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COVID-19 school health and safety protocols: good practices and lessons learnt to respond to Omicron

The COVID-19 pandemic and the recent Omicron variant wave have dramatically impacted societies in all sectors and at all levels. After near universal school closures in March 2020 that affected 1.6 billion learners and more than 100 million teachers and educators worldwide, countries around the world have developed health and safety protocols in an effort to safely keep schools open and protect students, teachers and other educational staff from the transmission of COVID-19. However, since the emergence of the Omicron variant in December 2021, these protocols have been disrupted and are being reevaluated as schools struggle to address a new set of challenges marked by staff shortages, threats to school safety and political battles over health measures. Based on an analysis of 35 countries, this brief report aims to provide a current overview of national health and safety protocols to keep schools open, their dimensions and how they are designed, implemented and regulated to ensure the continuation of education. It also aims to guide education systems by outlining some lessons learnt and effective practices on how the reopening of schools might be achieved safely and successfully. Finally, the report seeks to contribute to a better understanding of the impacts of the protocols on learning as well as the social and emotional wellbeing, health and development of learners and teachers. In a changing environment where infection rates are increasing at an exponential rate, it also explores how the Omicron variant is affecting current operations and what education systems should do to keep schools open while ensuring that all students are safe and learning.

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Importance of Workplace Safety Protocols: A Comprehensive Guide for Safety Officers

Table of Contents

Workplace safety is not just a legal requirement; it’s a fundamental aspect of a healthy and productive work environment. Safety officers play a crucial role in ensuring that employees can perform their duties without jeopardizing their well-being. In this comprehensive guide, we will delve into the various facets of workplace safety protocols and why they are of paramount importance.

Introduction

Workplace safety is a multifaceted concept encompassing policies, procedures, and practices designed to create a secure environment for employees. Beyond the legal requirements, instilling a culture of safety is vital for fostering a positive work atmosphere.

Legal Compliance and Regulations

To guarantee workplace safety, safety officers must have a solid understanding of legal obligations and safety regulations. Compliance ensures not only the well-being of employees but also shields the organization from potential legal repercussions.

Risk Assessment and Management

One of the cornerstones of an effective safety program is the identification and management of risks. Safety officers must conduct thorough risk assessments and implement strategies to mitigate potential hazards.

Employee Training Programs

A well-informed workforce is the first line of defense against accidents. Safety officers should design and implement comprehensive training programs, covering everything from using equipment safely to emergency response procedures.

Personal Protective Equipment (PPE)

The correct use of Personal Protective Equipment (PPE) is paramount for employee safety. Safety officers need to educate employees on the proper selection, usage, and maintenance of various PPE.

Emergency Response Plans

Effective emergency response plans can be the difference between a minor incident and a major catastrophe. Safety officers must work on creating detailed plans and regularly conduct drills to ensure everyone is prepared.

Health and Wellness Initiatives

Beyond physical safety, incorporating wellness initiatives contributes to a holistic approach to employee well-being. A healthy workforce is more likely to adhere to safety protocols and perform at their best.

Communication Channels

Clear communication is the backbone of any safety program. Safety officers should establish efficient communication channels, ensuring information reaches all levels of the organization in a timely and comprehensible manner.

Incident Reporting Procedures

Encouraging a transparent reporting system is crucial for continuous improvement. Safety officers should establish procedures that allow employees to report incidents without fear of reprisal.

Safety Culture in the Workplace

Fostering a culture of safety requires the active involvement of every employee. Safety officers should promote engagement in safety practices, making it a collective responsibility.

Monitoring and Auditing Processes

Regular monitoring and auditing processes are essential to ensure ongoing compliance with safety protocols. Safety officers should conduct thorough audits and address any deviations promptly.

Benefits of Workplace Safety

Prioritizing workplace safety has numerous benefits, including improved employee morale, increased productivity, and significant cost savings for the organization. A safe workplace is a positive workplace.

The primary objective of workplace safety protocols is to safeguard the lives and well-being of employees. By adhering to established safety measures, organizations minimize the risk of accidents, injuries, and fatalities.
Compliance with local, regional, and national safety regulations is essential to avoid legal consequences. Safety officers must stay informed about relevant laws and regulations to ensure that their organizations operate within the legal framework.
A safe work environment fosters a positive atmosphere and boosts employee morale. When employees feel secure, they are more likely to be engaged, productive, and committed to their tasks.
Workplace accidents can lead to substantial financial losses, including medical expenses, compensation claims, and potential legal fees. Implementing and enforcing safety protocols can significantly reduce the financial burden associated with workplace injuries.
A commitment to workplace safety reflects positively on a company’s reputation. A safe working environment enhances the company’s image and can attract top talent, clients, and business partners.
Accidents and injuries can disrupt normal business operations. Adhering to safety protocols helps prevent such disruptions, ensuring the continuity of work processes and minimizing downtime.
Safety officers play a crucial role in fostering a safety-conscious culture within an organization. By promoting awareness, training, and regular safety drills, they contribute to a workplace where safety is prioritized by all employees.
Safety protocols are integral to effective risk management. Identifying potential hazards, assessing risks, and implementing preventive measures contribute to a proactive approach in minimizing workplace incidents.
Safety officers are responsible for providing relevant training to employees. Empowered and well-trained workers are better equipped to identify and address potential safety concerns, contributing to a safer work environment.
Workplace safety is an evolving process. Safety officers should regularly review and update safety protocols to adapt to changing work conditions, technological advancements, and emerging risks.

In conclusion, workplace safety is not just a set of rules to follow; it’s a mindset that should be ingrained in the culture of an organization. Safety officers play a pivotal role in creating and maintaining a safe environment, ultimately contributing to the success and well-being of both employees and the organization.

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Regular emergency response drills should be conducted at least twice a year to ensure everyone is familiar with procedures.
Technology can enhance safety through monitoring systems, wearable devices, and innovative solutions for hazard prevention.
A transparent system encourages employees to report incidents without fear of punishment, leading to a safer work environment.
Yes, a positive safety culture fosters a sense of well-being and responsibility, positively impacting employee morale.
Organizations can experience cost savings in terms of reduced accidents, insurance premiums, and increased productivity.

Related Programs

Work health, and well-being, related articles, the changing face of worker safety, health, and well-being in a post-pandemic future, it’s not just personal: the economic value of preventing bullying in the workplace, a healthy workplace starts in bed, how covid-19 has changed the standards of worker safety and health — and how organizations can adapt.

Two warehouse workers wearing a mask and hardhat. The female is in the foreground pointing to the left and the male is in the background operating a vehicle.

by Katherine J. Igoe

Ensuring health and safety in the workplace is already a critically important issue; organizations that invest in occupational safety perform better, reduce turnover, and help workers do their jobs more effectively. But COVID-19 has forced companies to act quickly and decisively to keep workers safe. As employers endeavor to slow the spread of the virus while keeping a supportive and productive work environment, they’ve had to adapt new business processes and address existing structures that are lacking.

“COVID-19 has stressed the system. All the flaws that have been in place are totally exposed and have come to the forefront of our daily conversations,” says Jack Dennerlein , adjunct professor of ergonomics and safety in the Department of Environmental Health and co-director of Work Health and Well-being: Achieving Worker Health at the Harvard T.H. Chan School of Public Health. From distancing procedures to the availability of remote work, the pandemic has metaphorically ripped off the mask covering the flaws in organizations’ working conditions. How has COVID-19 changed the standards of worker safety and health, and how can employers adapt to these changes?

Total Worker Health and Its Impact in the Workplace

Total Worker Health (TWH) aims to address, reactively and proactively, the challenges of worker safety, health, and well-being. At its core, it measures and assesses what a worker experiences, collects data to understand what to change, provides approaches on how to modify an environment, and encourages collaboration across traditional organizational boundaries to ensure a safe workplace. It’s both an acknowledgement of workers’ existing health, and initiatives to keep them healthy.

“These two general fields — protecting and promoting health — work together in a single workplace. It makes sense to think about this as an integrated effort instead of two siloed efforts that act in parallel,” says Nico Pronk , adjunct professor of social and behavioral sciences, president of the HealthPartners Institute, chief science officer at HealthPartners, Inc., and co-director of Work Health and Well-being: Achieving Worker Health .

As an example, he explains, “If you have diabetes, your eyesight might be diminished, and you might end up with an injury because your work is putting you at risk.” Critically, though, TWH focuses more on an organization’s framework rather than solely on an individual: “the conditions of work rather than on the behaviors of the work. You set the environment — physical, social, economic — which shapes how the workplace is organized. Within that, these factors start to drive the behavior of the individuals within it.”

COVID-19 has fundamentally uprooted assumptions about worker safety, health, and well-being and been an accelerant of addressing these issues. The pandemic has also highlighted classic social issues that workers face, like childcare, sick leave, and disability issues, and underlined safety concerns in health care environments where professionals need to treat patients. The absence of TWH — where workers don’t feel safe in their workplace — is also much more visible. Implementing TWH effectively helps make organizations more resilient during this time.

Even though COVID-19 can be used as a leverage point, Dennerlein notes, “We should be doing it for the good of the people, not just because of COVID-19. If we want this country to be productive, we have to invest in the health and safety of our workforce.” Adds Pronk, “What if you didn’t get sick? What if you didn’t get injured? The benefits come back in spades. You cannot be successful if you don’t have healthy workers, but that recognition is still hardly there.”

“Protecting and promoting health work together in a single workplace. It makes sense to think about this as an integrated effort instead of two siloed efforts that act in parallel.”

Applying and Adapting Total Worker Health During the COVID-19 Pandemic

While the values of TWH may not change, the implementation has evolved to protect workers against COVID-19. In a paper titled “ An Integrative Total Worker Health Framework for Keeping Workers Safe and Healthy During the COVID-19 Pandemic ,” Dennerlein, Erika Sabbath, Susan Peters, and Glorian Sorensen outlined six key characteristics that are essential for applying TWH in this context:

Focusing on working conditions for infection control and supportive environments for increased psychological demands
Utilizing participatory approaches involving workers in identifying daily challenges and unique solutions
Employing comprehensive and collaborative efforts to increase system efficiencies
Committing as leaders to supporting workers through action and communications
Adhering to ethical and legal standards
Using data to guide actions and evaluate progress

In this way, organizations can address the unique demands (including physical, ethical, and legal) of counteracting COVID-19 alongside the needs of workers to complete their tasks in a safe space, while using data and feedback to make changes.

According to the researchers, the most challenging aspect of using a TWH framework is getting top-level support. “Overall organization engagement towards this shared vision of a goal is critical — some key performance indicator for the institution has to include TWH or recognizing its impact. You have to think about that at the systems level,” says Dennerlein.

“If we want this country to be productive, we have to invest in the health and safety of our workforce.”

The Practical Implications of Implementing Total Worker Health in a Pandemic

The researchers have worked with companies to take these theoretical constructs and translate them to practical insights in the workplace. “It took companies as much as six months to learn how to bring health and safety together. Health is in HR, safety is in Operations, and the two don’t usually interact,” Pronk says. Not rushing the organizations and giving them up to a year to develop an implementation plan was key.

After buy-in from leadership, the next step is to test these six characteristics using data and feedback. Previous studies show that program design principles or characteristics are correlated with good health outcomes. “The business units that scored the highest had the lowest number of health risks in their populations. The more they followed these characteristics, the healthier their group was,” Pronk says. Following implementation, organizations would then be able to make changes and use a team-based approach to maintain awareness and continue to evaluate efficacy.

Thus, TWH can be effective, and not just in the short-term. Even after COVID-19 is no longer an immediate threat, the challenges of worker health and safety remain. “What are we doing to create a more resilient workforce ? When we start thinking about the work of the future, workers are going to have to continually reinvent themselves, because work is constantly changing. COVID-19 was a big slap in the face for that. How do we all adapt?” says Dennerlein.

“We rely on the human element in the workforce so much because humans are problem-solvers. TWH tries to broaden that and realize what a great resource we have here. Why aren’t we using that element better? Why aren’t we weaving it more effectively into our organizations to help them make better decisions to affect the bottom line?”

Harvard T.H. Chan School of Public Health offers Work Health and Well-being: Achieving Worker Health , which provides the full set of skills needed to improve worker health, safety, and well-being in the workplace .

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Int J Environ Res Public Health

Nurses’ Adherence to Patient Safety Principles: A Systematic Review

Mojtaba vaismoradi.

1 Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway

Susanna Tella

2 Faculty of Health and Social Care, LAB University of Applied Sciences, 53850 Lappeenranta, Finland; [email protected]

Patricia A. Logan

3 Faculty of Science, Charles Sturt University, 2795 Bathurst, Australia; ua.ude.usc@nagolp

Jayden Khakurel

4 Research Centre for Child Psychiatry, Department of Child Psychiatry, Faculty of Medicine, University of Turku, 20014 Turku, Finland; [email protected]

Flores Vizcaya-Moreno

5 Nursing Department, Faculty of Health Sciences, University of Alicante, 03080 Alicante, Spain; [email protected]

Background: Quality-of-care improvement and prevention of practice errors is dependent on nurses’ adherence to the principles of patient safety. Aims: This paper aims to provide a systematic review of the international literature, to synthesise knowledge and explore factors that influence nurses’ adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using appropriate keywords to retrieve empirical articles published from 2010–2019. Using the theoretical domains of the Vincent’s framework for analysing risk and safety in clinical practice, we synthesized our findings according to ‘patient’, ‘healthcare provider’, ‘task’, ‘work environment’, and ‘organisation and management’. Findings: Six articles were found that focused on adherence to patient-safety principles during clinical nursing interventions. They focused on the management of peripheral venous catheters, surgical hand rubbing instructions, double-checking policies of medicines management, nursing handover between wards, cardiac monitoring and surveillance, and care-associated infection precautions. Patients’ participation, healthcare providers’ knowledge and attitudes, collaboration by nurses, appropriate equipment and electronic systems, education and regular feedback, and standardization of the care process influenced nurses’ adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing care practice, as both influence adherence to patient-safety principles. More studies using qualitative and quantitative methods are required to enhance our knowledge of measures needed to improve nurse’ adherence to patient-safety principles and their effects on patient-safety outcomes.

1. Introduction

The World Health Organization defines patient safety as the absence of preventable harm to patients and prevention of unnecessary harm by healthcare professionals [ 1 ]. It has been reported that unsafe care is responsible for the loss of 64 million disability-adjusted life years each year across the globe. Patient harm during the provision of healthcare is recognized as one of the top 10 causes of disability and death in the world [ 2 ]. Regarding the financial consequence of patient harm, a retrospective analysis of inpatient harm based on data collected from 24 hospitals in the USA showed that harm-reduction strategies could reduce total healthcare costs by $108 million U.S. and generate a saving of 60,000 inpatient care days [ 3 ]. Additionally, the loss of income and productivity due to other associated costs of patient harm are estimated to be trillions of dollars annually [ 4 ]. The burden of practice errors on patients, their family members, and the healthcare system can be reduced through implementing patient-safety principles based on preventive and quality-improvement strategies [ 5 ]. Patient-safety principles are scientific methods for achieving a reliable healthcare system that minimizes the incidence rate and impact of adverse events and maximizes recovery from such incidents [ 6 ]. These principles can be categorized as risk management, infection control, medicines management, safe environment and equipment [ 7 ], patient education and participation in own care, prevention of pressure ulcers, nutrition improvement [ 8 ], leadership, teamwork, knowledge development through research [ 9 ], feeling of responsibility and accountability, and reporting practice errors [ 10 ].

The nurses’ role is to preserve patient safety and prevent harm during the provision of care in both short-term and long-term care settings [ 11 , 12 ]. Nurses are expected to adhere to organizational strategies for identifying harms and risks through assessing the patient, planning for care, monitoring and surveillance activities, double-checking, offering assistance, and communicating with other healthcare providers [ 13 , 14 ]. In addition to clear policies, leadership, research driven safety initiatives, training of healthcare staff, and patient participation [ 1 , 15 ], nurses’ adherence to the principles of patient safety [ 16 , 17 ] is required for the success of interventions aimed at the prevention of practice errors and to achieve sustainable and safer healthcare systems.

Adherence to and compliance with guidelines and recommendations are influenced by personal willingness, culture, economic and social conditions, and levels of knowledge [ 18 , 19 ]. On the other hand, lack of adherence and compliance contravenes professional beliefs, norms, and expectations of the healthcare professional’s role [ 20 ].

Institutional systemic factors influencing nurses’ adherence to and compliance with patient-safety principles are as follows: the organizational patient-safety climate [ 21 ], workload, time pressure, encouragement by leaders and colleagues [ 22 , 23 , 24 ], level of ward performance [ 25 ], provision of education for the improvement of knowledge and skills [ 11 , 18 ], institutional procedures or protocols, and also communication between healthcare staff and patients [ 11 ]. In addition, personal motivation, resistance to change, feelings of autonomy, attitude toward innovation, and empowerment are personal factors that impact on the nurses’ adherence to patient-safety principles [ 26 ].

A theoretical framework for analysing risk and safety in healthcare practice has been devised by Vincent et al. (1998) [ 27 ] based on the Reason’s model of organizational accidents [ 28 ]. It combines ‘person-centred’ approaches, where the focus is on individual responsibility for the preservation of patients’ safety and prevention of their harm, and the ‘system-centred’ approach, which considers organizational factors as precursors for endangering patient safety [ 29 ]. According to this theoretical framework, initiatives aimed at the improvement of patient safety require systematic assessments and integrative interventions to target different elements in the hierarchy of the healthcare system, including patient, healthcare provider, task, work environment, and organization and management. This framework, and similar models for risk and safety management, can help with the analysis of patient harm, to identify probable pitfalls, as well as explore how to prevent future similar incidents [ 30 ].

Adherence to the principles of patient safety and the prevention and reduction of practice errors have been facilitated by technological solutions in recent years [ 31 , 32 ]; however, suboptimal quality and safety of care remain evident, indicating the need for improved understandings of the various factors and conditions that increase adherence in daily nursing practice [ 33 ]. Consequently, this review aimed to retrieve, explore, and synthesise factors evident in the international literature that influenced nurses’ adherence to patient-safety principles. Vincent’s framework was used for the classification of findings, in order to systematically present the findings and inform clinical practice.

2. Materials and Methods

2.1. design.

A systematic review was conducted. It is an explicit and clear method of data collection, systematic description, and synthesis of findings, to reach the study goal [ 34 , 35 , 36 ]. The review findings are presented narratively since heterogeneities in the methods, objectives, and results of studies that met the inclusion criteria did not lend themselves to meta-analysis. The Preferred Reporting Items Systematic Reviews and Meta-analysis (PRISMA) Statement (2009) was applied to inform this systematic review [ 36 ].

2.2. Search Methods

Search keywords were determined after team discussions, performing a pilot search in general and specialized databases, and consultation with a librarian. Key search terms relating to adherence to patient-safety principles by nurses were used to conduct a Boolean search. For operationalising the study concept, the definition of adherence as a behaviour carried out actively by people according to orders or advice was used [ 37 ]. The word adherence is used interchangeably with, and sometimes at the same time as, the word compliance, since both can indicate the outcome of care interactions between the healthcare provider and the caregiver [ 38 , 39 , 40 , 41 , 42 ]. However, adherence indicates responsibility and empowerment on the healthcare professional’s part to actively perform the expected behaviour compared to compliance that shows responsibility on the patient’s part to follow up the therapeutic regimen [ 43 , 44 ].

The search was limited to the time period of January 2010 to August 2019, in English scientific journals available through the following online databases: PubMed (including Medline), CINAHL, Scopus, Web of Science, PsycINFO, ProQuest, and EBSCO. In addition, the authors performed searches in Nordic and Finnish databases to improve the search coverage. To find relevant studies for inclusion in the data analysis and synthesis, inclusion criteria for selection were articles with a focus on adherence to patient-safety principles in clinical nursing interventions published in online peer-reviewed scientific journals. Articles on patients and other healthcare providers, or on non-clinical initiatives, or that had no exact relevance to adherence to patient-safety principles were excluded.

2.3. Search Outcome and Data Extraction

The authors (M.V., S.T., J.K., and F.V.M.) independently performed each step of the systematic review, holding frequent online discussions and making collective agreements on how to proceed through the review steps. Gray literature, such as unpublished dissertations and policy documents and cross-referencing from bibliographies, were assessed, to improve the search coverage. Guidance and support with the search process were obtained from the librarian, when needed. All authors independently screened the titles, abstracts, and full texts of the studies retrieved during the search process. In the cases where disagreements about the inclusion of selected studies occurred, discussions were held until a consensus was reached.

A data extraction table was used to collect data on the characteristics of studies. The table included the lead author’s name, publication year, country, design, sample size and setting, and information relating to adherence to patient-safety principles. Prior to the full data extraction, this table was pilot-tested with a few selected studies, to ensure that data relevant to the review aim and analysis would be appropriately gathered.

2.4. Quality Appraisal

The selected articles were appraised based on the appropriateness of the research structure using the evaluation tools provided by the Enhancing the QUAlity and Transparency of health Research (EQUATOR) website [ 45 ] and criteria outlined by Hawker et al. (2002) [ 46 ], addressing the study aim, research structure, theoretical/conceptual research framework, conclusion, and references. The appraisal tool appropriate to cross-sectional, observational and cohort studies such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to evaluate the suitability of selected studies for inclusion in the final data synthesis and analysis. The researchers believed that the quality appraisal items for determining the inclusion of a study in the final dataset did not align to a scoring system; therefore, they used a yes/no system to answer the appraisal-tool items during the quality appraisal and held frequent discussions on the importance and quality of each article before making the final decision on the selection of studies for data analysis and synthesis.

2.5. Data Abstraction and Synthesis

The Vincent’s framework for analysing risk and safety in clinical practice [ 27 , 47 ] was used to organize and connect the review findings to the wider theoretical perspective of patient safety. This framework was developed based on the Reason’s organisational accident model [ 28 ]. Accordingly, issues in patient safety originate in various systemic features at different categories of patient, healthcare provider, task, work environment, and organisation and management [ 27 , 47 ]. The use of this framework helped with the description and categorisation of data retrieved and accommodated heterogeneities in the studies retrieved, with respect to method, samples, settings, and findings, facilitating the integrative presentation of the review findings. The authors (M.V., S.T., P.A.L., J.K., and F.V.M.) reviewed the included studies, to allocate the studies’ findings to each category, and used frequent discussions to reach a consensus.

3.1. Search Results and Study Selections

The thorough literature search using the key terms led to the retrieval of 10,855 articles. After deleting irrelevant and duplicate titles, 382 entered the abstract-reading phase. Each abstract was assessed by using the inclusion criteria, resulting in 84 possibly relevant articles. The full texts were obtained from Finnish and Norwegian libraries and were carefully read to select only those articles that had a precise focus on adherence to patient-safety principles during clinical nursing interventions by nurses. This resulted in the final six articles chosen for data analysis. Excluded studies were on adherence by other healthcare providers, rather than nurses, or had no exact relevance to patient-safety principles. The methodological quality of the selected articles was assessed during the full-text appraisal, and no article was excluded. In general, they had acceptable qualities with respect to study research structure, theoretical and conceptual research frameworks, and relevant findings to the review aim. Grey literature and the manual search in the reference lists of the selected studies led to no more articles being discovered for inclusion. Appendix A presents the search results, giving the number of articles located in each database. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart is shown in Figure 1 .

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The study flow diagram according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

3.2. General Characteristics of the Selected Studies

The general characteristics of the selected studies ( n = 6) are presented in Table 1 . The studies were published from 2014 to 2019 and were conducted in Australia [ 48 ], Finland [ 49 ], Norway [ 50 ], South Korea [ 51 ], Sweden [ 52 ], and the UK [ 53 ].

Characteristics of selected studies for data analysis and synthesis.

Authors, Year, Country	Aim	Method	Sample and Setting	Main Finding	Conclusion
Förberg et al., 2014, Sweden [ ]	To investigate nurses’ adherence to the clinical practice guidelines regarding peripheral venous catheters and investigate their understandings of work context influencing it.	Survey	A children’s hospital with 245 beds, 373 nurses from 23 medical and surgical inpatient, intensive care, the operating, anaesthetic, advanced homecare, and outpatient wards.	The importance of the workplace condition in terms of information sharing and feedback.	The need for various strategies for improving adherence among nurses.
Rintala et al., 2014, Finland [ ]	To evaluate adherence to surgical hand rubbing directives among operating room personnel, in public hospitals in Southwest Finland.	Observational before-after intervention	11 surgical settings of four hospitals, 190 and 73 nurses in the first and second observation rounds, respectively.	The relative impact of the feedback intervention on adherence by nurses.	Necessity of effective educational methods and role models.
Alsulami et al., 2014, UK [ ]	To explore the follow-up of double-checking policies by nurses and assess the identity of medication-administration errors despite double-checking.	Prospective observational	Medical and surgical wards, the PICU and NICU, observation of preparation and administration of 2000 drug doses to 876 children.	Deviations from the policies of medication administration.	Encouragement of double-checking steps during medication administration, and prevention of interruptions.
Graan et al., 2016, Australia [ ]	To investigate the adoption of standardised nursing handover guidelines from the ICU to the cardiac ward in regard to understanding risks to patient safety before and after the implementation.	Three-stage, pre–post time series, and focus group interviews pre-and/or post-implementation.	A metropolitan private hospital with a 15-bed ICU and a 46-bed cardiac surgical ward; 20 consecutive episodes of ICU-to-ward handover and a further 20 post-implementation episodes; A purposive sample of 19 senior nurse managers and clinicians.	Unsafe practice of handover interventions and information gap.	The need for the adoption of standardised handover tools for reducing handover variabilities.
Fålun et al., 2019, Norway [ ]	To study cardiovascular nurses’ knowledge of, and adherence to, practice standards for cardiac surveillance and their knowledge improvements over time, in years 2011 and 2017.	Survey	363 nurses from 44 hospitals in 2011 and 38 hospitals in 2017.	Failure to fully adhere to cardiac telemetry monitoring standards.	Developing educational programmes regarding the safe practice of cardiac monitoring.
Lim et al., 2019, South Korea [ ]	To investigate nurses’ adherence to standard precautions and its association with their perceptions of safe care.	Cross-sectional	329 nurses working in a teaching hospital.	Intermediate adherence to standard precautions.	Devising integrative curricula to improve nurses’ transition to professional practice.

PICU: paediatric intensive care unit; NICU: neonatal intensive care unit; ICU: intensive care unit.

Three studies used a survey design [ 50 , 51 , 52 ]; one study used an observational method [ 53 ]; one applied an observational intervention design [ 49 ]; and another one was a three-stage pre-post time-series study [ 48 ]. Except for one study [ 49 ] that was published in the Finnish language, all other articles were written in English.

Diverse foci were evident in the studies: adherence to patient-safety principles on the management of peripheral venous catheters [ 52 ], surgical hand rubbing instructions [ 49 ], double-checking policies of medicines’ preparation and administration [ 53 ], handover from the intensive care unit (ICU) to the cardiac ward [ 48 ], cardiac monitoring and surveillance standards [ 50 ], and care-associated infection precautions [ 51 ].

3.3. Findings of Studies with Connection to the Vincent’s Framework

The findings were classified based on the theoretical framework for analysing risk and safety in clinical practice developed by Vincent (1998, 2010) [ 27 , 47 ] and grouped by factors related to the patient, healthcare provider, task, work environment, and organisation and management. Variations in the findings within the selected studies related to the type of patient-safety principles or different clinical settings facilitated the description and synthesis of findings under the above-mentioned categories ( Figure 2 ).

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Schematic model of nurses’ adherence to patient-safety principles based on the Vincent’s framework.

3.3.1. Patient

This category was about the role of patients and how they could impact nurses’ adherence to patient-safety principles. For instance, errors made during medicines’ preparation and administration, and a deviation from medication safety principles by nurses were reported. The deviation with a high possibility of endangering patient safety happened where the parents of patients or their companions were left unobserved and unsupervised by nurses to administer medicines to patients. Unobserved or unsupervised administration contravenes the medicines management principle, which requires a nurse’s direct supervision; a crucial consideration for the prevention of abuse and patient avoidance of taking medicines as prescribed [ 53 ]. Moreover, in spite of the emphasis on patient participation in patient-safety activities, nursing handovers were delivered mainly outside the patient’s room [ 48 ], or no information was provided to patients regarding the purpose and process of cardiac monitoring [ 50 ]. These deviations could hinder patients’ active involvement in their own safe care. Additionally, the only communication line between patients and nurses was the call bell, and nurses rarely questioned patients about their pain or comfort. These identified issues represent missed opportunities for the nurses’ continuous observation role for early detection and prevention of harm during handovers from the ICU to the cardiac ward [ 48 ].

3.3.2. Healthcare Provider

This category described how nurses’ knowledge and attitudes were associated with their adherence to patient-safety principles. Variations in nurses’ adherence to patient-safety principles could be attributed to their varied levels of knowledge and attitudes. Examples included nurses’ incomplete adherence to infection-control principles, which encompassed the daily inspection of peripheral venous catheter sites, surgical hand rubbing, disinfection of hands, and the use of disposable gloves and aprons when exposed to patient excretions [ 49 , 51 , 52 ]. Other examples were related to the principles of medicines’ management: inappropriate speed of intravenous bolus, incorrect medicines’ preparation, administration at incorrect times, problematic labelling of flush syringes and administration of intravenous antibiotics without flushing, not receiving the medicines’ complete dose by patients, and incorrect mixing of medicines with diluent [ 53 ]. Lack of sufficient knowledge and skills regarding cardiac monitoring and surveillance standards were also evident, with incorrect placement of cardiac electrodes and/or skin preparation before the procedure leading to inconsistent monitoring, which could endanger patient safety [ 50 ]. Interestingly, being a newly graduated nurse with less time having passed since obtaining the nursing certificate was associated with better adherence to the peripheral venous catheter-care principles, possibly due to having more informatics skills and updated knowledge of nursing care and following up of rules set by senior nurses [ 52 ]. Additionally, negative attitudes and perceptions toward the significance of care standards, individual aesthetic manicure preferences, and the presence of eczema and skin wounds hindered adherence to the surgical hand rubbing protocol, thus having negative implications for patient safety [ 49 ].

3.3.3. Task

In this category, the association between the identity and type of nursing task and adherence to patient-safety principles by nurses was considered. The lowest adherence rates were evident in ‘independent’ medicine management tasks such as dose calculation, rate of administering intravenous bolus drugs, and labelling of flush syringes. On the other hand, a higher rate of adherence was reported for ‘cooperative’ tasks with higher levels of complexity, such as the double-checking of drugs for the actual administration of medicine to the patient [ 53 ]. Similarly, a higher number of nurses working and collaborating together in the ward was associated with a higher rate of adherence to infection-control precautions, including putting sharp articles into appropriate boxes, covering both the mouth and nose, and disinfection of hands after glove removal [ 51 ].

3.3.4. Work Environment

The effect of equipment and the workplace condition on adherence to patient-safety principles was reported in this category. The availability of equipment and electronic resources and digitalization increased the likelihood of adherence to patient safety principles related to medicine management [ 53 ], peripheral venous catheter care [ 52 ], and cardiac monitoring and surveillance [ 50 ]. Accordingly, a telemetry cover on cardiac telemetry and monitoring units helped with the prevention of nosocomial infection by preventing contamination of shared equipment [ 50 ]. Electronic resources and digitalization helped with reminding the daily inspection and information-sharing between nurses regarding peripheral venous catheter insertion sites [ 52 ]. The existence of an environmental space for preparation of medicines without interruptions helped nurses adhere more closely to double-checking instructions of preparation and administration on weekends, as compared with weekdays [ 53 ].

3.3.5. Organisation and Management

This category focused on collaboration between nurses and the leadership role in motivating nurses’ adherence to patient-safety principles. As an example, adherence to the surgical hand rubbing principles, including properly drying hands after alcohol hand rubbing and washing with water and soap, and alcohol hand rubbing up to elbows, was improved after the provision of feedback by nurse leaders [ 49 ]. Regular practical feedback processes, interaction opportunities and observation of peers and senior colleagues, and leadership motivated nurses’ adherence to daily inspection of the peripheral venous catheter site and the use of disposable gloves when handling peripheral venous catheters insertion sites [ 52 ]. Adherence to patient-safety principles by cardiac nurses was improved through feedback provision and informing nurses in the ICU of the type of nursing interventions conducted in cases of serious dysrhythmias and their outcomes [ 50 ].

The provision of a standard process for handover, such as the introduction of a validated handover tool, improved nurses’ readiness to receive patients from the ICU. It informed the preparation of the required equipment for care, enabled performance of handovers at the patient bedside, and involved patients in their care, while also assisting with attending patients’ needs, checking patients’ identity, and collecting data of their medical history and allergies. Further, the standardising of the handover process helped with the continuity of care plan by formalising discussions between nurses and assisting with removal of any ambiguities, so increasing awareness of risks to patient safety [ 48 ]. The higher adherence rate to standard precautions for infection control were found when there was a higher nurse-to-patient ratio indicating the association between workload and patient-safety management [ 51 ]. Similarly, the development of a local practice standard for cardiac monitoring and surveillance, as well as for assessing the eligibility of patients for admission to critical and non-critical telemetry sections, would improve adherence to patient-safety principles for the cardiac patient [ 50 ].

4. Discussion

This systematic review integrated current international knowledge through the categorization of factors affecting adherence to patient-safety principles by nurses to the elements of the Vincent’s framework (1998 and 2010) for analysing risk and safety in clinical practice [ 27 , 47 ].

In this review, leaving patients’ companions unsupervised during medicines’ administration, performing handovers outside patients’ rooms, and lack of the provision of information and appropriate communication with patients hindered patient participation in their understandings of their own care. Lack of engagement of patients in safe-care initiatives contravenes nurses’ adherence to patient-safety principles. Benefiting from patients’ participation requires understanding of how to improve the patient’s willingness to act as an active member of the healthcare team, development of practical guidelines for such an engagement with the consideration of patients and their relatives’ knowledge and skills of the care process, as well as definition of the role and provision of supervision and guidance by nurses. The assigned participation task should be communicated appropriately to the patient, have congruity with patients’ knowledge of nursing routines and their own implementation capacity, as well as be incorporated into routine care with the consideration of infrastructures and healthcare missions [ 14 , 54 , 55 ]. It has been suggested that planning and performing nursing care at the patient’s bedside can improve patient participation, reduce work interruptions [ 56 ], and consequently improve nurses’ adherence to safe care guidelines [ 11 ].

The findings of this review highlighted that nurses’ knowledge, perceptions, and attitudes influenced their adherence to patient-safety principles. Nurses have multiple roles and central responsibility to keep patients safe in the complex healthcare environment [ 57 , 58 ]. The effect of personal and professional values and attitudes on the consistency of adherence to patient safety by nurses has been shown to be more important than the effect of their workloads [ 22 ]. It is believed that individual factors such as nurses’ attitudes, perceptions, knowledge, and information seeking can facilitate or hinder the use of clinical practice guidelines by nurses and consequently endanger patient safety [ 11 , 26 ] through inconsistent adherence to patient-safety principles [ 59 ].

It was evident that collaborative tasks fostered nurses’ adherence to patient-safety principles. Improving nurses’ knowledge of tasks improves nurses’ adherence [ 60 ]. Moreover, the coordinated management approach and collaboration with team members enhance the effectiveness of patient-safety interventions due to the creation of a shared understanding of changes that should be made by all healthcare staff to improve the quality of care [ 61 , 62 ].

With regard to the work environment, the findings of this review highlighted how equipment and electronic systems could assist with sharing information between healthcare providers and enhance adherence to patient-safety principles. One part of the healthcare system’s commitment to patient safety is the preparation of appropriate work equipment [ 63 , 64 ]. Technology can support data security and facilitate nursing care through the provision of real-time and ubiquitous documentation, which is needed for professional interactions and collaboration [ 65 ]. Digital systems can reduce the time needed to perform nursing care and limit errors in drug administration, as well as improve nurses’ and patients’ satisfaction with care [ 66 , 67 ].

An appropriate work environment was characterised as one where nurses were less interrupted, and lower workloads improved adherence to patient-safety principles. An appropriate work environment is associated with better patient safety and less burnout. Workload and burnout act as negative mediators of safe care [ 68 , 69 ]. A work environment characterised by a heavy workload and mental pressure [ 23 , 24 , 70 ] and frequent disruptions [ 71 ] has been implicated in reducing nurses’ adherence to safety-related principles. There is an association between patient safety and the nurses’ work environment [ 39 , 72 , 73 ] and implementation of patient-safety principles to prevent errors and adverse events [ 26 , 74 ].

The findings of this review emphasized the role of regular education and provision of feedback to nurses. Taking responsibility for actions and behaviours through education and feedback is a crucial aspect of professional practice [ 75 ]. The empowerment of nurses to intervene based on care standards is an expectation of healthcare leaders which can be achieved through the development of the culture of patient safety [ 33 , 76 , 77 , 78 ], the implementation of educational programs, and timely feedback and reminders [ 79 , 80 , 81 ]. Further, the use of standard processes, supported by validated tools, guided nurses and facilitated their adherence to patient-safety principles. Usability, format, easy access of the contents of guidelines, and consideration of time, staffing, chain of communication, accuracy of practice, supplies of equipment, and logistics are the main advantages of guidelines that facilitate the implementation of safe care [ 26 , 82 ].

Limitations and Suggestions for Future Studies

In spite of the emphasis on adherence to patient-safety principles and patient-care outcomes, this study has directly focused on nurses’ adherence to patient-safety principles, which can impact our understandings of the variation of factors influencing this important concept. However, the wide nature of the search in the electronic databases and in various languages convinced the researchers that the study topic has been addressed appropriately and an answer based on the current knowledge can be provided. However, the limited number of studies that met the inclusion criteria for this review hinders the full exploration of the relationship between individual and systemic factors that impact on nurses’ adherence to patient-safety principles in inpatient and outpatient settings.

5. Conclusions

This review has shown that adherence to patient-safety principles was affected by numerous intersecting and complex factors. Variations in the studies’ aims, methods, and results hinder the formation of a determinant conclusion on how adherence to patient-safety principles can be improved. However, based on the review results, general indications are that improvement of nurses’ knowledge about patient safety, collaboration in performing tasks, reduction of workloads, provision of appropriate equipment and electronic systems for communication and sharing information, regular feedback in the workplace, and standardization of the care processes can help with enhancing nurses’ adherence to patient-safety principles. Future qualitative and quantitative studies are needed to better understand how to promote and mitigate adherence to safe-care principles by clinical nurses.

Acknowledgments

Nord University, Bodø, Norway has supported the publication of this manuscript through coverage of publication charges.

Search strategy and results based on each database.

Database	Total in Each Database	Selection Based on Title Reading	Selection Based on Abstract Reading	Selection Based on Full-Text Reading/Appraisal
ProQuest	3169	0	0	0
CINAHL	4271	40	8	1
EBSCO	673	7	5	0
PubMed [including Medline]	33	27	20	1
PsycINFO	442	42	6	0
Scopus	1387	203	33	2
Web of Science	856	62	11	1

Oria	4	0	0	0
Idunn	0	0	0	0
Norart	0	0	0	0
Helsebiblioteket.no	1	0	0	0
Cristin	4	0
Finnish database—Medic	15	1	1	1
Manual search/backtracking references	0	0	0	0
	10855	382	84	6

Author Contributions

The authors contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript as follows; M.V., S.T., J.K., F.V.-M.: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software; M.V., S.T., J.K., F.V.-M., P.A.L.: Writing—original draft, Writing—review and editing. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors have no conflicts of interest to declare.

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Know the Facts and Get Your COVID Vaccine

DO NOT DELETE THE "EMPTY" SECTION CONTROL BELOW THIS. IT CONTAINS THE GHOST OF CLARA BARTON.

COVID-19 is a serious public health risk. Know the facts, get your vaccine, and help your loved ones get the vaccine.

Everyone ages 5 and up should get a COVID-19 vaccine.
Everyone ages 12 and up should get a booster shot.

Vaccines reduce your risk of severe illness and death from COVID-19. COVID-19 vaccines are safe, effective, and free.

As viruses spread, they change. Some variants emerge and persist. Reducing the spread of infection can slow the emergence of new variants. So get vaccinated, get your booster shot, and continue to wear masks in indoor public places.

(Para español, visite redcross.org/coronavirus-espanol )

Vaccines will protect you from severe illness and death from the Coronavirus and its variant.

Get your vaccine, why get a vaccine.

Get a vaccine to protect yourself, your loved ones and your community. Vaccines are effective at preventing severe illness and death from the coronavirus and the Delta variant. Get a vaccine booster shot as soon as it is recommended for you to increase your protection.

Vaccines are safe and effective. Medical experts carefully tested the vaccines among thousands of adults with diverse backgrounds.

Find a vaccine location near you

COVID-19 vaccines are free and available to anyone who wants one, regardless of their immigration or health insurance status.

There are three easy ways to find a nearby location where you can get the COVID-19 vaccine:

Search vaccines.gov ( vacunas.gov ).

Text your zip code to 438829 .

Call 1-800-232-0233 .

(TTY 888-720-7489)

Wear a mask in indoor public places.

Vaccines will protect you from severe illness and death. After you are fully vaccinated, wear a mask in indoor public places. You can still be infected and transmit the virus to others.
If you are not vaccinated, get your vaccine, and wear a mask in indoor public places.
Make sure your mask covers your nose and mouth and secure it under your chin.

Stay 6 feet away from others.

Inside your home : Avoid close contact with people who are sick.
Outside your home : Remember that some people without symptoms may spread the virus. Stay at least 6 feet (about two arm lengths) from other people.

Avoid crowds and poorly ventilated indoor spaces.

Avoid crowded places like restaurants, bars, fitness centers, or movie theaters.
Avoid indoor spaces that do not offer fresh air from the outdoors.
If indoors, bring in fresh air by opening windows and doors.

Wash your hands often.

Wash your hands often with soap and water for at least 20 seconds.
If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
Avoid touching your eyes, nose, and mouth with unwashed hands.

Monitor your health daily.

Be alert for symptoms: Watch for fever, cough, shortness of breath, or other symptoms of COVID-19.
Follow CDC guidance if you develop symptoms.

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Get accurate information

Know the facts about COVID-19 vaccines. Accurate vaccine information is critical and can help stop common myths and rumors.

Review these credible resources from the U.S. Centers for Disease Control and Prevention:

Your COVID-19 Vaccine

About COVID-19 Vaccines

Vaccines for COVID-19

Key Things to Know about COVID-19 Vaccines

Frequently Asked Questions about COVID-19 Vaccination

Myths and Facts about COVID-19 Vaccines

Vaccine Facts

How do vaccines work.

COVID-19 vaccines help our bodies develop immunity to the virus that causes COVID-19 without us having to get the illness. [ 4 ]

When we get a vaccine, it activates our immune response. This helps our bodies learn to fight off the virus without the danger of an actual infection. If we are exposed to the virus in the future, our immune system “remembers” how to fight it.

All COVID-19 vaccines, authorized by the U.S. Food and Drug Administration, provide significant protection against serious illness and hospitalization due to COVID-19. [5]

Again, it takes time for your body to build immunity after vaccination, so you won’t have full protection until 2 weeks after your final dose.

COVID vaccines will not give you COVID-19. [6]
COVID-19 vaccines do not contain live virus.
Getting vaccinated can help prevent serious illness and hospitalization with COVID-19. [7]
People who have gotten sick with COVID-19 may still benefit from getting vaccinated. [8]
COVID-19 vaccines will not cause you to test positive on COVID-19 viral tests. [9]
COVID-19 vaccines do not change or interact with your DNA in any way. [10]
There is currently no evidence that COVID-19 vaccination causes any problems with pregnancy, including the development of the placenta. In addition, there is no evidence that female or male fertility problems are a side effect of any vaccine, including COVID-19 vaccines.

What are the most common side effects?

After getting vaccinated, you might have some side effects, which are normal signs that your body is building protection. Common side effects are pain, redness and swelling in the arm where you received the shot, as well as tiredness, headache, muscle pain, chills, fever and nausea. These side effects could affect your ability to do daily activities, but they should go away in a few days. Learn more about what to expect after getting a COVID-19 vaccine.

Are COVID-19 vaccines safe?

COVID-19 vaccines are safe and effective. COVID-19 vaccines are being held to the same safety standards as other common vaccines. Several expert and independent groups evaluate the safety of vaccines being given to people in the United States. Medical experts carefully tested the vaccines among thousands of adults with diverse backgrounds.

How do I protect my child?

Help protect your whole family by getting yourself vaccinated as soon as you can.
Get your children vaccinated as soon as they're eligible.
Ensure everyone in your family wears a mask when they are indoors in public places.

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Download coronavirus safety tips.

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More Information

For the latest information, please visit:

The Center of Disease Control and Prevention (CDC)
World Health Organization

If you live outside the United States, health and safety tips can be found through the World Health Organization and by following your local Red Cross or Red Crescent society’s social media channels.

Directory for Red Cross and Red Crescent Societies

We are sorry for your loss. Our Virtual Family Assistance Center offers national, state and local information and resources that we hope will help you during this challenging time.

What to Know about COVID-19 and Blood Donation

The American Red Cross has an urgent and ongoing need for blood and platelet donations to prevent another blood shortage as hospitals resume surgical procedures and patient treatments that were temporarily paused in response to the COVID-19 pandemic. In recent weeks, hospital demand for blood products has significantly increased and patients are relying on the generosity of blood and platelet donors to help ensure hospital shelves are stocked.

The safety of our donors, volunteers and staff remains a top priority. Each Red Cross blood drive and donation center follows a high standard of safety and infection control. Learn more about our COVID-19 safety protocols here .

Donating blood products is essential to community health and the need for blood products is constant. The Red Cross urgently needs the help of donors and blood drive hosts to ensure blood products are readily available for patients. If you are feeling well, please make an appointment to give by using the Red Cross Blood Donor App, visiting RedCrossBlood.org or calling 1-800-RED CROSS.

Volunteer to Help Others

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Discover a new purpose by joining a lifesaving team to help support blood collections in your community. Two key volunteer opportunities are available:

As a Blood Donor Ambassador volunteer, you will engage donors by greeting, registering, answering questions, providing information, and supporting them through the recovery process at the refreshments table. The special attention you would provide helps create a favorable impression that encourages ongoing donor support.

As a Transportation Specialist volunteer, you will be the critical link between blood donors and blood recipients by delivering blood, platelets or other blood products to a hospital.

Click "Apply Now", then search for “Blood” or “Biomed” in the search bar to find positions.

*Note: Positions will vary based on location.

View other high priority volunteer positions »

Explore all volunteer opportunities »

Latest News About COVID-19

You can donate blood after getting a COVID-19 Vaccine

The Red Cross began working in early March to ensure the continued delivery of our lifesaving mission amid the many challenges presented by this coronavirus outbreak. This report provides an accounting of our activities during the first year under COVID-19.

Support all the urgent humanitarian needs of the American Red Cross.

Essay on Safety in School

Students are often asked to write an essay on Safety in School in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Safety in School

Importance of safety.

Safety in school is crucial. It ensures a secure environment for students to learn and grow.

Physical Safety

Physical safety includes maintaining a clean and hazard-free environment. Regular checks of school premises prevent accidents.

Emotional Safety

A supportive environment helps students express themselves without fear. It encourages positive interactions and respect.

Online Safety

With digital learning, online safety is vital. It includes protecting personal information and avoiding harmful content.

Role of Everyone

250 words essay on safety in school, introduction.

Safety in schools is paramount to foster an environment conducive to learning and development. Safeguarding the physical and emotional well-being of students is a collective responsibility involving educators, parents, and the students themselves.

Physical safety in schools involves ensuring that the premises are secure and free from hazards. This includes regular inspections of school buildings and facilities, implementing fire safety measures, and ensuring safe food handling practices. Moreover, schools should have an effective emergency response plan in place for situations such as natural disasters or violent incidents.

Emotional safety is equally important in cultivating a nurturing learning environment. This includes implementing policies against bullying and harassment, promoting inclusivity, and providing mental health support. Schools should foster a culture of respect and empathy, where students feel safe to express themselves without fear of judgement or ridicule.

Role of Technology

Advancements in technology can play a significant role in enhancing safety in schools. Surveillance systems, access control measures, and digital platforms for reporting concerns can help maintain a secure environment. Additionally, online platforms can provide resources for mental health support and promote positive interactions among students.

In conclusion, safety in schools is a multifaceted issue that requires ongoing attention and effort. It is essential to strike a balance between physical and emotional safety, and to leverage technology to enhance these efforts. By doing so, schools can ensure that they provide a safe and supportive environment where students can thrive.

500 Words Essay on Safety in School

The importance of safety in schools.

A safe learning environment is a fundamental right of every student. It directly impacts their academic performance, mental health, and overall well-being. A secure environment instills a sense of belonging, making students feel comfortable and confident in expressing themselves. It also encourages regular attendance, as students are more likely to engage in learning when they feel safe.

Physical safety in schools encompasses several aspects. Firstly, school buildings should adhere to safety standards to prevent accidents. Regular maintenance checks of infrastructure, including classrooms, laboratories, and playgrounds, are essential. Secondly, schools must have plans in place for emergencies like fires, natural disasters, or health crises. Regular drills can ensure students and staff are well-prepared for such situations. Lastly, schools should emphasize the importance of personal safety and hygiene, especially in the current context of the COVID-19 pandemic.

Emotional and Psychological Safety

The digital age has brought with it new safety concerns. With the increasing use of technology in education, online safety has become a critical issue. Schools need to educate students about responsible digital citizenship, including the risks of sharing personal information online, the potential for cyberbullying, and the importance of reporting inappropriate online behavior.

Role of Stakeholders

Ensuring safety in schools is a collective responsibility. Administrators need to establish clear safety protocols and invest in necessary infrastructure upgrades. Teachers play a critical role in creating a respectful classroom environment and implementing safety guidelines. Parents must reinforce these safety measures at home and keep open lines of communication with the school. Lastly, students themselves play a vital role in adhering to safety norms and reporting any breaches.

If you’re looking for more, here are essays on other interesting topics:

Apart from these, you can look at all the essays by clicking here .

Hand-washing

Hand-washing with soap and water for at least 20 seconds can help stop the spread of germs at home and in school. For kids and adults who tend to hurry, keep washing until you sing the entire "Happy Birthday" song twice, which takes about 20 seconds.

Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water aren't available.

Have your child cover the mouth and nose with an elbow or a tissue when coughing or sneezing. Then throw the tissue in the trash and wash the hands right away. Remind your child to avoid touching the eyes, nose and mouth.

Schools can make hand-washing easier by making sure all the supplies are ready for use.

Also, schools can build in time for kids and staff to wash hands. It's time well spent before eating, after going to the bathroom, or after coughing, sneezing or blowing the nose.

Wearing face masks

Face masks can protect you from breathing in germs. Face masks also can protect others from breathing in your germs if you're sick.

Wear a mask that covers your nose and mouth, fits your face without gaps, and is comfortable for you to wear all day.

When the germs that cause COVID-19 are spreading in your area, masks can lower the risk of infection. But some people may choose to wear masks at other times.

Schools can support masking in a few ways.

Teach students and staff about why people may choose to wear a face mask.
Accommodate people who can't wear masks due to a disability.
Provide access to clear masks that allow for lip reading.

Don't place a face mask on a child younger than age 2 or a person with a disability who can't safely wear a mask. It can be hard to find a mask that fits a child's face so be prepared to try more than one if needed.

Some masks may have instructions on how to make them fit without gaps. And you may need to teach your child how to put the mask on or take it off correctly.

When the COVID-19 virus spread is high

Getting a vaccine, having good airflow and following good hygiene habits such as washing hands are basic steps to protect from infection. Wearing a face mask also may be part of your typical response.

But other actions may be needed during an outbreak of COVID-19. If the level of illness in the community is high, other steps can help manage the risk of getting sick.

Schools and health agencies may communicate actions parents and caregivers can expect schools to take during this time.
Schools may ask parents to look for certain symptoms.
Schools may change the policy for when a person who is ill can come back to school. Some schools may test people who don't have symptoms to screen for COVID-19.
Schools may put teachers and kids into separate groups, called cohorting. That way even if people in one group get sick, those in other groups may not.
Schools may change where classes are held, focus on being outside or increase space between kids within the classroom.

What to do if your child has COVID-19

Your child's school likely has a policy about illness and school attendance, but in general, there are some symptoms that are best managed at home. This includes fever, vomiting and loose stools, also called diarrhea. People with these symptoms are likely able to spread whatever germ they have.

If your child has COVID-19, talk to your child's healthcare professional. Most children recover quickly without serious illness.

Also, contact the school. Make sure you understand the school's policy on when your child can return to school.

Once your child is feeling better, the policy for getting back in the classroom may be clarified by the school. But generally, people can get back to their daily activities if the following are true.

They haven't had a fever for 24 hours without taking medicine for fever.
Respiratory symptoms are getting better.
They can eat and drink without throwing up.
Stools are back to what are typical.

Preventing illness in schools

No one can avoid all germs, but there are ways to help lower the risk of illness.

Teaching good hygiene helps keep your child from missing school due to illness and helps keep your family safe from germs that could travel home.

Another option may be to get involved at your child's school. Learn about the school's policies on how to manage illnesses so you understand the risks and how to lessen them.

Information for pediatric healthcare providers. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html. Accessed June 13, 2024.
Stay up to date with your vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Accessed June 13, 2024.
Goldman L, et al., eds. COVID-19: Epidemiology, clinical manifestations, diagnosis, community prevention, and prognosis. In: Goldman-Cecil Medicine. 27th ed. Elsevier; 2024. https://www.clinicalkey.com. Accessed June 13, 2024.
Everyday actions for schools to prevent and control the spread of infections. Centers for Disease Control and Prevention. https://www.cdc.gov/orr/school-preparedness/infection-prevention/actions.html. Accessed June 13, 2024.
Taking steps for cleaner air for respiratory virus prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/respiratory-viruses/prevention/air-quality.html. Accessed June 13, 2024.
How to protect yourself and others. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed June 13, 2024.
About handwashing. Centers for Disease Control and Prevention. https://www.cdc.gov/clean-hands/about/. Accessed June 13, 2024.
Additional strategies that may be used to minimize infectious disease transmission in schools during times of elevated illness activity. Centers for Disease Control and Prevention. https://www.cdc.gov/orr/school-preparedness/infection-prevention/strategies.html. Accessed June 13, 2024.
Community respirators and masks. Centers for Disease Control and Prevention. https://www.cdc.gov/niosh/topics/publicppe/community-ppe.html. Accessed June 13, 2024.
When students or staff are sick. Centers for Disease Control and Prevention. https://www.cdc.gov/orr/school-preparedness/infection-prevention/when-sick.html. Accessed June 13, 2024.

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http://orcid.org/0000-0002-7341-0233 Abolfazl Etebarian Khorasgani 1 ,
Tahereh Najafi Ghezeljeh 2 ,
Hamid Sharif-Nia 3 , 4 ,
Mansoureh Ashghali Farahani 5 ,
http://orcid.org/0000-0002-2514-5543 Fateme Golestan 1 ,
Ferdos Saraipour 6
1 Student research committee , School of Nursing and Midwifery, Iran University of Medical Sciences , Tehran , Iran
2 Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences , Tehran , Iran
3 Department of Nursing , Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences , Sari , Iran
4 Psychosomatic Research Center, Mazandaran University of Medical Sciences , Sari , Iran
5 Nursing and Midwifery Care Research Center , Health Management Research Institute, Iran University of Medical Sciences , Tehran , Iran
6 Department of Medical Library and Information Science , School of Health Management and Information Science, Iran University of Medical Sciences , Tehran , Iran
Correspondence to Dr Tahereh Najafi Ghezeljeh; najafi.t{at}iums.ac.ir

Introduction Patient safety culture is a critical factor in improving the quality of home healthcare and preventing adverse events in patients receiving care in home health centres. However, the concept of patient safety culture in home healthcare centres is not clearly defined, and its dimensions and characteristics are still largely unknown. The aim of this scoping review is to provide a comprehensive overview of research on patient safety culture in home healthcare centres, identify related definitions and characteristics, and focus on key factors to fill the existing knowledge gaps.

Methods and analysis This review will follow Arksey and O’Malley’s methodological framework, updated by the Joanna Briggs Institute (JBI), which comprises five stages: identifying the research question, identifying relevant studies, selecting the studies, charting the data, and collating, summarising and reporting the results. The inclusion criteria will be based on the Population, Concept and Context framework. A comprehensive search of PubMed, Embase, Scopus, ProQuest, Web of Science, Cochrane and grey literature sources, with no date restrictions, was conducted with the assistance of a qualified research librarian to include all relevant published study designs and ensure a thorough understanding of the topic. The search will be continuously updated until the study is completed. In addition, we will review the reference lists of the final included studies and their citations to find further relevant studies. Studies that are duplicates and those not written in Persian or English will be excluded. The selection of studies based on the eligibility criteria will carried out by two independent reviewers who will perform a title/abstract screening followed by a full-text screening. Data extraction will be conducted using a standardised form from the JBI. Descriptive and content analyses will be conducted to identify key concepts in the literature reviewed.

Ethics and dissemination No ethical review is required for this study. Results will be submitted for publication in a peer-reviewed journal and presented at conferences.

Protocols & guidelines
Health & safety
Primary Health Care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2023-082604

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STRENGTHS AND LIMITATIONS OF THIS STUDY

A systematic search of databases and grey literature sources will identify all available evidence.

We will apply the PRISMA-ScR reporting guidelines to ensure a rigorous approach.

Exclusion of studies reported in languages other than English or Persian may result in important resources being overlooked.

Introduction

Home healthcare has become an important aspect of healthcare that aims to provide patients with the services and support they need. This idea is based on the realisation that the home environment can promote healing, independence and overall well-being for patients. 1 2 Given the limited healthcare resources and inadequate hospital capacity faced by many countries around the world, particularly in developing regions, home healthcare can be a valuable solution to meet various care needs. 2 3

While the home environment can offer benefits for patient recovery and quality of life, the delivery of healthcare services outside of the traditional hospital setting also poses particular challenges for ensuring patient safety. 2 A key factor that can significantly contribute to patient safety in home care settings is the establishment of a strong safety culture, which has been shown to significantly improve patient outcomes, staff performance and organisational effectiveness. 4 Safety culture is a multifaceted concept that encompasses a range of attitudes, practices and organisational values that together help to prevent incidents and promote patient well-being. 5 Organisational culture encompasses shared values, beliefs, norms, and practices that shape behaviours and attitudes. 6 Meanwhile, the safety climate captures the current perception of safety, which is influenced by the organisation’s policies and practices. 6 7 Understanding these differences is critical in healthcare to promote a safe work environment.

In the changing healthcare landscape, the concept of a patient safety culture in home healthcare centres is not clearly defined, and is difficult to understand. This lack of clarity presents a major challenge to improving the quality of home care, where the intimate and informal nature of home care intersects with the stringent requirements of medical safety standards.

Home healthcare, with its personalised and decentralised approach, requires a more nuanced understanding of safety culture to address the unique dynamics of non-clinical care settings. The impetus for this research comes from the potential to transform home healthcare from an alternative option to a preferred choice based on a foundation of trust and safety.

To address this gap, we aim to conduct a scoping review to summarise the existing literature on patient safety culture in home care centres. The completion of a scoping review protocol is an essential requirement before the commencement of a review. 8 The protocol is a unique manuscript that describes the aims, methodology and search strategy of the study. It must be finalised to ensure that the review is conducted systematically and efficiently. 9 It is therefore essential that the scoping review protocol is written carefully and comprehensively to ensure success of the review. The aim of this scoping review is to clarify the concept of patient safety culture in home healthcare centres and to identify existing gaps in the current understanding and literature on this topic. The findings of this scoping review will form a basis for future research and contribute to the development of policies and strategies to improve patient safety culture in home healthcare centres.

Methods and analysis

A scoping review approach was chosen due to the broad nature of the research question in this study. This scoping review will be conducted according to the latest updated methodological guidelines of the Joanna Briggs Institute (JBI), 10 building on the work of Tricco et al , in five stages:

Stage 1: Identify the research question

Stage 2: Identify relevant studies

Stage 3: Study selection

Stage 4: Chart data

Stage 5: Collate, summarise and report the results.

The study reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. 11

The research question is the starting point for any review and creates search strategies and roadmaps for subsequent steps, although research questions originally designed for scoping reviews are usually refined during the process of iterative development before finalisation. 10 12 This review attempts to answer the following question:

What are the definitions, dimensions, nature and characteristics of patient safety culture in the home healthcare centre?

Stage 2: Identifying relevant studies

Inclusion criteria.

The inclusion criteria for the scoping review will follow the Population, Concept and Context (PCC) framework recommended by the JBI for this type of study. 10 The PCC framework is preferred to the traditional 'population, intervention, comparison, and outcome' model for systematic reviews because it does not focus on compiling evidence for a particular intervention. 13

Populations

Healthcare providers in the home contexts, including management, clinical and non-clinical staff.

Patients who have received healthcare services in the home contexts, regardless of demographic characteristics.

Family caregivers, also known as home healthcare provider associates.

This review will consider all the papers and documents that focus on patient safety culture, safety climate or organisational culture.

The organisation and management of home care centres play a critical role in the culture of patient safety. It is important to examine the structure, management and leadership of these centres to fully grasp this concept. For this reason, in addition to the home care context, the home care centres that organise care should also be considered. This review will consider studies including home care context and home healthcare centres.

Types of sources

Given that patient safety culture in home healthcare centres is a concept that has been studied to a limited extent, we will include all the published studies and grey literature, regardless of publication date, to ensure that we have a comprehensive understanding of the topic. In our review, we will consider all relevant study designs, including qualitative, quantitative and mixed methods, and we will also include systematic reviews that meet our inclusion criteria. In addition, we will also consider grey literature, such as text and opinion papers, editorials, and ethical or reflective articles so that we do not miss out on valuable insights.

Exclusion criteria

All studies that are duplicates or published in languages other than Persian and English will be excluded. In addition, the authors of articles that were selected during screening and whose full text is not available will be contacted three times by email, and if they do not respond, they will be excluded from the study.

Search strategy

The search strategy followed the three-phase search process recommended by the JBI. 10 It was developed in an iterative process under the guidance of an experienced health sciences librarian and validated by a second librarian using the Peer Review of Electronic Search Strategy checklist. 14 In the first phase, an initial search was conducted in two electronic databases (PubMed and Scopus) that matched the research title. In the initial search, the titles and abstracts of the identified articles and the index terms used to describe the articles were reviewed. For the search strategy, we used medical terms and native language terms. In the second phase, we conducted a comprehensive search of PubMed, Embase, Scopus, ProQuest, Web of Science, Cochrane and grey literature sources without date range restriction on 18 May 2023, with the help of a qualified research librarian to include all relevant published study designs and ensure a thorough understanding of the topic ( online supplemental appendix 1 ). The results of this initial search are presented in online supplemental appendix 1 , but the search process will be continuously updated until the end of the study. In the third phase, we expanded our search strategy by examining the websites of prominent patient safety and quality improvement organisations, such as The Institute for Healthcare Improvement, The National Patient Safety Foundation, Patient Safety and Quality Healthcare, The Patient Safety Movement Foundation, and The National Institute for Health and Care Excellence in the relevant field. Our approach was to use primary keywords supplemented by manual searches (browsing) to ensure comprehensive coverage. It is important to emphasise that all materials identified through these additional searches were subject to careful review. However, despite our diligent efforts, we were unable to find additional relevant information that had not already been captured through our electronic database searches. Finally, we will review the reference lists of the final included studies and their citations to find additional relevant studies. Details of how many studies were identified can be found in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flow chart ( online supplemental appendix 2 ).

Supplemental material

After searching databases, using EndNote V.X7 software, the search results are uploaded and duplicate articles are removed. First, a pilot screening process based on the inclusion criteria will be performed separately by two reviewers (AEK and FS) to revise the criteria if necessary. In this pilot screening process, a sample of 25 titles/abstracts will be screened based on their titles and abstracts and marked as ‘included’, ‘excluded’ or ‘uncertain’ by two reviewers. Any inconsistencies identified in the eligibility criteria and/or selection process will be reviewed by the reviewers. If the agreement rate in the team reaches 75% or more, the selection of articles can continue. If two people fail to reach an agreement, a third person must arbitrate (TN). 14 Researchers can contact the authors of the primary studies or reviews for further information and clarification if necessary. 10 11 14 After conducting the pilot process, we will select articles in a two-step process. The first step involves preliminary screening of articles based on their titles and abstracts. Subsequently, the full texts of the identified articles will be screened independently by two reviewers (AEK and FS). Based on the review’s questions and the aims of the study, the studies will be included or excluded according to the eligibility criteria. Articles will be excluded if they do not fulfil at least one criterion or if the full text is not available. The reasons will be documented for each article. Disagreements about inclusion or exclusion will be resolved by consensus or, if necessary, by consulting a third team member (TN).

Stage 4: Charting the data

Charting of the data is an essential step in the scoping review process as it enables a detailed analysis of the selected studies. This process involves extracting specific details relating to the title, authors, journal, publication date, sample size, study objectives, population, content, context, study approach, methodology, key findings and other relevant data in relation to the research questions of the included studies ( online supplemental appendix 3 ). This information will then be organised and categorised to identify the key themes and questions arising from the data. The extracted data will be entered into a data extraction tool, such as Microsoft Excel table V.2013, to facilitate analysis and synthesis. To refine the data-charting form and ensure that all relevant information is correctly extracted from the included studies, a pilot test of two or three studies will first be conducted by two independent reviewers (AEK and FG) in an iterative process in which they will continually update the data-charting form. The extracted data will undergo careful quality check to resolve any discrepancies or inconsistencies between the two independent reviewers. A third reviewer (TN) will review any studies where the two independent reviewers identify a discrepancy that they cannot resolve. The authors of the papers will be contacted to request missing or additional data if necessary.

Stage 5: Collating, summarising and reporting the results

The results of the charting process will be thoroughly analysed and synthesised by our team of experts. We will then present the collected and summarised results in an organised format that includes tables, charts and a narrative summary report. The report will cover the following aspects: (1) Descriptive analysis: In this section, we will provide an overview of the existing data and present the distribution of studies based on their publication dates and countries of origin. (2) Content analysis: Here we will outline the theoretical and methodological approaches of the studies in relation to the research question and objectives. The research team will ensure that the findings are clear and concise and ambiguities are avoided for better understanding. This method will add to the existing knowledge of the research question and provide new insights into the topic. In addition, the team will confirm that the results are in line with the objectives of the study and provide valuable information to stakeholders for decision-making.

Patient and public involvement

Ethics and dissemination.

No ethics approval is required for this scoping review. The results will be disseminated through scientific publications and presentations at relevant conferences.

Ethics statements

Patient consent for publication.

Not applicable.

Prusynski RA ,
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Contributors AEK conceived the study, developed the research questions, drafted the manuscript and approved the final manuscript. TNG contributed meaningfully to the design, drafting and editing and approved the final manuscript. HS-N, MAF, FS and FG supported the design of the study, critically reviewed drafts, edited the manuscript and approved the final manuscript. TNG guarantees and takes full responsibility for the overall content as guarantor.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Reopening Schools in the Context of COVID-19: Health and Safety Guidelines From Other Countries

As the United States considers reopening schools after the first wave of the COVID-19 pandemic, policymakers and administrators need to consider how to reopen in a way that keeps students and staff safe. This brief provides insight into health and safety guidelines and social distancing strategies used in other countries that have successfully reopened their schools in the context of COVID-19. Examples are intended to support school policymakers and administrators in the United States as they plan for reopening.

Introduction

Schools across the United States canceled in-person classes beginning in March 2020 to contain the spread of the COVID-19 virus. In many states and districts, school buildings are closed for the duration of the school year. Across the country, policymakers and school leaders are making plans to reopen schools for the next academic year, and some are preparing to do so sooner. In order to reopen schools safely and mitigate disease spread, state and district leaders will need to address several important health considerations.

This brief compiles preliminary information on health and safety guidelines from five countries that have continued or reopened schools during the COVID-19 outbreak: China, Denmark, Norway, Singapore, and Taiwan. (See “Selected Countries With Open Schools.”)

Each of these countries has been successful, to date, in avoiding spread of COVID-19 in schools. Countries that have reopened differ significantly from the experiences so far in the United States, however, in terms of the extent of their testing and tracking of cases. The capacity to test and track cases, and to isolate individuals who have been exposed to infection, is related to the success of these strategies.* As states plan to reopen schools, they should thus do so in close coordination with their state and/or local health authorities.

The brief focuses on guidelines in three areas: attendance, social distancing, and hygiene and cleaning. Information was gathered from health and safety guidance documents from each country’s Ministry of Education (as of May 3) as well as media and journal articles. Where no citation is given, evidence comes from the list of References on pp. 11–12 .

*The Learning Policy Institute has not investigated the health implications of using any of these practices in the United States and does not endorse the safety or effectiveness of these practices or of any medical practices.

Selected Countries With Open Schools, March/April 2020

China , where the COVID-19 pandemic originated, closed most schools in January 2020 for the Chinese New Year holidays and began the first reopening of schools in regions where two criteria could be met: Schools could implement standard safety precautions and officials determined the risk to be low. Most regions had reopened by the end of March, often starting with students in their final year of middle and high school to support preparation for high school and college entrance exams. Xinhua News Agency. (2020, April 26). China endeavors to ensure safe classes resumption amid COVID-19 . XinhuaNet . (accessed 05/11/20); Normile, D. (2020, March 29). Can China return to normalcy while keeping the coronavirus in check? Science ; Xinhua News Agency. (2020, April 23). 广州: 确保校园防疫安全迎接学生返校复课 [Guangzhou takes precautions to welcome students back to school] . XinhuaNet . (accessed 05/08/20).
Denmark was the first European country to restart school after closure, allowing municipalities to reopen schools as early as April 15. In the first phase of reopening, only children under age 12 returned to school, while older children continued distance learning at home. Younger children came back to school first because they were viewed as facing lower health risks, benefiting less from distance learning, and needing greater supervision from working families.
Norway allowed daycare and preschools to open on April 20 and Grades 1–4 (ages 6–11) on April 27 in regions with low infection rates. Grades 5–10 continued remote education.
Singapore’s schools remained open as COVID-19 spread, finally closing as students switched to home-based learning on April 8 in tandem with the country’s partial shutdown with “Circuit Breaker” measures. At that time, the government announced that schools would close until the first week of May. They appear not to have been a source of transmission of the disease, with just eight known infections of school-age children, none of which were school-related. Low, E. L., & Tam, C. P. (2020, April). Singapore’s education efforts against the global pandemic (before Circuit Breaker on 8 April 2020) [Memo]. Compiled from published media including The Straits Times , Channel News Asia , and the Singapore Ministry of Education’s official Facebook page. Personal email with Linda Darling-Hammond, President and CEO of the Learning Policy Institute (2020, April 24).
Taiwan has been recognized to have effectively minimized spread of COVID-19 with national policies that avoided widespread planned school closures, applying the same strategy it used during the 2009 H1N1 influenza pandemic. Instead of a national shutdown, Taiwan mandated temporary, local class or school closures based on local infection rates in conjunction with in-school health and safety measures.

Note: This list does not include all countries with schools open in March and April 2020. These countries were chosen because they documented the strategies they used related to the three areas of interest in this report—attendance, social distancing, and hygiene and cleaning. Where applicable, we also refer to guidance in countries that plan to reopen soon, such as Austria and South Korea.

Reopening Schools COVID 19 Summary Health Safety Practices TABLE 2250x1525b

Attendance and Health Screening

An important step to supporting safety in schools is allowing at-risk students and staff to stay home and ensuring that all suspected or confirmed cases of COVID-19 are immediately quarantined. It is thus important for schools to provide ongoing distance learning and continuity plans to support students and staff who are in and out of school for health reasons. It is also likely that schools may need to be prepared for distance learning in situations in which schools need to close temporarily to prevent further spread of the virus.

Attendance Policy

The decision to return to school in the countries studied here was generally made when local infection rates had slowed significantly and other parts of the economy were being reopened. In some cases the decision to reopen schools was informed by multiple stakeholders. In Denmark, for example, the Ministry of Education made the choice to reopen in consultation with teacher and student unions. In South Korea, the Ministry surveyed families and teachers to solicit input about reopening schools. Korean Ministry of Education (2020, May 5). 유·초·중·고·특수학교 등교수업 방안 발표 [Announcement of teaching plans for elementary, middle, high, and special schools] [Press release].

Given the health risks, however, on-site school attendance has generally been voluntary for all students in the first wave of reopening. Denmark and Norway, for example, have made on-site student attendance optional for the 2020–21 school year, and school employees over the age of 60 and those with designated health risks have been given the option to contribute to school operations from home. By Denmark’s second week of reopening school, 80–90% of primary school students and half of children in preschool and kindergarten had returned to school. Denmark has adjusted staffing to accommodate the small number of employees who stayed home for medical reasons, but officials say that schools are operating at capacity and cannot yet accommodate all students.

Health Screening and Quarantine Procedures

Screening : Health screening occurs daily for students and staff in schools that have reopened. Health and safety guidelines include temperature checks and reporting symptoms upon arrival, before entering the building. China and Singapore advise at least two temperature checks daily, a practice used in Singapore in 2003 during the SARS outbreak. In Singapore, students take their own temperatures, and families must additionally report any international travel to teachers before a student enters the building. Research conducted in Singapore during the SARS outbreak indicates that mandatory, twice-daily temperature monitoring did not identify children with a fever but may have had a positive psychological effect in reassuring parents that their children were safe. Chng, S. Y., Chia, F., Leong, K. K., Kwang, Y. P., Ma, S., Lee, B. W., Vaithinathan, R., & Tan, C. C. (2004). Mandatory temperature monitoring in schools during SARS. Archives of Disease in Childhood, 89 , 738–739. Some countries require that staff wear protective gear when taking students’ temperature, such as masks and gloves, and clean thermometers after each use. In Taiwan and some parts of China, these materials are provided by the government.

Reopening Schools COVID 19 SINGAPORE 594x396

Students in Singapore undergo temperature checks at the gate before entering school. (Photo by Suhaimi Abdullah/Getty Images.)

Quarantine : Students and staff are immediately sent home if they exhibit any symptoms of the virus or if they report having been in contact with someone who is infected. (In Singapore, contact with infected individuals is also tracked by the voluntary use of a phone app. Baharudin, H. (2020, April 10). Coronavirus: S’pore contact tracing app now open-sourced, 1 in 5 here have downloaded . The Straits Times . ) If symptoms are identified upon arrival, the individual must wait in a designated room until picked up. Quarantine procedures vary by country. In Denmark, children who come to school with symptoms are sent home immediately for 48 hours, and students who live with someone known to be infected with COVID-19 are not allowed to come to school. Norway allows students to return to school after they are symptom-free for 1 day, and students with a cold or pollen allergies are specifically allowed to attend school if they do not have a fever. In China, students who have had contact with someone with COVID-19 must self-quarantine for 14 days before returning to school; students who have symptoms themselves must be taken to a hospital for evaluation and may return to school after they recover.

School Closure

Administrators must develop contingency plans for closing classrooms or schools in the event that students or staff contract COVID-19. Taiwan, for example, follows procedures, called classroom suspension, that it used during the H1N1 influenza outbreak. If one or more students or staff persons in a class is confirmed to have COVID-19, that class is suspended for 14 days; in high school this applies to all classes the person attended. If two or more cases are confirmed in a school, the school is closed for 14 days. If one third of schools in a city or district are closed, then all schools must close.

Questions for State and District Policymakers:

What should expectations be for virtual and in-person student and staff attendance?
How will schools efficiently and effectively conduct health screenings?
What quarantine procedures should be required?
What criteria should schools use to determine if closure is warranted?
How will school policies be effectively communicated to students and families?

Social Distancing

Studies of previous influenza outbreaks show that schools can safely prevent the spread of disease in some contexts if measures are put into place to support social distancing. Viner, R. M., Russell, S. J., Croker, H., Packer, J., Ward, J., Stansfield, C., Mytton, O., Boell, C., & Booy, R. (2020). School closure and management practices during coronavirus outbreaks including COVID-19: A rapid systematic review. The Lancet Child & Adolescent Health, 4 (5), 397–404; Ridenhour, B. J., Braun, A., Teyrasse, T., & Goldsman, D. (2011). Controlling the spread of disease in schools. PLoS ONE, 6 (12), 16–18; Lofgren, E. T., Rogers, J., Senese, M., & Fefferman, N. H. (2008). Pandemic preparedness strategies for school systems: Is closure really the only way? Annales Zoologici Fennici, 45 (5), 449–458. Social distancing has two main components, as identified by the U.S. Centers for Disease Control and Prevention and the World Health Organization: keeping individuals at a safe distance from one another (3 to 6 feet) and reducing the number of people with whom an individual interacts face-to-face. Countries are taking various approaches to accomplish social distancing in schools, including reducing class size, keeping students in a stable homeroom class, seating students farther apart with assigned seats, canceling large-scale gatherings such as assemblies and sporting events, and using staggered school schedules so that fewer students attend school at the same time or are congregated in common areas at one time.

Social Distancing in Classrooms

Denmark’s guidance requires students to maintain 2 meters (6 feet) of separation in class and recommends that classes be divided into one or more stable groups. In practice, this has meant reducing group size to 10 or 11 students. Staff are limited to working with one or two classes, and support staff help teachers cover the split classes. In addition to using primary school classrooms, schools are using outside areas, gyms, and secondary school classrooms because, at the time of this writing, older children had not yet returned to school. Kingsley, P. (2020, April 17). In Denmark, the rarest of sights: Classrooms full of students . New York Times ; Hunter, M., & Jaber, Z. (2020, April 26). Touch a shadow, ‘You’re it!’: New routines as Denmark returns to school after coronavirus lockdown . NBC News . When older students return to face-to-face classes, they will stay in their homeroom classes while teachers rotate in and out, with the exception of biology and chemistry classes, which will continue to take place in lab rooms.

Norway’s guidance is similar to Denmark’s, limiting class size to 15 students per class in primary school and 20 students in middle school. It furthermore allows two staff members to work together to teach a split class. Guidance makes clear that social distancing may be difficult with young children and that, while distance should be maintained as much as possible, “comfort and contact for the smallest children in child care should be maintained.”

Taiwan, in contrast, has not set maximum class sizes. Schools keep students in a homeroom class with a core teacher, while subject-specific teachers move between classes. Studies suggest that, during the H1N1 outbreak, this approach to social distancing, combined with Taiwan’s classroom suspension procedures described above, contained the spread of disease and reduced social disruption. Yen, M. Y., Chiu, A. W., Schwartz, J., King, C.-C., Lin, Y. E., Chang, S.-C., Armstrong, D., & Hsueh, P.-R. (2014). From SARS in 2003 to H1N1 in 2009: Lessons learned from Taiwan in preparation for the next pandemic. Journal of Hospital Infections, 87 (4), 185–193. In addition to maintaining stable homerooms, students as young as kindergarten wear masks supplied by the government, and desks are separated from one another, sometimes using dividers.

In Singapore, usual class sizes were maintained at about 30 students, but classrooms tended to be large already, allowing for students to be spaced 1–2 meters (3–6 feet) apart. In kindergarten through Grade 2, children sit together in stable clusters. In Grades 3 and up, children have assigned seats in rows set up as if they are taking examinations, and they may not move around. Peng, T. C., & Ling, L. E. (2020, April). Singapore’s education efforts against the global pandemic (before Circuit Breaker on 8 April 2020) [Memo]. Compiled from published media including The Straits Times , Channel News Asia , and the Singapore Ministry of Education’s official Facebook page. Personal email with Linda Darling-Hammond, President and CEO of the Learning Policy Institute (2020, April 24). Similar measures are being taken in China, although practices vary locally. Some schools have reduced class size from an average of 50 students to fewer than 30. Xiao, Z., Leijing, H., & Qun, Z. (2020, March 30). Xinhua Headlines: Schools begin to reopen in China amid strict measures . XinhuaNet . (accessed 04/27/20); Shuo, Z. (2020, April 28). Classes to resume for Wuhan students in May . China Daily . (accessed 05/08/20).

Austria, which at the time of this writing planned to reopen its primary schools on May 18, recommends that schools stagger student attendance to allow sufficient space for social distancing. Federal guidance offers sample schedules; for example, schools may send one group of students to school on Monday to Wednesday one week but on Thursday to Friday the following week. Schools are required to send schedules to families weeks in advance so that they can plan accordingly. Hong Kong, alternatively, will offer only half-day classes to facilitate schools’ cleaning of their premises. The week before Singapore schools closed on April 8, schools had 1 day a week of home-based learning, with grade levels assigned different days of the week to reduce school traffic.

Should all students return at the same time, or should start dates vary by students’ grade level or specific needs?
Should in-school learning be blended with distance learning to reduce school traffic?
What is a feasible yet safe physical distancing expectation?
Might classroom spacing or group size vary by age?
What school spaces are available to be repurposed as classrooms? Are there nearby community facilities that might be used for classrooms as well?
What staff might be available to teach or monitor small groups?
Might teachers rotate from class to class to avoid students congregating in hallways during passing time?

Social Distancing Outside of Class

Schools will need to consider how to keep students and staff at a safe distance from one another outside of class, particularly during arrival and dismissal, mealtimes, recess, and class changes.

Reopening Schools COVID 19 DENMARK 594x396

Parents and children stand in a queue to get inside Stengaard School north of Copenhagen, Denmark. (Photo by Ólafur Steinar Gestsson / Ritzau Scanpix / AFP) / Denmark OUT (Photo by OLAFUR STEINAR GESTSSON/Ritzau Scanpix/AFP via Getty Images.)

Arrival : Where possible, schools are generally encouraged to stagger their start and end times and to have designated routes to class with multiple entrances to avoid having students and families congregate. Family members and visitors are not allowed on the school premises, except when needed in younger grades. In Norway, a letter was sent home before school start to explain these procedures. In Denmark, arrivals and departures are sometimes staggered by grade, so the children come into school single file, with markings on the ground to show where students should wait as they enter. In Austria, China, and Taiwan, students and teachers are required to wear face masks and wash their hands as they enter the building. (In Austria, masks may be taken off in class.) Before schools reopened, local officials in some areas of China required staff to run simulations and drills before students returned to ensure an orderly flow of traffic. Xiao, Z., Leijing, H., & Qun, Z. (2020, March 30). Xinhua Headlines: Schools begin to reopen in China amid strict measures . XinhuaNet . (accessed 04/27/20).

Mealtimes : Guidance generally recommends handwashing before and after meals; encourages students to be spaced well apart and stay with homeroom groups; and sets standards for handling food and utensils and cleaning tables. Shared food and buffet-style meals are not allowed. Typically, students eat at their desks. In Taiwan and China, some schools use dividers to reduce germ transmission, as lunch is the one time each day students take off their masks. Penna, D. (2020, April 20). As coronavirus lockdowns ease, this is how other countries are gradually reopening schools . The Telegraph . Some of China’s schools split students up at lunchtime so that some students use the cafeteria with assigned seating that is partitioned or spaced apart, while others eat in their classrooms; cookware, utensils, and towels must be sterilized after each use. Singapore also assigns seating in the cafeteria to be able to trace individuals’ contacts. As part of Singapore’s voluntary tracking system, individuals are notified when they have been in contact with someone who has contracted COVID-19. Baharudin, H. (2020, April 10). Coronavirus: S’pore contact tracing app now open-sourced, 1 in 5 here have downloaded . The Straits Times . Norway discourages use of the cafeteria but suggests that, when used, only one homeroom group enter at a time.

Recreation : Indoor and inter-school sports activities have generally been suspended, while outdoor playtime is allowed in small, supervised groups. Taiwan has suspended all sports and physical education; in China, physical education continues in some schools based on local decision-making. Lin, W. (2020, May 5). Student death stirs controversy over face mask rule in PE classes . Global Times . Denmark and Norway recommend that schools use outdoor spaces as much as possible, including for gym class. They encourage play in homeroom groups divided into smaller groups—for example five children in one area—with increased adult supervision to ensure that students do not touch one another. Singapore staggered timing for recess for different groups, a practice recommended in other countries as well.

Transportation : Several countries’ guidance discourages the use of public transportation, although all recognize it may be necessary and suggest the use of masks and frequent cleaning. School buses are allowed in China, Denmark, and Norway, but schools are encouraged to use buses at half capacity (e.g., only one student in a row designed for two), and in Norway, students are encouraged to take their own transportation to school when possible. In Jiangxi, China, some schools created new bus routes to accommodate the change in ridership and to reduce the need for students to take public transportation. People’s Daily. (2020, April 26). 全国各地中小学陆续复课 [Primary and secondary schools gradually resume classes] . (accessed 05/08/20). Taiwan is still running school buses and public transit as usual but requires cleaning and disinfection of seats, armrests, and grab handles at least once every 8 hours, including before and after shifts of students are transported. Taiwan Centers for Disease Control. (2020, February 19). Government agencies working in unison to ensure proper cleaning and disinfection procedures for the upcoming school semester [Press release]. (accessed 05/05/20).

How might traffic be reduced in common spaces? Are staggered start, end, and passing times feasible?
Where should students eat so that they are not congregated in large groups, and how should school meals be distributed?
How should playground use be scheduled to reduce contact between groups?
How will students get to and from school, and how might this affect scheduling?

Hygiene and Cleaning

Countries have taken common approaches to handwashing, which are consistent with the U.S. Centers for Disease Control and Prevention’s recommendations for frequent handwashing and cleaning of commonly touched surfaces to mitigate the virus. Countries’ guidance on cleaning products and procedures vary, however; states should consult federal and state guidance on the use of disinfectants and allowable chemical use in schools.

Reopening Schools COVID 19 CHINA 594x396

Students study in a classroom with transparent dividers placed on each desk to separate each other as a precautionary measure against the spread of COVID-19 at Wuhan No. 23 Middle School. (Photo by Getty Images.)

Masks : In China, masks are required at all times for teachers, as well as for students as young as age 3, and in Taiwan they are required whenever a distance of 2 meters (6 feet) cannot be maintained. The government provides students and staff with free masks to wear at school. Xinhua News Agency. (2020, March 17). Millions of students back to school as coronavirus retreats in China . XinhuaNet . (accessed 05/05/20); Taiwan Centers for Disease Control. (2020, February 17). Starting February 20, children to be allowed for 4 masks every week due to increased mask production and start of new semester [Press release]. Denmark and Norway, on the other hand, do not require students to wear masks. Austria will require masks when students enter and move about the building, but not during class.

Handwashing : Frequent handwashing is recommended in all countries, sometimes as often as every 2 hours. Denmark and Norway have created posters and videos to support schools’ teaching of healthy habits, and guidance requires school employees to receive training on hygiene standards. In Singapore, the Ministry of Education also launched cartoon heroes known as the Soaper 5 to remind students to practice good personal hygiene. Denmark’s guidance allows for the use of wipes and hand sanitizer with 70–85% rubbing alcohol in the case that water is not accessible. When South Korea reopens its schools, it will require that students participate in online classes related to personal hygiene and health and safety measures the week before they return to school. Korean Ministry of Education. (2020, May 5). 유·초·중·고·특수학교 등교수업 방안 발표 [Announcement of teaching plans for elementary, middle, high, and special schools] [Press release].

Areas and materials to clean : Cleaning is frequent, especially in common spaces. In Taiwan, for example, the Central Epidemic Command Center provided guidance for the cleaning and disinfecting of schools and school buses before students returned from their February break, and schools were reminded to institute appropriate cleaning and disinfecting procedures once school resumed. Taiwan Centers for Disease Control. (2020, February 19). Government agencies working in unison to ensure proper cleaning and disinfection procedures for the upcoming school semester [Press release]. (accessed 05/05/20). Schools in all countries are encouraged to wipe down high-touch areas, such as doorknobs and desks, every 2 hours. In Norway and Singapore, students wipe their own desks. Windows and doors are left open as much as possible to maintain ventilation. In Norway, toilets and sinks are expected to be cleaned 2–4 times a day, and tablets and computers must be wiped after each use.

Shared materials : Shared materials are discouraged, but when used they must be cleaned before being used by other groups of students. Denmark specifies that toys must be washed twice daily, and those that cannot be cleaned easily should not be used. Computers or tablets, when needed, should be shared by only a few students. In Norway, library books may be used if students wash their hands first, but other countries have closed libraries.

Cleaning products : Guidelines in China, Denmark, Norway, and Taiwan all recommend careful cleaning with soap and water or disinfectant at least once daily and outline proper waste disposal and removal. In most cases, government entities provide schools with cleaning supplies. Recommended cleaning products vary by country. China’s guidelines, like South Korea’s, recommend wiping or spraying chlorine dioxide concentrations of 500 mg/L on furniture, door frames, doorknobs, sinks, and floors; surfaces should be precleaned with water, and water should be used after 30 minutes to remove disinfectant. This practice, which is not recommended by all countries, may be related to the chemical concentration of the cleaning products recommended. In Norway, guidance requires the use of water and ordinary detergents, but it does not require the routine use of disinfectant or protective gear when cleaning most areas.

What areas and equipment need to be cleaned, by whom, and how often?
What cleaning supplies will be used, and what should standards be for their use?
Should students and staff be required to wear masks, and if so, when?
How often will students and staff be expected to wash or sanitize hands, and how will this be handled?
Will more sinks need to be installed for handwashing, or will hand sanitizer be available?

Research suggests that social distancing techniques, along with careful hygiene, cleaning, and use of quarantine, can reduce the spread of disease in schools. The international examples described in this brief provide insight into how these strategies can be put into operation in various contexts to protect the health and safety of students, staff, and families.

See reference list.

Reopening Schools in the Context of COVID-19: Health and Safety Guidelines From Other Countries by Hanna Melnick and Linda Darling-Hammond, with the assistance of Melanie Leung, Cathy Yun, Abby Schachner, Sara Plasencia, and Naomi Ondrasek is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License .

Core operating support for the Learning Policy Institute is provided by the Sandler Foundation and the William and Flora Hewlett Foundation.

Updated July 13, 2020. Revisions are noted here .

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COVID-19 transmission and protective measures

COVID-19 transmission

COVID-19 spreads primarily from person to person in several different ways:

It can spread through small liquid particles. These particles range from larger respiratory droplets to smaller aerosols released when an infected person coughs, sneezes, speaks, sings or breathes.
It spreads mainly between people who are in close contact with each other, typically within 1 metre.
It can also spread in poorly ventilated and/or crowded indoor settings where aerosols remain suspended in the air or travel farther than 1 metre.
It can also spread if a person touches surfaces that have been contaminated by the virus.

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Importance of Workplace Safety Protocols: A Comprehensive Guide for Safety Officers

Introduction

Legal Compliance and Regulations

Risk Assessment and Management

Employee Training Programs

Personal Protective Equipment (PPE)

Emergency Response Plans

Health and Wellness Initiatives

Communication Channels

Incident Reporting Procedures

Safety Culture in the Workplace

Monitoring and Auditing Processes

Benefits of Workplace Safety

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1. Introduction

2. Materials and Methods

2.2. Search Methods

2.3. Search Outcome and Data Extraction

2.4. Quality Appraisal

2.5. Data Abstraction and Synthesis

3.1. Search Results and Study Selections

3.2. General Characteristics of the Selected Studies

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3.3.2. Healthcare Provider

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4. Discussion

Limitations and Suggestions for Future Studies

5. Conclusions

Acknowledgments

Author Contributions

Conflicts of Interest

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