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Table of Contents
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 77-78

COVID-19 – reminds failure of compliant precaution practices in the society

1 Department of Medicine (ID Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission12-Aug-2020
Date of Acceptance09-Mar-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Prasan Kumar Panda
Department of Medicine (ID Division), All India Institute of Medical Sciences, Sixth Floor, College Block, Rishikesh - 249 203, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCFM.IJCFM_95_20

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How to cite this article:
Panda PK, Shankar R. COVID-19 – reminds failure of compliant precaution practices in the society. Indian J Community Fam Med 2022;8:77-8

How to cite this URL:
Panda PK, Shankar R. COVID-19 – reminds failure of compliant precaution practices in the society. Indian J Community Fam Med [serial online] 2022 [cited 2022 Dec 4];8:77-8. Available from: https://www.ijcfm.org/text.asp?2022/8/1/77/349392


A simple basic understanding is that standard and transmission-based isolation precautions are to be used by health-care workers (HCWs). The Centers for Disease Control and Prevention guideline has laid down these standards in their 2007 document for the infection control staff.[1] Hence, these terms are meant for HCWs, not for patients. The absolute term “universal precaution,” introduced in 1985–1988, refers to the practice of avoiding contact with patient's body fluids, which was replaced by “standard precautions” in 1996.[2],[3] Latter includes a set of practices that are applied to the care of patients regardless of the status of infection (suspicion or confirmation). The key elements are; hand hygiene, gloves and gowns, facial protection, prevention of needle-stick and injuries from other sharp instruments, respiratory hygiene and cough etiquette, environmental cleaning, waste disposal, handling and process of linens, and patient care equipment. Special types of transmission, i.e., “Transmission-based precautions” (contact, droplet, and airborne) are also there for patients who are known or suspected to be infected or colonized with certain infectious agents. These evidence-based practices by HCWs are designed to protect patients and their HCWs and prevent cross-infections. Of all these precautions, had it been practiced by all uniformly, at least hospital-acquired infections could be zero. Sadly, this has never happened in any hospital, as evidenced; violations (deviations from recommended operating practices or procedures), mistakes (failures of intention), and slips (failures of execution) are commonly seen.[4] Furthermore, these precautions have never been translated to common people practices where patients live majority of times, before reaching any doctor/hospital.

In the past two decades, the world has seen three coronaviruses emerge with considerable global health consternation. The SARS outbreak in Guangdong (2003), MERS in South Arabia (2012), and COVID-19 in Wuhan (2019) may represent only the tip of the iceberg of epiphenomenon toward noncompliant precaution practices in society.[5] Transmission of COVID-19 can occur through droplet (most common), contact (direct/indirect), and/or airborne transmissions. It is rightly said that COVID-19 is nothing but nature's repeating calls to awaken human beings.[6] All these transmissions can be prevented by special precautions. Hand hygiene and cough etiquette have been advocated for the common public by various health agencies from time to time. In theory, had these measures and precautions which existed well before the outbreaks of SARS, MERS, and COVID-19, been practiced by the common people before reaching hospitals, such outbreaks would not have spread in the first place? This looks more exaggerated when science has proved asymptomatic can transmit infections too. However, if we will not follow standard precautions, then no matter what special precautions we take, it is fruitless.

Isolation through separation of ill people from noninfected people usually occurs in hospital settings but could also be done at home for mild infections as seen these days with the COVID-19 pandemic. It has also been observed that the application of the principles of self-quarantine (or even self-isolation) among the people is inadequate compounding the present situation. Among some economic sections, people have a single room for all family members, self-quarantine/isolation is not possible. However, the use of face mask, maintaining physical distance as much as possible, sleeping separately, cleaning the bathroom after every use, and frequent use of hand hygiene by affected family member with flu-like illness can be a possible solution to counter this pandemic.[7] Here comes the importance of proper ventilation, environmental cleaning, and wearing the right use of personal protective equipments (PPEs). Recently one special edition in a newspaper reported, “Half of India is not wearing masks and the other half is wearing them wrong.”[8] During the initial period of COVID-19 pandemic, on asking experts for ideas “how to conserve PPEs,” at least 290 experts gave their suggestions. Common to all was to have right precaution practices. Here, right means with respect to need, place, and person.[9] Hence, if all scientific precautions would be translated to the public, then many outbreaks could be prevented.

Namaste, sometimes spoken as “Namaskar,” is a customary Indian greeting.[10] Namaste is usually spoken with a slight bow and hands pressed together, palms touching and fingers pointing upward, thumbs close to the chest. This practice is so important in contact precautions that now it is commonplace to greet each other by folding hands and saying “Namaste” as opposed to shaking hands. This is just one simple measure people take by themselves without any scientific pieces of evidence, but it is a good move. Similarly, few other good community precautions are hand/body part washing when coming back home from outside visit, not using other's clothes for own use and changing clothes for sleeping/worship, soft-spoken speech (to avoid more aerosol generation), observing silences for few hours/days, drying clothes in sunlight, doing yoga and pranayama, and eating foods having ayurvedic medicinal values.[11]

As recently proved, COVID-19 can be transmitted by airborne transmissions, and this is probably the main reason why pandemic is still on with recurring waves. This mode of spread needs special care in the form of negative pressure isolation room for each patient. However, the majority of hospitals do not have this facility and general public is unaware of this negative pressure concept. When basic personal health preventive steps such as performing hand wash/rub appropriately, observing cough etiquette, wearing mask in the right way, self-isolation/quarantine once symptomatic/exposed, staying in ventilated environment, taking vaccinations timely, and maintaining a clean surrounding environment are not being followed, then expecting all hospitals to have negative pressure rooms cannot be debated.

Several factors may be responsible for this unfortunate complacence in lack of environmental cleaning, optimal hand hygiene practices, cough etiquette, respiratory hygiene, right wearing of PPE, proper physical distancing, isolation rooms, and timely vaccinations to stop spread of COVID-19. First, there may be a lack of awareness of precautions among the greater mass; secondly, there could be an indifferent attitude of the common public for these measures, and thirdly, lack of role models in the society who will educate and influence all. Thus, we are yet to translate our evidence to common practices which is the need of the hour to counter such pandemics.

  References Top

Siegel JD, Rhinehart E, Jackson M, Chiarello L. The Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Available from: https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html. [Last accessed on 2022 Feb 04].  Back to cited text no. 1
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020;395:565-74.  Back to cited text no. 2
Centers for Disease Control (CDC). Recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR Morb Mortal Wkly Rep 1985;34:681-6, 691-5.  Back to cited text no. 3
Krein SL, Mayer J, Harrod M, Weston LE, Gregory L, Petersen L, et al. Identification and characterization of failures in infectious agent transmission precaution practices in hospitals: A qualitative study. JAMA Intern Med 2018;178:1016-57.  Back to cited text no. 4
Guarner J. Three emerging coronaviruses in two decades. Am J Clin Pathol 2020;153:420-1.  Back to cited text no. 5
Panda PK, Bahurupi YA. COVID-19 – Nature's repeating calls to awaken human beings. J Med Evid 2020;1:78-9.  Back to cited text no. 6
  [Full text]  
Bauchner H, Fontanarosa PB, Livingston EH. Conserving supply of personal protective equipment – A call for ideas. JAMA 2020;323:1911.  Back to cited text no. 9
Oxhandler, Holly. Namaste theory: A quantitative grounded theory on religion and spirituality in mental health treatment. Religions 2017;8:168.  Back to cited text no. 10
Tyagi R, Gupta V, Kumar R, Wander GS. Traditional Indian practices: Time to revisit and re-adopt for a healthier lifestyle. J Anaesthesiol Clin Pharmacol 2020;36 Supp 1:S166-71.  Back to cited text no. 11


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