Comparing Dynamics and Determinants of Severe Acute Respiratory Syndrome Coronavirus 2 Transmissions Among Healthcare Workers of Adult and Pediatric Settings in Central Paris

Abstract Background Healthcare workers (HCWs) have paid a heavy toll during the coronavirus disease 2019 (COVID-19) outbreak. Routes of transmission remain to be fully understood. Methods This prospective study compared a 1500-bed adult and 600-bed pediatric setting of a tertiary-care university hospital located in central Paris. From 24 February until 10 April 2020, all symptomatic HCWs were screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on a nasopharyngeal swab. HCWs screened positive were questioned on their profession, symptoms, and occupational and nonoccupational exposures to SARS-CoV-2. Results Among 1344 HCWs tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no deaths were reported. Most HCWs (70%) had patient-facing occupational activities (22% in COVID-19 dedicated units). The total number of HCW cases peaked on 23 March, then decreased slowly, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking and personal protective equipment [PPE] for direct care to COVID-19 patients). Attack rates were of 3.2% and 2.3% in the adult and pediatric settings, respectively (P = .0022). In the adult setting, HCWs more frequently reported exposure to COVID-19 patients without PPE (25% vs 15%, P = .046). Report of contacts with children attending out-of-home care facilities dramatically decreased over the study period. Conclusions Universal masking, reinforcement of hand hygiene, and PPE with medical masks for patients’ care allowed protection of HCWs and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities.

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Comparing dynamics and determinants of SARS-CoV-2 transmissions among health care workers of adult and pediatric settings in central Paris

10.1101/2020.05.19.20106427 ◽

2020 ◽

Cited By ~ 3

Author(s):

Adrien CONTEJEAN ◽

Jeremie LEPORRIER ◽

Etienne CANOUI ◽

Fanny ALBY-LAURENT ◽

Emmanuel LAFONT ◽

...

Keyword(s):

Health Care ◽

Home Care ◽

Health Care Workers ◽

Tertiary Care ◽

Occupational Exposures ◽

Continuous Increase ◽

Pediatric Setting ◽

Out Of Home Care ◽

Care Workers ◽

Care Facilities

Background: From the start of the pandemic, health-care workers (HCW) have paid a heavy toll to the coronavirus disease-19 (COVID-19) outbreak. Objectives: To describe the dynamics and determinants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in HCW. Design: Prospective observational study conducted from February 24th until April 10th, 2020. Setting: Comparison of a 1,500-bed adult and a 600-bed pediatric setting of a tertiary-care university hospital located in central Paris. Participants: All symptomatic HCW screened for SARS-CoV-2 on a nasopharyngeal swab. Measurements: HCW screened positive were prospectively questioned on their profession, symptoms, occupational and non-occupational exposures to SARS-CoV-2. Results: Among 1344 symptomatic HCW tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no death were reported. Most HCW (70%) had patient-facing occupational activities (22% in COVID-19 dedicated units). The total number of HCW cases peaked on March 23rd, then decreased slowly, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking and personal protective equipment (PPE) for direct care to COVID-19 patients). Attack rates were of 3.2% and 2.3% in the adult and pediatric setting, respectively (p=0.0022). In the adult setting, HCW more frequently reported exposure to COVID-19 patients without PPE (25% versus 15%, p=0.046). Report of contacts with children attending out-of-home care facilities dramatically decreased over the study period. Limitations: Lack of COVID-19 negative controls and recall bias. Conclusion: Universal masking, reinforcement of hand hygiene, and PPE with medical masks for patients' care allowed protection of HCW and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities.

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Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Neuropediatrics ◽

10.1055/s-0041-1731802 ◽

2021 ◽

Author(s):

Gerardo Garza-Alatorre ◽

Ana Luisa Carrion-Garcia ◽

Alfredo Falcon-Delgado ◽

Elda Carolina Garza-Davila ◽

Angel R Martinez-Ponce de Leon ◽

...

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Early Recognition ◽

Tertiary Care ◽

Delayed Diagnosis ◽

University Hospital ◽

Pediatric Stroke ◽

Care Hospital ◽

Continuous Increase ◽

Common Risk Factors

Abstract Background and objectives Pediatric cerebrovascular disease carries significant morbidity and mortality. Early recognition of a pediatric stroke as well and its most common risk factors are important, but that diagnosis is often delayed. It is believed that the incidence in our center is higher than it appears. This study aims to assess the incidence and characteristics of the pediatric stroke in our university hospital. Likewise, this study seeks to evaluate if a longer symptoms-to-diagnosis time is associated with mortality in patients with ischemic stroke. Methods A retrospective study including children with stroke admitted to the UANL University Hospital from January 2013 to December 2016. Results A total of 41 patients and 46 stroke episodes were admitted. About 45.7% had an ischemic stroke and 54.3% had a hemorrhagic stroke. A mortality of 24.4% and a morbidity of 60.9% were recorded. Regarding ischemic and hemorrhagic stroke, an increased symptoms-to-diagnosis time and a higher mortality were obtained with a relative risk of 2.667 (95% confidence interval [CI]: 1.09–6.524, p = 0.013) and 8.0 (95% CI: 2.18–29.24, p = < 0.0001), respectively. A continuous increase in the incidence rate, ranging from 4.57 to 13.21 per 1,000 admissions comparing the first period (2013) versus the last period (2016), p = 0.02, was found in our center. Conclusions Pediatric stroke is a rare disease; however, its incidence shows a continuous increase. More awareness toward pediatric stroke is needed.

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754. Prevalence of Latent Tuberculosis Infection Among Healthcare Workers at a Tertiary Care University Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.761 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S271-S271

Author(s):

Eun Ju Choo ◽

Se Yoon Park

Keyword(s):

Risk Factors ◽

Healthcare Workers ◽

Latent Tuberculosis Infection ◽

Tertiary Care ◽

Latent Tuberculosis ◽

Tuberculosis Infection ◽

University Hospital ◽

Increased Risk ◽

High Prevalence ◽

Univariate Analyses

Abstract Background We investigated the prevalence of latent tuberculosis infection (LTBI) among healthcare workers (HCWs) and analyzed its risk factors in a tertiary care university hospital in South Korea in a population with intermediate tuberculosis (TB) burden. Methods A standard questionnaire regarding the baseline demographics and risk factors for LTBI was given to each participant. QuantiFERON-TB GOLD In-Tube (QFT-GIT) assay and chest radiography were performed to investigate the rate of LTBI. Results A total of 1,429 participants, 213 (14.9%) doctors and 988 (69.1%) nurses and 228 (16.0%) others were enrolled. The mean age of the subjects was 33.0 years old, and 1,175 (82.2%) were female. Of the participants, 94.5% had received BCG vaccine. QFT-GIT assays were positive for 156 subjects (10.9%). Of the 213 doctors, 28 (13.1%) were positive by QFT-GIT, and among the 988 nurses, 94 (9.5%) had positive QFT-GIT results. Experience of working in hospital was significantly associated with positive LTBI test results by QFT-GIT assay. Gender and duration of employment as an HCW were significantly associated with having a positive QFT-GIT result in univariate analyses. In multivariate analyses, duration of employment as an HCW (>15 years) (odds ratio, 1.98; 95% confidence interval, 1.14–3.43) was independently associated with increased risk of a positive QFT-GIT result. Conclusion A high prevalence of LTBI was found among our HCWs. Considering the association between the experience of working in hospital and high risk of LTBI. The risk for tuberculosis infection among HCWs was higher than general population, which suggests that stricter preventive strategies against nosocomial tuberculosis infection should be implemented. Disclosures All authors: No reported disclosures.

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COVID-19 Pandemic: Perspective of an Italian Tertiary Care Pediatric Center

Healthcare ◽

10.3390/healthcare8030311 ◽

2020 ◽

Vol 8 (3) ◽

pp. 311 ◽

Cited By ~ 1

Author(s):

Daniele Donà ◽

Carlo Giaquinto ◽

Eugenio Baraldi ◽

Alessandra Biffi ◽

Piergiorgio Gamba ◽

...

Keyword(s):

Healthcare Workers ◽

Infection Prevention ◽

Tertiary Care ◽

Phone Call ◽

Nasopharyngeal Swab ◽

Administrative Staff ◽

Double Gate ◽

Rapid Spread ◽

Novel Coronavirus ◽

Pediatric Center

Since February 2020, Italy has been faced with the dramatic spread of novel Coronavirus SARS-CoV-2. This impetuous pandemic infection forced many hospitals to reorganize their healthcare systems. Predicting a rapid spread of the SARS-CoV-2 virus within our region, the Department for Women’s and Children’s Health promptly decided (i) to revise the distribution of the clinical areas in order to create both designated COVID-19 and COVID-19-free areas with their own access, (ii) to reinforce infection prevention control (IPC) measures for all healthcare workers and administrative staff and (iii) to adopt the new “double-gate approach”: a phone call pre-triage and nasopharyngeal swab for SARS-CoV-2 detection before the admission of all patients and caregivers. Between 21 February 2020 till 04 May 2020, only seven physicians, two nurses and two of the administrative staff resulted positive, all during the first week of March. No other cases of intra-department infection were documented among the healthcare workers since all the preventive procedures described above were implemented. It is predicted that similar situations can happen again in the future, and thus, it is necessary to be more prepared to deal with them than we were at the beginning of this COVID-19 pandemic.

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Nosocomial Acquisition of Methicillin-ResistantStaphylococcus aureusDuring an Outbreak of Severe Acute Respiratory Syndrome

Infection Control and Hospital Epidemiology ◽

10.1086/502516 ◽

2005 ◽

Vol 26 (2) ◽

pp. 134-137 ◽

Cited By ~ 6

Author(s):

Susan M. Poutanen ◽

Mary Vearncombe ◽

Allison J. McGeer ◽

Michael Gardam ◽

Grant Large ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Infection Control ◽

Retrospective Cohort ◽

Healthcare Workers ◽

Community Hospital ◽

Tertiary Care ◽

Appropriate Use ◽

Contact Precautions ◽

Control Education ◽

Tertiary Care Hospitals

AbstractObjective:The four hospitals assessed in this study use active surveillance cultures for methicillin-resistantStaphylococcus aureus(MRSA) and contact precautions for MRSA-positive patients as part of routine infection control practices. The objective of this study was to determine whether nosocomial acquisition of MRSA decreased in these hospitals during an outbreak of severe acute respiratory syndrome (SARS) when barrier precautions were routinely used for all patients.Design:Retrospective cohort study.Setting:Three tertiary-care hospitals (a 1,100-bed hospital; a 500-bed hospital; and an 823-bed hospital) and a 430-bed community hospital, each located in Toronto, Ontario, Canada.Patients:All admitted patients were included.Results:The nosocomial rate of MRSA in all four hospitals combined during the SARS outbreak (3.7 per 10,000 patient-days) was not significantly different from that before (4.7 per 10,000 patient-days) or after (3.4 per 10,000 patient-days) the outbreak (P= .30 andP= .76, respectively). The nosocomial rate of MRSA after the outbreak was significantly lower than that before the outbreak (P= .003). Inappropriate reuse of gloves and gowns and failure to wash hands between patients on non-SARS wards were observed during the outbreak. Increased attention was paid to infection control education following the outbreak.Conclusions:Inappropriate reuse of gloves and gowns and failure to wash hands between patients may have contributed to transmission of MRSA during the SARS outbreak. Attention should be paid to training healthcare workers regarding the appropriate use of precautions as a means to protect themselves and patients.

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Prospective Observational Study of Screening Asymptomatic Healthcare Workers for SARS-CoV-2 at a Canadian Tertiary Care Center

10.1101/2020.07.21.20159053 ◽

2020 ◽

Author(s):

Deepali Kumar ◽

Victor H Ferreira ◽

Andrzej Chruscinski ◽

Vathany Kulasingam ◽

Trevor J Pugh ◽

...

Keyword(s):

Health Care ◽

Healthcare Workers ◽

Protein Microarray ◽

Care Center ◽

Tertiary Care ◽

Significant Proportion ◽

Nasopharyngeal Swab ◽

Care Workers ◽

Protein Microarray Analysis ◽

Care Worker

We screened three separate cohorts of healthcare workers for SARS-CoV-2 via nasopharyngeal swab PCR. A seroprevalence analysis using multiple assays was performed in a subgroup. The asymptomatic health care worker cohorts had a combined positivity rate of 29/5776 (0.50%, 95%CI 0.32-0.75) compared to the symptomatic cohort rate of 54/1597 (3.4%) (ratio of symptomatic to asymptomatic 6.8:1). Sequencing demonstrated several variants. The seroprevalence (n=996) was 1.4-3.4% depending on assay. Protein microarray analysis showed differing SARS-CoV-2 protein reactivities and helped define likely true positives vs. suspected false positives. Routine screening of asymptomatic health care workers helps identify a significant proportion of infections.

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Incidence of Pertussis Infection in Healthcare Workers

Infection Control and Hospital Epidemiology ◽

10.1086/501593 ◽

1999 ◽

Vol 20 (02) ◽

pp. 120-123 ◽

Cited By ~ 57

Author(s):

Seth W. Wright ◽

Michael D. Decker ◽

Kathryn M. Edwards

Keyword(s):

Emergency Department ◽

Pertussis Toxin ◽

Healthcare Workers ◽

Tertiary Care ◽

Annual Incidence ◽

University Hospital ◽

Serological Evidence ◽

Pertussis Infection ◽

Symptomatic Disease ◽

Filamentous Hemagglutinin

AbstractObjective:To determine the incidence of pertussis infection in two groups of healthcare workers.Design:Retrospective cohort study.Setting:660-bed, urban, tertiary-care university hospital.Participants:106 resident physicians and 39 emergency department employees.Interventions:Antibodies to pertussis toxin and filamentous hemagglutinin were determined in fresh serum specimens and in stored sera collected 1 to 3 years previously. A 50% rise in both the pertussis toxin and filamentous hemagglutinin from the initial to the follow-up specimen was considered diagnostic of a pertussis infection.Results:Two of 106 residents had serological evidence of a pertussis infection during 151.3 subject-observation years, for an annual incidence rate of 1.3% (95% confidence interval [CI95], 0%-3.5%). Three of 39 emergency department employees had serological evidence of a pertussis infection during 81.2 subject-observation years, for an annual incidence of 3.6% (CI95,, 0%-9.6%). Of these 5 subjects, 2 had symptomatic disease.Conclusion:We found both symptomatic and asymptomatic pertussis infections in two cohorts of healthcare workers. Although the incidence rates were somewhat lower than found in other studies, they nonetheless were higher than for almost all other diseases for which we vaccinate healthcare workers. Our results would support the use of acellular pertussis vaccine in healthcare workers.

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CHILD-CARE TRENDS SHIFT AS MORE MOTHERS WORK

PEDIATRICS ◽

10.1542/peds.88.5.a26 ◽

1991 ◽

Vol 88 (5) ◽

pp. A26-A26

Keyword(s):

Child Care ◽

Home Care ◽

Census Bureau ◽

Home Setting ◽

The Past ◽

Out Of Home Care ◽

Care Facilities ◽

Paid Labor ◽

Lost Time ◽

Child Care Facilities

In 1987, 55% of women with preschoolers worked in the paid labor force, up from 35% in 1977. During that decade, trends in child care also changed. According to the Census Bureau, most children under the age of five are cared for in a home setting—66% in 1987. But out-of-home care has become more common in the past 10 years. In 1977, only 13% of children under the age of five were in organized child-care facilities. In 1987, the share was 24%. The share of preschoolers watched in their own home has dropped to 30% from 34%, and the share watched in someone else's home has fallen to 36% from 41%. The share of children cared for by their mother at work, either in the home or workplace environment, declined to 9% from 11%. Even with a stable child-care arrangement in place, disruptions occur. Altogether, 7% of working mothers with children under the age of 15 lost time from work in the month before the survey because child-care arrangements went awry. Women whose youngest child was one to two years old had the highest rate, 10%.

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PERCEPTIONS OF EMPOWERMENT AMONG HOME CARE AIDES

Innovation in Aging ◽

10.1093/geroni/igz038.2588 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S704-S704

Author(s):

Sandra S Butler ◽

Nancy Kusmaul

Keyword(s):

Home Care ◽

Healthcare Workers ◽

Job Strain ◽

Direct Care ◽

Structured Interviews ◽

Recruitment And Retention ◽

Institutional Settings ◽

Care Aides ◽

Home Care Aides ◽

Care Assistance

Abstract Workforce issues in eldercare are of growing concern with the dramatic aging of our population and the growing need for personal care assistance. Due to difficult job conditions, recruitment and retention of direct care workers have presented challenges throughout the country both in facility-based and community-based care. The empowerment of workers has been theorized as one vehicle for improving job satisfaction among healthcare workers. Models of structural and psychological empowerment have been explored as factors to reduce job strain among healthcare workers in institutional settings, but have not been well examined in the home care setting. This paper will report on an exploratory study of perceptions of empowerment among home care aides (HCAs) in two states. In-person and telephone semi-structured interviews were conducted with 12 HCAs ranging in age from 20 to 64; eight were white and U.S. born and four were black and African born. All 12 study participants reported positive aspects of empowerment in their home care work (e.g., receiving information and good support, feeling competent, having an impact on their clients’ lives, and finding the work meaningful), and most felt autonomous in their work and believed they had the resources they needed to do the job. Nonetheless, negative aspects of empowerment were also frequently described (e.g., poor support, constrained information and resources, limited autonomy due to regulations, and few opportunities for advancement). This paper will explore and interpret these seemingly contradictory findings, with a discussion of implications for recruitment and retention of this valuable workforce

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Physical health complaints among healthcare workers engaged in the care of critically ill COVID-19 patients: A single tertiary-care center prospective study from Japan

10.1101/2020.10.09.20210393 ◽

2020 ◽

Author(s):

Hiroki Namikawa ◽

Yoshihiro Tochino ◽

Akiko Okada ◽

Keiko Ota ◽

Yasuyo Okada ◽

...

Keyword(s):

At Risk ◽

Prospective Study ◽

Physical Health ◽

Critically Ill ◽

Healthcare Workers ◽

Tertiary Care ◽

Physical Symptoms ◽

University Hospital ◽

Health Complaints ◽

Increased Risk

AbstractBackgroundHealthcare workers (HCWs) who care for patients with the novel coronavirus infectious disease (COVID-19) are at an increased risk and fear contracting the infection themselves. HCWs are chronically exposed to very intense stress, both and physically and mentally. Hospitals must reduce both the physical and mental burden of HCWs on the front lines and ensure their safety. No prospective study has focused on the physical health complaints among HCWs engaged in the care of critically ill COVID-19 patients. This study aimed to investigate the occupational risk among HCWs of experiencing physical symptoms during the current COVID-19 pandemic.MethodsA twice-weekly questionnaire targeting HCWs who care for COVID-19 patients was performed at Osaka City University Hospital from April 30 to May 31, 2020 using a shareable Research Electronic Data Capture tool. The demographic characteristics of the participants, frequency of exposure to at-risk care, and physical complaints were evaluated.ResultsA total of 35 doctors, 88 nurses, and 35 technicians were engaged in the care of these critically ill COVID-19 patients. 76 HCWs participated in this study, of whom 24 (31.6%) were doctors, 43 (56.6%) were nurses, and 9 (11.8%) were technicians. The frequency of experiencing any physical symptom was 25.0% among HCWs. Exposure to at-risk care was significantly higher among nurses than among doctors (p < 0.001); likewise, the frequency of experiencing physical symptoms was higher among nurses than among doctors (p < 0.01). The multivariate analysis revealed that nurses (odds ratio 8.29; p = 0.01) might be independently at risk of experiencing physical symptoms.ConclusionsOur results indicate that occupational health care at hospitals must be allocated to HCWs who are highly exposed to at-risk care, particularly nurses engaged in the care of COVID-19 patients.

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