Evaluation of Healthcare Personnel Exposures to Patients with SARS-CoV-2 Associated with Personal Protective Equipment Use

Abstract Objective: Personal Protective Equipment (PPE) is a critical aspect of preventing transmission of SARS-CoV-2 in healthcare settings. We aimed to identify factors related to lapses in PPE usage that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP). Design: Retrospective cohort study Setting: Tertiary care medical center in Minnesota Participants: A total of 345 HCP that sustained a significant occupational exposure to a patient with Coronavirus Disease 2019 (COVID-19) from May 13th, 2020 through November 30th, 2020 were evaluated. Results: Eight HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day post-exposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by RT-PCR during the post-exposure quarantine (RR 10.25 (95% Confidence Interval (CI) 1.28-82.39), p=.009). Overall, the most common reason for a significant exposure was the usage of a surgical facemask instead of a respirator during an aerosolizing generating procedure (AGP) (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the post-exposure quarantine (RR 0.99 (95% CI 0.96-1), p=1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19. Conclusions: The use of universal eye protection is a critical aspect of PPE to prevent patient to HCP transmission of SARS-CoV-2.

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SARS-CoV-2 Infection in Healthcare Personnel and Their Household Contacts at a Tertiary Academic Medical Center: Protocol for a Longitudinal Cohort Study (Preprint)

10.2196/preprints.25410 ◽

2020 ◽

Author(s):

Emily J Ciccone ◽

Paul N Zivich ◽

Evans K Lodge ◽

Deanna Zhu ◽

Elle Law ◽

...

Keyword(s):

Risk Factors ◽

Personal Protective Equipment ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Well Being ◽

Healthcare Personnel ◽

Protective Equipment ◽

Household Contacts ◽

Tertiary Care Medical Center

BACKGROUND Healthcare personnel are at high risk for exposure to the SARS-CoV-2 virus. While personal protective equipment may mitigate this risk, prospective data collection on its use and other risk factors for seroconversion in this population is needed. OBJECTIVE The primary objectives of this study are to (1) determine the incidence of and risk factors for SARS-CoV-2 infection among healthcare personnel at a tertiary medical center and (2) actively monitor personal protective equipment use, interactions between study participants via electronic sensors, secondary cases in households, and participant mental health and well-being. METHODS To achieve these objectives, we designed a prospective, observational study of SARS-CoV-2 infection among healthcare personnel and their household contacts at an academic tertiary care medical center. Enrolled healthcare personnel completed frequent surveys on symptoms and work activities and provided serum and nasal samples for SARS-CoV-2 testing every two weeks. Additionally, interactions between participants and their movement within the clinical environment were captured with a smartphone app and Bluetooth sensors. Finally, a subset of participants' households was randomly selected every two weeks for further investigation, and enrolled households provided serum and nasal samples via at-home collection kits. RESULTS As of September 30, 2020, 164 healthcare personnel and 33 household participants have been enrolled. Recruitment and follow-up are ongoing and expected to continue until March 2021. CONCLUSIONS Much remains to be learned regarding risk of SARS-CoV-2 infection among healthcare personnel and their household contacts. Through use of a multi-faceted study design enrolling a well-characterized cohort, we will collect critical information regarding SARS-CoV-2 transmission in the healthcare setting and its linkage to the community.

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Implementation of Preoperative Screening Protocols in Otolaryngology During the COVID-19 Pandemic

Otolaryngology ◽

10.1177/0194599820931041 ◽

2020 ◽

Vol 163 (2) ◽

pp. 265-270 ◽

Cited By ~ 2

Author(s):

Matthew J. Urban ◽

Tirth R. Patel ◽

Richard Raad ◽

Phillip LoSavio ◽

Kerstin Stenson ◽

...

Keyword(s):

Medical Center ◽

Point Of Care ◽

Tertiary Care ◽

Operative Procedures ◽

Preoperative Screening ◽

Critical Aspect ◽

Significant Delay ◽

Care Protocol ◽

Tertiary Care Medical Center ◽

High Risk Case

Objective To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic. Methods This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a “high-risk case protocol” was utilized to maximize available resources. As information and technology evolved, a “universal point-of-care protocol” was implemented. Results Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure ( P = .92). Discussion Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on “COVID-19 clinics” or other community testing facilities. Implications for Practice Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.

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Understanding Workflow and Personal Protective Equipment Challenges Across Different Healthcare Personnel Roles

Clinical Infectious Diseases ◽

10.1093/cid/ciz527 ◽

2019 ◽

Vol 69 (Supplement_3) ◽

pp. S185-S191 ◽

Cited By ~ 6

Author(s):

Molly Harrod ◽

Laura Petersen ◽

Lauren E Weston ◽

Lynn Gregory ◽

Jeanmarie Mayer ◽

...

Keyword(s):

Personal Protective Equipment ◽

Physical Therapists ◽

Medical Center ◽

Academic Medical Center ◽

Geographic Location ◽

Physical Contact ◽

Healthcare Personnel ◽

Protective Equipment ◽

Effective Strategies ◽

Field Notes

Abstract Background Hospitals use standard and transmission-based precautions, including personal protective equipment (PPE), to prevent the spread of infectious organisms. However, little attention has been paid to the potentially unique challenges of various healthcare personnel (HCP) in following precaution practices. Methods From September through December 2016, 5 physicians, 5 nurses, and 4 physical therapists were shadowed for 1 hour 30 minutes to 3 hours 15 minutes at an academic medical center. Observers documented activities using unstructured field notes. Focus groups were conducted to better understand HCP perspectives about precautions and PPE-related challenges. Data were analyzed by comparing workflow and challenges (observed and stated) in precaution practices across HCP roles. Results Precaution patients were interspersed throughout physician rounds, which covered a broad geographic range throughout the hospital. Patient encounters were generally brief, and appropriate use of gowns and cleaning of personal stethoscopes varied among observed physicians. Nurses were unit based and frequently entered/exited rooms. Frustration with donning/doffing was especially apparent when needing supplies while in a precaution room, which nurses acknowledged was a time when practice lapses could occur. The observed physical therapists worked in one geographic location, spent extended periods of time with patients, and noted that given their close physical contact with patients, gowns do not fully protect them. Conclusions Movement patterns, time with patients, care activities, and equipment use varied across HCP, leading to a diverse set of challenges in following precaution practices and PPE use. Attention to these differences among HCP is important for understanding and developing effective strategies to prevent the potential spread of infectious organisms.

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Improving the Use of Personal Protective Equipment: Applying Lessons Learned

Clinical Infectious Diseases ◽

10.1093/cid/ciz619 ◽

2019 ◽

Vol 69 (Supplement_3) ◽

pp. S165-S170 ◽

Cited By ~ 9

Author(s):

Sujan C Reddy ◽

Amy L Valderrama ◽

David T Kuhar

Keyword(s):

Best Practices ◽

Personal Protective Equipment ◽

Lessons Learned ◽

Healthcare Personnel ◽

Protective Equipment ◽

Delivery Of Care ◽

Healthcare Settings

Abstract Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.

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A Cross-Sectional Study of Knowledge and Practice with Regard to Personal Protective Equipment in Covid-19 Management among Healthcare Workers at a Tertiary Care Center of Ananthapuram District, Andhra Pradesh

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/378 ◽

2021 ◽

Vol 8 (24) ◽

pp. 2011-2016

Author(s):

Niharika B ◽

Suchitra R ◽

Shreenivas Shouri ◽

Posina Priyanka

Keyword(s):

Personal Protective Equipment ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Healthcare Personnel ◽

Protective Equipment ◽

Sectional Study ◽

Cross Sectional ◽

Level Of Knowledge ◽

Knowledge And Practice

BACKGROUND The healthcare personnel are the first ones to get exposed to corona virus disease (COVID 19) infection while serving the patients in the hospital. Correct knowledge and practice regarding personal protective equipment (PPE) kit usage is the need of the hour which acts as a barrier for infection. The level of knowledge on PPE, method of guidance and the perceived need for PPE by healthcare personnel play an important role in controlling the infections in hospital settings. METHODS A cross-sectional study was conducted at the Covid Care Center of a Tertiary Care Hospital of Ananthapuramu district among healthcare staff using a pre-structured closed-ended questionnaire regarding socio-demographic details and usage of personal protective equipment. The score obtained was classified as good if the score ranges from 6 to 8 & poor if the score is from 0 to 5. RESULTS 28 out of 64 subjects (43.7 %) had good knowledge & practice regarding PPE kit usage. Majority of them had given correct responses for PPE kit components, wearing masks and disposal of PPE while most of them scored poorly in donning and doffing steps, wearing gloves and foot covers. CONCLUSIONS Most of the study subjects had good knowledge regarding wearing masks, PPE kit components, & method of disposal of PPE. Majority of them did not know the correct steps for donning & doffing of PPE & wearing gloves. Most of the doctors did not even have adequate knowledge on appropriate usage and disposal of PPE. As per the study, neither gender nor job title could determine the level of knowledge & practice of PPE kit. Well planned training sessions for health care workers (HCWs) regarding the steps of donning and doffing of PPE, correct method of disposal of PPE & using right substitutes is important. KEYWORDS PPE Kit, Healthcare, Donning, Doffing

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Development of a Flexible, Computerized Database to Prioritize, Record, and Report Influenza Vaccination Rates for Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/596043 ◽

2009 ◽

Vol 30 (4) ◽

pp. 361-369 ◽

Cited By ~ 15

Author(s):

Michael Melia ◽

Sarah O'Neill ◽

Sherry Calderon ◽

Sandra Hewitt ◽

Kelly Orlando ◽

...

Keyword(s):

Influenza Vaccination ◽

Patient Care ◽

Medical Center ◽

Tertiary Care ◽

The United States ◽

Healthcare Personnel ◽

Direct Patient Care ◽

Vaccination Rates ◽

Tertiary Care Medical Center ◽

The Status

Objective.To describe the method used to develop a flexible, computerized database for recording and reporting rates of influenza vaccination among healthcare personnel who were classified by their individual levels (hereafter, “tiers”) of direct patient contact.Design.Three-year descriptive summary.Setting.Large, academic, tertiary care medical center in the United States.Participants.All of the medical center's healthcare personnel.Methods.The need to develop a computer-based system to record direct patient care tiers and vaccination data for healthcare personnel was identified. A plan that was to be implemented in stages over several seasons was developed.Results.Direct patient care tiers were defined by consensus opinion on the basis of the extent, frequency, and intensity of direct contact with patients. The definitions of these tiers evolved over 3 seasons. Direct patient care classifications were assigned and recorded in a computerized database, and data regarding the receipt of vaccination were tracked by using the same database. Data were extracted to generate reports of individual, departmental, and institutional vaccination rates, both overall and according to direct patient care tiers.Conclusions.Development of a computerized database to record direct patient care tiers for individual healthcare workers is a daunting but manageable task. Widespread use of these direct patient care definitions will facilitate uniform comparisons of vaccination rates between institutions. This computerized database can easily be used by infection control personnel to accomplish several other key tasks, including vaccination triage in the context of shortage or delay, prioritization of personnel to receive interventions in times of crisis, and monitoring the status of other employee health or occupational health measures.

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COVID-19: The Importance of Adequate Personal Protective Equipment in Healthcare Medical Staff

Journal of Regenerative Biology and Medicine ◽

10.37191/mapsci-2582-385x-2(2)-021 ◽

2020 ◽

Cited By ~ 1

Author(s):

Anne Weissenstein

Keyword(s):

Health Care ◽

Personal Protective Equipment ◽

Health Care Services ◽

Infection Prevention And Control ◽

Protective Equipment ◽

Emotional Resilience ◽

Healthcare Facilities ◽

Care Services ◽

Healthcare Settings ◽

And Control

We present an update on infection prevention and control for COVID-19 in healthcare settings. This update focuses on measures to be applied in settings with increasing community transmission, growing demand for concern about COVID-19 patients, and subsequent staffing issues in the event of shortages of personal protective equipment for healthcare facilities worldwide. The comfort and emotional resilience of health care workers are key components in maintaining essential health care services during the COVID-19 virus (coronavirus) outbreak.

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Hand Hygiene and Personal Protective Equipment in Healthcare Settings During COVID-19 Pandemic in Bangladesh

SSRN Electronic Journal ◽

10.2139/ssrn.3634834 ◽

2020 ◽

Author(s):

Md Rezaul Karim ◽

Sushil Kumar Sah ◽

Afsarunnesa Syeda ◽

Muhammad Tanvir Faysol ◽

Aminur Rahman ◽

...

Keyword(s):

Hand Hygiene ◽

Personal Protective Equipment ◽

Protective Equipment ◽

Healthcare Settings

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Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.325 ◽

2021 ◽

pp. 1-26

Author(s):

Akane Takamatsu ◽

Hitoshi Honda ◽

Tomoya Kojima ◽

Kengo Murata ◽

Hilary Babcock

Keyword(s):

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Vaccination Rate ◽

Multifaceted Intervention ◽

Vaccine Hesitancy ◽

Healthcare Personnel ◽

Tertiary Care Center ◽

Post Intervention ◽

Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

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