Due to their direct contact with patients, health care workers usually have a heightened risk of been infected with contagious diseases. During the Hajj period, there is always a high concentration of individuals in Mecca, which provides a conducive environment for the outbreak of various contagious diseases. Therefore, these study revealed the level of awareness among HCWs on how to prevent acute respiratory infections (ARI). It also showed the measures that they were undertaking and the effectiveness of these tactics. In general, proper training, vaccination of HCWs, as well as pilgrims, can limit the emergence and spread of flu-related ailments.
Demographic Characterization
In the research, a majority of participants were male, who were 69.4% of the population and female 30.6%. The high concentration of male doctors indicated that health care is a male dominated profession in Saudi Arabia. The uptake of vaccination in Mecca was statistically low, at 84.7%. This low level was in agreements with results from a research by Ghabrah et al. (3), which indicated that vaccination rate among health care workers is 84.2%. Further, this low level of vaccination was associated with the high level of flu outbreaks during Hajj (5, 6). From the research, it was observed that there was a high rate of disease outbreaks among HCWs, which may be attributed to lack of undertaking appropriate preventive measures. At least 53% of all HCWs had suffered from influenza in the past one year.
Vaccination Uptake and Associated Factors
The vaccination uptake was observed to be low based on international standards. There was only an uptake of vaccination by 84.7% of HCWs. It was also observed that female take vaccines more than male HCWs, which may be due to their social role. There was still a high proportion of individuals who did not take vaccine due to lack of knowledge of their effectiveness. 40%, cited that lack of knowledge as the cause of them not been vaccinated. These results aligned with those of Turkestani e al. (7), which showed the need for training in order to increase the rate of vaccination.
Concern of Disease
There was a significant level of lack of concern for the ARI. The sub-optimal level of immunization was by itself an indication of this lack of concern. Among male patients, the percentage of non-uptake of vaccines was 36% for meningococcal meningitis, 36% for seasonal influenza, 75.6% for pneumococcal, and 60.5% for Hepatitis.  A similar trend was observed among female HCW with 7.9% non-uptake for meningococcal meningitis, 15.8% for seasonal flu, 79% for pneumococcal, and 63.2% for Hepatitis B vaccine. These rates indicated that the rate of uptake was relative to the severity of the disease. Further, women and men had a higher uptake of meningococcal meningitis and seasonal influenza vaccine, which was an indication of the associated risk of occurrence of these diseases.
Non-Pharmaceutical Measure
Hand washing and wearing of facemasks were used to assess the effectiveness of non-pharmaceuticals methods in preventing ARIs. From the study, it was observed that experienced workers mostly disinfect their hands before starting their tasks. The rates were 45.3% for those who disinfect more than 6 times, 51.6% for those who disinfect between 1 and six, and 3.2% for those who disinfect only once. On the first time HCWs, the rates were 5.4%, 59.5%, and 35.1% for 0 disinfection, a disinfection of 1-6 times, and for disinfection of more than 6 respectively. In general, the study showed that more experienced HCWs were more careful about health hygiene as a means of preventing infection.
In terms of health care profession, HCWs with more knowledge were found o be more careful in ensuring there was no contamination. Among physicians, the usage of face masks was 4.8%, 42.9%, and 52.4% when working for 0 hours, 1 to 6 hours, and when working for more than 6 hours. On a similar note, these individuals indicated high levels of hand acre hygiene. When working for 0 hours, the level was 4.8%, when working for between 1 and 6 hours the rate was 57.1%, finally, it was 38.1% when working for more than 6 hrs. Among students, the rate was 6.7%, 44.4%, and 48.9% for 1, 1-6, and more than 6 hours respectively. Hand washing was 4.4%. 57.8%, and 37.8% for 0, 1-6, and more than 6 hours respectively. This study collaborates studies by previous research by Al-Ghamdi and Kabbash (2), which found that an increase in HCW’s knowledge reduces the chances of cross-infections.
Facemasks and Niqabs
The use of facemasks was higher among experienced female HCWs than on experienced male HCWs. In male HCWs, the use of masks was 14% for those with less than one year experience, 46.5% for those with experience of 1-6 years, and 39.5% for those with an experience of more than 6 years. Among women, the rate was 0% from those with experience of less than a year, 34.2% for those with experience of 1-6 years, and 65.8% for those with experience of more than 6 years. According to Al-Asmary et al. (1), facemasks and niqabs do not offer any protection against acute respiratory tract infection. Since facemasks and niqab are not designed to prevent the flow of particulate respirators, they cannot effectively prevent the spread of acute respiratory tract infections (4). From this perspective, the use of these gadgets was based on perceived prevention ability and not actual proven ability. To sum up, the use of surgical masks should be discontinued and instead, HCW should use N95 masks, which are designed to filter particulates, they should also use alcohol-based disinfectants, increase the level of training and awareness in order to encourage HCWs to prevent against risks of infections with ARI (1).
References List

  1. Al-Asmary, S., Al-Shehri, A., Aboub-Zeid. A., Abdel-Fattah, M., Hifawy, T., El-Said, Y. Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia. International Journal of Infectious Diseases. 2007; 11: 268—272.
  2. Al-Ghamdi, A., & Kabbash I. Awareness of healthcare workers regarding preventive measures of communicable diseases among Hajj pilgrims at the entry point in Western Saudi Arabia. Saudi Medical Journal. 2011; Vol. 32 (11): 1161-1167.
  3. Ghabrah, T., Madani, T., Albarrak, A., Alhazmi, M., Alazaraqi, T., Alhudaithi, M., Ishaq, A. Assessment of infection control knowledge, attitude and practice among healthcare workers during the Hajj period of the Islamic year 1423 (2003). Scandinavian Journal of Infectious Diseases. 2007; 39(11-12): 1018-1024.
  4. Madanin, T., & Ghabrah, T. Meningococcal, influenza virus, and hepatitis B virus vaccination coverage level among health care workers in Hajj. BMC Infectious Diseases. 2007; 1(1): 7-80.
  5. Memish, Z., Assiri, A., Alshehri, M., Hussain, R., & Almor, I. The prevalence of respiratory viruses among healthcare workers serving pilgrims in Makkah during the 2009 influenza A (H1N1) pandemic. Travel Medicine and Infectious Disease. 2012; 10: 18-24.
  6. Shibl, A., Senok, A., Memmish. Z. Infectious diseases in the Arabian Peninsula and Egypt. Clin Microbiol Infect. 2012; 18: 1068-1080.
  7. Turkestani, A., Ibrahim, B., Menish, M. Using health educators to improve knowledge of healthy behaviour among Hajj 1432 (2011) pilgrims. Eastern Mediterranean Health Journal. 2013; 19: 2-4.