through various publication media, socialization of health protocols has been carried out so that all people can comply with recommendations/ instructions, not only about health protocols but knowledge about the symptoms, causes, prevention and statistics of COVID-19 is also socialized [3]. But in reality, many people still need to implement health protocols, such as not wearing masks, not keeping their distance, and not maintaining the cleanliness of wishful thinking. Based on a survey, the percentage of compliance that have not been compliant in avoiding crowds (34%), maintaining a minimum distance of 2 meters (36%), and reducing mobility (36%) [4].
Non-compliance with implementing health protocols can potentially expand the spread of COVID-19 in the community. A fight is an attitude that will appear in a person that is a reaction to something in the rules that must be carried out. This attitude arises when the individual is faced with a stimulus that requires an individual response [5].
The Depati Hamzah Regional General Hospital is one of the referral hospitals for COVID-19 patients. Therefore, it is necessary to prevent and control COVID-19 for workers or employees because it is categorized as a workplace with a high risk of exposure. Work or work duties have a high potential for close contact with people or patients known or suspected to be infected with COVID-19 and contact with objects and surfaces that may be contaminated by the virus [6].
Employees confirmed with COVID-19 at The Depati Hamzah Regional Hospital in 2020 totalled 26 people consisting of 8 men and 18 women. In 2021 there were 157 people comprised of 49 men and 107 women. In 2022, the period from January to May amounted to 120 people consisting of 22 men and 88 women.

Methods
The research method used in this study is a quantitative research using a Cross-Sectional design, which is a study that studies the relationship between the risk factors and the effect factor. The observations were applied at once at the same time. This research was conducted at the Regional General Hospital Depati Hamzah. The variables were independent knowledge and attitudes of employee compliance with the implementation of health protocols.
The population in this study was all employees at the Depati Hamzah Regional General Hospital.
The total sample was 94 respondents. Statistical descriptive analysis was used in this study. Fig. 1 shows the level of adherence to the protocols. Respondents tend to comply with protocols during a pandemic (84%).

Implementation
The statistical test results obtained a value ρ= 0.522 where ρ > 0.05. It means that Ho received it. There is no significant relationship between knowledge and employee compliance in implementing health protocols. Knowledge is the result of "knowing, " which happens after people have sensed a particular object [7]. This sensing occurs through the five human senses.
Knowledge or cognition is a binding domain for forming a person's actions [8]. Behaviours based on knowledge will be more lasting than behaviours not based on knowledge. This study aimed to determine community compliance in implementing health protocols in their daily routines. Ref. [10] also reported the same finding about the knowledge influence on the decision to implement the protocols in another issue.

Implementation
The statistical test results obtained ρ = 0.441 where ρ > 0.05. It means that Ho received it.
There is no significant relationship between attitudes and employee compliance in implementing health protocols. An attitude is a still-closed reaction or response of a person to a stimulus or object. That attitude cannot be directly seen but can only be interpreted in advance from closed behaviour. The attitude manifestly shows the connotation of the appropriateness of a reaction to a particular stimulus that, in everyday life, is a reaction of an emotional nature to social motivation. Attitude is not yet an action or activity but is a predisposition to the act of behaviour. Other research on attitude and compliance with the Compliance with the Implementation of Health Protocols During the COVID-19 Pandemic for Employees in Hospitals (Fajrianti, et al.) 5 protocol explained this situation [11]. Nurses play an essential role in reducing infection among home healthcare patients by complying with infection control procedures.
There is no relationship directly between attitudes and employee compliance with the implementation of health protocols during the COVID-19 pandemic due to the large number of employees who behave well 41 (80.4%) with obedient submission. This finding was more significant than those who act well but do not comply. It can be assumed that employees behave well because they can accept, respond, and respect themselves and others in preventing COVID-19 and implementing health protocols. It can be proven by the high level of compliance, 84%. The positive attitude of the respondents is also related to motivation and way of thinking, which is based on the understanding gained from good knowledge so that it can influence the respondent. Based on the results of interviews with several respondents, there were concerns from employees who were afraid of contracting it if they found friends or other employees who had symptoms of COVID-19 and reported to the homework safety department for screening efforts for those who were in close contact. So that the employee already has an excellent attitude to comply to prevent transmission. The issue of protocol compliance is essential in many areas. Ref. [11] discussed this issue in home healthcare concerning the nurse's knowledge and attitude. Ref [12] studied the many factors related to protocol compliance based on socio-demographic disparities. In the future, there are many possibilities to handle the pandemic using technology [13]. But, the hospital staff or employees still have a crucial impact on the success of the health protocol implementation [14].

Conclusion
Based on the study results, it was concluded that there was no relationship between knowledge and attitudes with compliance with the implementation of health protocols during the COVID-19 pandemic in employees at the hospital. The next study should focus on the critical factors infulencing the implementing health protocols. Other discussion should find the knowledge and attitude to the motivation on implementing a particular policy.