International Journal of Emergency Mental Health and Human Resilience
Open Access

According to the joint statement of the International Labour Organization (ILO) and World Health Organization (WHO) (2020), the COVID-19, also SARS-Cov-2, pandemic has pulled the world towards deglobalization and put an unprecedented challenge to public health, and growth. After the first COVID-19 wave in India has caused severe havoc, the government implemented a complete lockdown of 54 days, which impeded the infection rate and effectively curtailed the infection to the community, only the frontline workers, including Healthcare workers (HCWs), medical professionals, police officers, and other staff working in the primary circle were prone to infection (Kar et al., 2021). Numerous studies all around the world conducted during and post covid assessed the health and hygiene practices of HCWs hygiene practices at workplaces and in person, A comprehensive cross-sectional study on occupational and personal health and hygienic practices of HCWs in India concluded a suboptimal acquiescence to preventive practices amongst the HCWs, the study also identified some obstacles, such as more than 58% HCWs use personal gadgets during duties which could be fomites and may cause infections(Agarwal, Ranjan, Saraswat, et al., 2021). Many articles published around the globe during the pandemic evaluated the health and hygiene practices of medical professionals and HCWs, and many others assessed the health practices of frontline workers (Asaad et al., 2020; Modi et al., 2020; Singh Gambhir et al., 2020). Limited studies assessed the knowledge, attitude, and behavior of other non-frontline workers and communities since the country was under strict lockdown, only necessities were permitted to function, and minimal need was felt to evaluate the health practices of non-frontline workers (Altaher et al., 2021; Kaushik et al., 2021; Kiaghadi et al., 2020).

The outbreak caused by a mutated version of COVID-19 left everyone vulnerable to infection unlike 1^st wave, and no lockdown was implemented to avoid disruption in the country’s economy (Chandra, 2021). According to a study by Max Health care, India, mutation of SARs-COV-2, also the 2^nd wave magnified the life loss to around 40% more than in 1^st wave (Jha, 2021), This could be attributed to poor health and hygiene practices in communities, irresponsible approach towards infection and unseemly awareness(Jain et al., 2021). A study published in The Lancet Respiratory Medicine Journal accounted for the 2^nd covid outbreak to ‘poor execution of coherent containment’ and overcrowded regions(Asrani et al., 2021) however, the study dealt with more implications of the 2^nd covid wave and not on health and hygiene assessment. (Kaushik et al., 2021) via an extensive survey of 21406 participants report a poor knowledge base and awareness among the varied age group in the community. It concludes the need to extend the knowledge and hygiene practice in the community.

Nonetheless, there are numerous surveys with different applications, but none, by themselves, can provide a comprehensive description of the health and hygiene practices of factory/industry workers who were more susceptible to infection during the 2^nd wave. Since the impact of COVID-19 further burdened the occupational health of factory and industry workers as they were more prone to infection. As suggested, a study assessed COVID-19 risk, vulnerability, and prevalence in the community and reported, that COVID-19 infection could be fatal to workforces in compromised environmental conditions such as air pollutants, and carbon emissions, also in extreme temperature and humidity(Conticini et al., 2020; Hossain, 2020; Kiaghadi et al., 2020). There is a dearth of studies dwelling on the assessment and suboptimal health and hygienic practices of the factory and industry workers, particularly in India.

Since Chittaranjan Locomotives, Kolkata is India’s largest and recognized as the world’s most productive locomotives (Onofrei, 2020), this study aimed to examine the health and hygiene practices of the Chittaranjan locomotive workers (CLWs) and their awareness of COVID-19. Conferring to the GOI, the Ministry of Railway’s report, 35 employees from CLW were reported covid positive during the first wave including 1 death. Nonetheless, above all curbs and lockdown covid cases were reported (Ministry of Railways, 2020), The then Railway minister Piyush Goyal in a press conference revealed, that an estimated 1952 railway employees succumbed to death due to COVID-19(Business Standard, 2021; The Hindu, 2021). Subsequently working on a social ground, the chances of spread are more and 2nd covid outbreak was strongly correlated with environmental factors which may turn lethal to the community. This objectified a dire need to assess the health and hygiene practices of Chittaranjan locomotive workers.

REGION: Chittaranjan Locomotive works is located near Kolkata, the capital city of West Bengal, and lists among the most populous cities in India.

STUDY DESIGN: The qualitative, cross-sectional survey regarding health & hygiene practices and knowledge of the same during the 2^nd wave of the COVID-19 pandemic was conducted from 9^th May 2021 to 2^nd June 2021, during the 2nd covid wave in India (Figure 1).

Figure 1: Source- worldometer.info/india daily new covid cases in the country.

Following the COVID-19 safety protocols and guidelines, with the help and permission of senior officials and administration. An online/offline survey was conducted, and the questionnaire was distributed in electronic forms using google forms as well as in physical form to the workers. All the employees were either from the main unit or the ancillary unit of CLW.

PARTICIPANTS: A total of 938 employees who used to be on-field support in the social circle for the most duration of time and are most vulnerable to infection were given the questionnaire via several modes (physical, digital, and google forms links), out of which 898 responded to the questionnaires. The response rate to the survey was approximately 95%, this could be credited to the officials who briefed the significance of the study and the momentous of their responses. After an initial screening of the retorts received, 46 responses were eliminated from the study due to incomplete and unclear responses. 852 Group- C and D employees which included casual laborers (348), multitasking staff (181), and groundsmen (323), responded to the questionnaires. All the employees were between the age range of 20- 49 years.

Purposive sampling for Group classification was done, and later randomization was employed. All groundsmen and employees on-field were given the questionnaire regarding preventive health & hygiene practices during the 2nd wave of the COVID-19 pandemic and were asked to fill it out without any senior official monitoring the responses to avoid the chance of any behavioral alteration of the workers. All the participants were briefed about the purpose and significance of the study and informed consent was taken.

SURVEY TOOL: A pre-validated questionnaire developed to assess the preventive health and hygiene practices of HCWs in India was used to assess the practices of CLW workers (Agarwal, Ranjan, Saikaustubh, et al., 2021). The questionnaire consisted of two sections, Section -A contains 29 items answered on 5 points Likert scale to evaluate preventive practices during COVID-19, and Section- B consisted of 27 semi-structured items to examine the reason for sub-optimal practices. For the survey to evaluate the preventive practices of CLW workers, only Section-A of the questionnaire was considered. The Content validity of section-A was remarkable (Content validity Ratio (CVR) = ¼ 0.87, Content Validity Index (S-CVI/Av) = ¼ 0.978). The internal consistency (Cronbach’s alpha coefficient) was enumerated to be 0.85.

Out of 29 items from the pre-validated questionnaire- Hand hygiene (5), social distancing (7), Mask & PPE (10), Gadget and fomites (3), Lifestyle (2), 6 items from Mask & PPE subsection, and 2 items from exposure subsection were eliminated as they were practices oriented predominantly to HCWs and were redundant to the present study. After the elimination of those items, 21 questions were finalized for the survey.

The questionnaire consisted of two sections, first part (Section-A) assessed basic information such as name, age, category (labor, MTS, groundsmen), work unit (main/ ancillary), and education qualification. The second section (Section-B) consisted of 21 items to assess the preventive health and hygiene practices of CLW workers.

STATISTICS: Responses were collected in excel sheets and were analyzed using the same. Descriptive statistics and percentile method was used for the analysis.

Table 1 displays demographic data of 852, responses from group C and D CLW workers with a mean age of 35 years, out of which 21% were Multitasking staff with a mean age of 31 years, 38% were groundsmen with a mean age of 36 years and 41% were casual laborers aging the average age of 39 years.

Section A

Demographic characteristics of the employees (Table 1)

Table 1.Demographic characteristics of the employees.

Section B

Prevention practices against COVID-19 infections among Locomotive workers (Table 2).

Table 2.Responses (%) of employees to Hand hygiene items of the questionnaire.

HAND HYGIENE: Table 3 shows the number of responses and percentage of responses to the preventive health and hygiene practices by CLW workers. In the hand hygiene section of the survey, 571 (67%) workers ‘rarely’ shake hands while meeting colleagues, but 85 (10%) employees were likely to shake hands ‘commonly’ but not all the time, likewise approximately 333 (39%) and 468 (55%) of the workers were cognizant to hand sanitization responded ‘always’ and ‘most of the times’ respectively, after contact with any common place. For employees who wash their hands for at least 20sec, the majority were on the edge with 434 employees responding ‘always’ comprising 51%, the rest 290 (34%) workers reported ‘not always’ but ‘mostly’ abide to wash their hands for a set duration.

Table 3. Responses (%) of employees to Social Distancing items of the questionnaire.

Nearly 500 (58%) employees making the majority of the share believe they always follow the proper steps of washing hands and sanitizing. Nevertheless, 41% (351) reported proper hand wash practices responding ‘mostly’ but ‘not always’. When asked whether they touch their eyes, nose, or mouth without washing or sanitizing 435 (51%) and 179 (21%) responded ‘rarely’ and ‘sometimes’ respectively. Also, a noticeable percentage (20%) of employees were recorded to practice touching their nose and mouth commonly (almost 50% of the time during work).

SOCIAL DISTANCING: When asked about distancing family members (at least 1m) the responses were nearly proportionate as 321(38%) marked ‘always’, 281(33%) choose ‘mostly’ and 221 (26%) opted for ‘commonly’ which implies employees didn’t maintain a safe distance with family members. Contrastingly, 71% (605) of the employees always maintained at least 1m distance from co-workers at the workplace, 68% (580) while eating food with colleagues, and 58% (453) while talking to fellow workers during duty. The awareness to maintain social distancing was prevalent in employees with 71% (605) out of 852 always maintaining a 1m distance from others in public places. Only a few people 68 (8%) were less aware comparatively, (Table 3).

MASKS: The results of masks were expected to be lower than the actual outcomes. 88% (751) of workers preferred to wear masks almost all the time inside work premises, furthermore, almost all of them 85% (724) wear it aptly covering both mouse and nose. Not the majority but 170 workers which is approximately 20% accepted the practice of touching the outer surface of masks while wearing them. Nonetheless, the workers put on the masks properly but disposing of the mask was found to be jeopardized, only 70% (596) of workers used dustbins or separate bags to dispose of their masks rest were either unaware or ‘sometimes’ disposed of masks suitably (Table 4).

Table 4.Responses (%) of employees to Mask related items of the questionnaire.

GADGETS/FOMITIES: 248 (29%) workers responded ‘occasional’ use of personal items like mobile phones, pens, etc. while 77 (9%) of them accepted the use of gadgets and phones ‘commonly’ during work. Sanitization habits of personal gear were found to be imperiled as only 409 (48%) always sanitize their mobile phones and other personal items, 298(35%) opted ‘mostly’, but there was a section of workers who retorted ‘rare’ (4%) or just ‘occasional’ (6%) sanitization of their items. However, 681 (80%) workers take precautions while buying things to avoid exposure (Table 5).

Table 5. Responses (%) of employees to Gadgets and Fomites related items of the questionnaire.

LIFESTYLE: 87% (742) of the workers when asked about their sleeping habits responded positively, as they always had 6-8 hrs of sound sleep. Regarding the news and virusrelated updates, 79% (673) of workers followed the news and there were few in the category around 10% (94) of workers who either sometimes or rarely took updates on COVID-19 (Table 6).

Table 6.Responses (%) of employees to Mask related items of the questionnaire.

The spread of COVID-19 infection in the first wave was attenuated majority by strict lockdown and seizing human movement, truncating the spread and fatalities in India, but the later wave of mutation was nothing less than a catastrophe for India. The spread of infection is subsided at present, but WHO warns of future mutation (Callaway, 2021), which could be even more fatal. Studies claim substandard community health practices lack of awareness and a resilience attitude were also the reasons behind the loss(Asrani et al., 2021; Chandra, 2021). This study tried to assess the preventive health practices of locomotive workers who work amidst challenging environments, making them most susceptible to infections. Hand hygiene practices for most of the employees were satisfactory, but there still exist some suboptimal practices of shaking hands with colleagues at the workplace, which is the most common way of infection transmission. Nevertheless, the hand sanitization and handwash practices were adaptive and workers were aware of it, but some were skeptical of the time duration (20 secs.) they wash hands, and lack of attentiveness as it takes time specifically in case of the COVID-19 virus to wash (UNICEF, 2021).

Some workers reported touching of nose and mouth during work, this could be associated with the habit of touching the face leading to elevated chances of infection and illnesses, timely reminders and active consciousness can dissuade this practice.

Family members were deemed to be the most vulnerable to infection from employees but the responses reveal inadequate distance from family members. However, all the workers agreed to maintain a safe distance from co-workers at the workplace while working and eating, but while on duty rooms and while the team works this distance tends to be reduced where social distancing was not always followed and sometimes compromised, this could lead to widespread infection as social distancing was one of the imperative measures to avoid infections, (Kaushik et al., 2021) pointed out the concern regarding compliance to the risk and preventive practices in public. However, the awareness of workers in public spaces and avoiding social gatherings could be attributed to the creative and extensive measures taken by the government to generate awareness.

Putting masks on working premises and wearing them properly was followed by almost 90% of the workers all the time, which is the most operative way to prevent the spread (Leung et al., 2020), But, the practice of touching the outer surface of the mask could be fatal in terms of carrying the infection. But subconsciously workers sometimes during their work or while putting off the mark touched it. This may take time but they need to practice the habit of not touching the mask as it may carry a hefty viral load (WHO, 2020). Also, proper disposal of masks was a concern, as many workers either were unaware or didn’t dispose of masks properly.

The findings of the study by Agarwal, Ranjan, Saraswat, et al., (2021) correspond to the present study, HCWs followed adequate precautionary measures to avoid infections but reported suboptimal practices in carrying personal items like mobile phones and gadgets. These could be the potential carriers of infections that remain in primary contact with the people throughout the time in and outside work premises. Lifestyle habits including sleep were adequate for almost all the workers, and they also agreed to stay updated on covidrelated news.

The study reports substantial awareness among CLW workers in certain areas, at the same time lower scores in certain critical areas to curtail the COVID-19 spread. This study gives an insight into preventive practices followed by Group C & D workers with lower education levels, where practices could be developed using repetitive instructions and monitoring by government and officials, as done during the COVID-19 pandemic, whereas there exist some important practices proper hand washing, carrying and disposing of masks which need technical guidance. At times when the infection is widespread personal items could be potential carriers of infection which need special care and attention.

Further, studies could be conducted to compare the health and hygiene practices between group A and C&D workers as there exist awareness and educational differences, also, other than CLW there are a lot of laborers and workers who live in compromised environments their health and hygiene status need to be assessed to create health awareness and apprehension.

The authors do not have any existing conflict of Interest

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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