1029 Published by Bali Medical Journal | Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1029-1037 | doi: 10.15562/bmj.v10i3.2817 REVIEW ABSTRACT Factors affecting the occurrence of covid-19 transmission on health workers: a literature review Fitri Arofiati 1* , Feiby F Muntu Untu 2 Introduction: The COVID-19 pandemic has a serious impact on health care workers both physically and psychologically since they become more susceptible to COVID-19 infection due to frequent exposure to individuals infected by COVID-19, work pressure, inadequate conditions of protective equipment, and the accuracy of decision making. This study aims to identify factors affecting the spread of COVID-19 in hospitals. Methods: The study used the literature review method, with article searches on five databases, namely PubMed, EBSCOhost, MEDLINE, ProQuest, and google scholar. The searching process for articles used keywords, including related word synonyms and MESH. The number of the research articles identified included PubMed, EBSCOhost, MEDLINE, ProQuest and google scholar, with 1302. The next step was to use prism chart analysis and select 15 journals that met the inclusion and predefined exclusion criteria. Results: The research analysis results showed that the health workers who were most affected by the COVID-19 transmission were the nursing profession. Factors that influenced the message of COVID-19 in hospitals included internal factors, such as comorbidities, work experience, education and training, stress, hand hygiene, and external factors: hospital environmental design, reduction of personal protective equipment, culture and ethnicity, government policies. Conclusion: The COVID-19 pandemic that has not ended requires changes in the design of care facilities, culture, the behavior of health workers, government policies that can break the chain of transmission of COVID-19 to health workers in hospitals. Keywords: COVID-19, Health Workers, Transmission. Cite This Article: Arofiati, F., Untu, F.F.M. 2021. Factors affecting the occurrence of covid-19 transmission on health workers: a literature review. Bali Medical Journal 10(3) Special Issue ICONURS: 1029-1037. DOI: 10.15562/bmj.v10i3.2817 1 Master of Nursing, Postgraduate Program, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia; 2 Prof. Dr. R.D. Kandou General Hospital, Manado, North Sulawesi, Indonesia; *Corresponding author: Fitri Arofiati; Master of Nursing, Postgraduate Program, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia; fitri.arofiati@umy.ac.id Received: 2021-10-22 Accepted: 2021-12-02 Published: 2021-12-28 1029 Published by Bali Medical Journal Bali Medical Journal (Bali MedJ) 2021, Volume 10, Number 3 Special Issue ICONURS: 1029-1037 P-ISSN.2089-1180, E-ISSN: 2302-2914 Open access: www.balimedicaljournal.org INTRODUCTION e 2019 coronavirus disease outbreak (COVID-19) is a highly contagious disease caused by Coronavirus 2 (severe acute respiratory syndrome) (SARS- CoV-2). SARS-CoV-2 is a virus variant that has never been identified in humans. 1 Coronavirus is known to cause severe respiratory symptoms, including Middle East Respiratory Syndrome (MERS) and severe acute respiratory syndrome (SARS). Symptoms of acute respiratory distress, such as fever, cough, and shortness of breath, are common signs and symptoms of COVID-19 infection. In general, coronavirus incubation lasts five to six days, with the longest incubation period being fourteen days. COVID-19’s most severe symptoms can result in pneumonia, kidney failure, acute respiratory problems, and even death. 1 As of July 9, 2020, the number of cases has been rapidly increasing and covering a wide range of countries in a relatively short period. WHO (World Health Organization) confirmed 11.84.226 cases with 545.481 deaths worldwide (Case Fatality Rate/CFR 4,6%). e COVID-19 pandemic has had a physical and psychological impact on health care workers. 2 Due to their frequent contact with affected individuals, health care workers are more vulnerable to COVID-19 infection than the general population. Health care workers have been asked to work under stressful conditions, without adequate protective equipment, and to make difficult decisions with serious consequences. Globally, health and social systems are currently struggling. 2 is situation is difficult, especially in a humanitarian context, particularly in fragile low-income countries with already weakened health and social systems. According to the World Health Organization, one out of every ten health workers is infected with coronavirus in some countries. 2 In March 2020, 9% of the people in Italy who got affected by COVID-19 were health care workers. 3 e International Council of Nurses reported in May 2020 that the COVID-19 pandemic had infected at least 90,000 health care workers and killed over 260 nurses. By March 2020, one in every four doctors in the UK would have died caused by the illness, exile, or caring for a family member infected with COVID-19. Several countries have expressed concern about increasing the cost of personal security. 4 In China, insufficient staff training, a lack of PPE, a lack of understanding of PPE use, and ambiguous PPE guidelines have resulted in infections and deaths among healthcare workers. 5 Several countries