Routine saliva testing for the identification of silent COVID-19 infections in healthcare workers

AbstractObjectiveCurrent COVID-19 guidelines recommend symptom-based screening and regular nasopharyngeal (NP) testing for healthcare personnel in high-risk settings. We sought to estimate case detection percentages with various routine NP and saliva testing frequencies.DesignSimulation modelling study.MethodsWe constructed a sensitivity function based on the average infectiousness profile of symptomatic COVID-19 cases to determine the probability of being identified at the time of testing. This function was fitted to reported data on the percent positivity of symptomatic COVID-19 patients using NP testing. We then simulated a routine testing program with different NP and saliva testing frequencies to determine case detection percentages during the infectious period, as well as the pre-symptomatic stage.ResultsRoutine bi-weekly NP testing, once every two weeks, identified an average of 90.7% (SD: 0.18) of cases during the infectious period and 19.7% (SD: 0.98) during the pre-symptomatic stage. With a weekly NP testing frequency, the corresponding case detection percentages were 95.9% (SD: 0.18) and 32.9% (SD: 1.23), respectively. A 5-day saliva testing schedule had a similar case detection percentage as weekly NP testing during the infectious period, but identified about 10% more cases (mean: 42.5%; SD: 1.10) during the pre-symptomatic stage.ConclusionOur findings highlight the utility of routine non-invasive saliva testing for frontline healthcare workers to protect vulnerable patient populations. A 5-day saliva testing schedule should be considered to help identify silent infections and prevent outbreaks in nursing homes and healthcare facilities.

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Routine saliva testing for the identification of silent coronavirus disease 2019 (COVID-19) in healthcare workers

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1413 ◽

2021 ◽

pp. 1-5

Author(s):

Kevin Zhang ◽

Affan Shoukat ◽

William Crystal ◽

Joanne M. Langley ◽

Alison P. Galvani ◽

...

Keyword(s):

Healthcare Workers ◽

Healthcare Personnel ◽

Infectious Period ◽

Case Detection ◽

Healthcare Facilities ◽

Presymptomatic Stage ◽

Percent Positivity ◽

Vulnerable Patient ◽

Testing Schedule ◽

Reported Data

Abstract Objective: Current COVID-19 guidelines recommend symptom-based screening and regular nasopharyngeal (NP) testing for healthcare personnel in high-risk settings. We sought to estimate case detection percentages with various routine NP and saliva testing frequencies. Design: Simulation modeling study. Methods: We constructed a sensitivity function based on the average infectiousness profile of symptomatic coronavirus disease 2019 (COVID-19) cases to determine the probability of being identified at the time of testing. This function was fitted to reported data on the percent positivity of symptomatic COVID-19 patients using NP testing. We then simulated a routine testing program with different NP and saliva testing frequencies to determine case detection percentages during the infectious period, as well as the presymptomatic stage. Results: Routine biweekly NP testing, once every 2 weeks, identified an average of 90.7% (SD, 0.18) of cases during the infectious period and 19.7% (SD, 0.98) during the presymptomatic stage. With a weekly NP testing frequency, the corresponding case detection percentages were 95.9% (SD, 0.18) and 32.9% (SD, 1.23), respectively. A 5-day saliva testing schedule had a similar case detection percentage as weekly NP testing during the infectious period, but identified ~10% more cases (mean, 42.5%; SD, 1.10) during the presymptomatic stage. Conclusion: Our findings highlight the utility of routine noninvasive saliva testing for frontline healthcare workers to protect vulnerable patient populations. A 5-day saliva testing schedule should be considered to help identify silent infections and prevent outbreaks in nursing homes and healthcare facilities.

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Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N’zérékoré Prefecture, Guinea: a cross-sectional study

10.21203/rs.2.17924/v2 ◽

2020 ◽

Author(s):

Manuel Raab ◽

Lisa M. Pfadenhauer ◽

Tamba Jacques Millimouno ◽

Michael Hoelscher ◽

Guenter Froeschl

Keyword(s):

Healthcare Workers ◽

Good Knowledge ◽

Infection Prevention And Control ◽

Public Healthcare ◽

Case Detection ◽

Rural Healthcare ◽

Healthcare Facilities ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices ◽

Suspect Case

Abstract Introduction: The 2013-2016 Ebola epidemic in West Africa began in Guinea’s Forest region, a region now considered to be at high risk for future epidemics of viral haemorrhagic fevers (VHF). Good knowledge, attitudes and practices towards VHF amongst healthcare workers in such regions are a central pillar of infection prevention and control (IPC). To inform future training in IPC, this study assesses the knowledge, attitudes and practices (KAP) towards VHF amongst healthcare workers in public healthcare facilities in the most populated prefecture in Forest Guinea, and compares results from urban and rural areas. Methods: In June and July 2019, we interviewed 102 healthcare workers in the main urban and rural public healthcare facilities in the N’zérékoré prefecture in Forest Guinea. We used an interviewer-administered questionnaire adapted from validated KAP surveys. Results: The great majority of respondents demonstrated good knowledge and favourable attitudes towards VHF. However, respondents reported some gaps in preventive practices such as VHF suspect case detection. They also reported a shortage of protective medical equipment used in everyday clinical work in both urban and rural healthcare facilities and a lack of training in IPC, especially in rural healthcare facilities. However, whether or not healthcare workers had been trained in IPC did not seem to influence their level of KAP towards VHF. Conclusions: Three years after the end of the Ebola epidemic, our findings suggest that public healthcare facilities in the N’zérékoré prefecture in Forest Guinea still lack essential protective equipment and some practical training in VHF suspect case detection. To minimize the risk of future VHF epidemics and improve management of outbreaks of infectious diseases in the region, current efforts to strengthen the public healthcare system in Guinea should encompass questions of supply and IPC training.

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Accidental Exposures to Biological Products – A Risk for Medical Staff and Patients

Studia Universitatis Babeş-Bolyai Bioethica ◽

10.24193/subbbioethica.2020.02 ◽

2020 ◽

Vol 65 (1-2) ◽

pp. 21-31

Author(s):

Erzsébet Kálmán ◽

Amanda Rădulescu ◽

Andreea Hăngănuţ ◽

Vlad Bocăneţ ◽

Cristina Borzan

Keyword(s):

Medical Staff ◽

Healthcare Workers ◽

Hiv Transmission ◽

Healthcare Facility ◽

Cross Sectional Study ◽

Healthcare Personnel ◽

Post Exposure Prophylaxis ◽

Carrier Status ◽

Cross Sectional ◽

Healthcare Facilities

"Hypothesis: While performing professional activities, the healthcare workers (HCW) can be exposed to blood and other potentially infectious materials from the patients they are taking care of. In order to minimize the risk of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission, these accidental exposures should be reported and followed by post-exposure prophylaxis. If seroconversion of the injured person occurs, the healthcare unit intervenes by various methods to ensure that the infected HCW does not represent a source of infection for other patients [1]. Objective: Through this study we aimed to assess the perception of different categories of healthcare personnel about their testing for their carrying of HBV, HCV and HIV at the time of employment in a healthcare facility and their right to confidentiality regarding their health status. We also wanted to evaluate the opinion of the medical staff about the patient’s right to be informed about the risk of HBV, HCV and HIV transmission, if there is an infected person in the medical team. Method: A multicentric cross-sectional study was performed, by applying an original pre-tested questionnaire to different professional categories of medical staff from different categories of healthcare facilities. Results: Over 20% of respondents declared they were not tested at the time of employment, but almost 40% claimed that they were tested every year since employment. Only 20% of the participants considered they have the right to confidentiality regarding the state of viral carrying, but ⅓ consider that there is no discrimination if a healthcare facility refuses to hire a HBV, HCV, HIV carrier. Out of all participants questioned, ½ of the respondents agree that the medical staffs who are a carrier for a transmissible virus can be detached in a less dangerous healthcare department in order to avoid the transmission of the virus to patients. Almost equally, there were participants who believed that they could not be compelled to reveal their carrier status to the patient, and those who would have no hesitation in informing their patient about their status Keywords: Blood and other potentially infectious materials, exposure, healthcare workers, patient, confidentiality. "

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Coronavirus Disease 2019 (COVID-19) Infections Among Healthcare Workers, Los Angeles County, February–May 2020

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1200 ◽

2020 ◽

Author(s):

Stacy Hartmann ◽

Zachary Rubin ◽

Heidi Sato ◽

Kelsey O Yong ◽

Dawn Terashita ◽

...

Keyword(s):

Los Angeles ◽

Healthcare Workers ◽

Los Angeles County ◽

Infectious Period ◽

Risk Of Infection ◽

Term Care ◽

Healthcare Facilities ◽

Patient Interviews ◽

The Impact

Abstract Across the world, healthcare workers (HCW) are at a greater risk of infection by coronavirus disease 2019 (COVID-19) due to the nature of their work. The Los Angeles County Department of Public Health (LAC DPH) set out to understand the impact of COVID-19 on healthcare facilities and HCWs by tracking and analyzing data from case-patient interviews of HCWs. As of 31 May, over 3 months into the pandemic, nearly 5500 positive HCWs were reported to LAC DPH, representing 9.6% of all cases. Cases reported working in 27 different setting types, including outpatient medical offices, correctional facilities, emergency medical services, and so forth, with the highest proportion from long-term care facilities (46.6%) and hospitals (27.7%). Case patients included both clinical and nonclinical roles, with nearly half (49.4%) of positive HCWs being nurses. Over two-thirds of HCWs (68.6%) worked at some point during their infectious period, and nearly half (47.9%) reported a known exposure to a positive patient and/or coworker within their facility. Overall, compared to all LAC cases, HCWs reported lower rates of hospitalization (5.3% vs 12.2%) and death (0.7% vs 4.3%) from COVID-19. There are many factors that increase HCWs risk of infection, including high-risk work environment, limited supply of personal protective equipment, and even pressure to help and work during a pandemic. In response to these data, LAC DPH created resources and provided guidance for healthcare facilities to best protect their patients and staff during the COVID-19 pandemic.

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Outbreak of Pertussis Among Healthcare Workers in a Hospital Surgical Unit

Infection Control and Hospital Epidemiology ◽

10.1086/506232 ◽

2006 ◽

Vol 27 (6) ◽

pp. 546-552 ◽

Cited By ~ 27

Author(s):

F. Brian Pascual ◽

Candace L. McCall ◽

Aaron McMurtray ◽

Tony Payton ◽

Forrest Smith ◽

...

Keyword(s):

Healthcare Workers ◽

Positive Culture ◽

Control Measures ◽

Infectious Period ◽

Acute Cough ◽

Face To Face ◽

Outbreak Period ◽

Hospital Patients ◽

Reported Data ◽

Surgical Unit

Background.In September 1999, a pertussis outbreak was detected among surgical staff of a 138-bed community hospital. Patients were exposed toBordetella pertussisduring the 3-month outbreak period.Objective.To describe the outbreak among surgical staff, to evaluate implemented control measures, and to determine whether nosocomial transmission occurred.Methods.Clinical pertussis was defined as acute cough illness with a duration of 14 days or more without another apparent cause; persons with positive culture, PCR, or serologic test results were defined as having laboratory-confirmed pertussis. Surgical healthcare workers (HCWs) were interviewed regarding pertussis symptoms, and specimens were obtained for laboratory analysis. Patients exposed toB. pertussisduring an ill staff member's 3-week infectious period were interviewed by phone to determine the extent of nosocomial spread.Participants.A total of 53 HCWs assigned to the surgical unit and 146 exposed patients. HCWs with pertussis were defined as case subjects; HCWs without pertussis were defined as non-case subjects.Results.Twelve (23%) of 53 HCWs had clinical pertussis; 6 cases were laboratory confirmed. The median cough duration in the 12 case subjects was 27 days (range, 20-120 days); 10 (83%) had paroxysms. Eleven (92%) of 12 case subjects and 28 (86%) of 41 non-case subjects received antibiotic treatment or prophylaxis. Seven case subjects (58%) reported they always wore a mask when near patients. Of 146 patients potentially exposed to pertussis from the 12 case subjects, 120 (82%) were interviewed; none reported a pertussis-like illness.Conclusions.Surgical staff transmittedB. pertussisamong themselves; self-reported data suggests that these HCWs did not transmitB. pertussisto their patients, likely because of mask use, cough etiquette, and limited face-to-face contact. Control measures might have helped limit the outbreak once pertussis was recognized.

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Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N’zérékoré prefecture, Guinea: a cross-sectional study

10.21203/rs.2.17924/v3 ◽

2020 ◽

Author(s):

Manuel Raab ◽

Lisa M. Pfadenhauer ◽

Tamba Jacques Millimouno ◽

Michael Hoelscher ◽

Guenter Froeschl

Keyword(s):

Healthcare Workers ◽

Good Knowledge ◽

Infection Prevention And Control ◽

Public Healthcare ◽

Case Detection ◽

Rural Healthcare ◽

Healthcare Facilities ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices ◽

Suspect Case

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SARS-CoV-2 Ig G among Healthcare Workers and the General Population

Pathogens ◽

10.3390/pathogens10040465 ◽

2021 ◽

Vol 10 (4) ◽

pp. 465

Author(s):

Gregorio P. Milani ◽

Mario G. Bianchetti ◽

Giuseppe Togni ◽

Andreas W. Schoenenberger ◽

Franco Muggli

Keyword(s):

General Population ◽

Healthcare Workers ◽

Geographical Area ◽

Healthcare Personnel ◽

Protein Subunit ◽

Positive Serology ◽

Seroprevalence Data ◽

And Gender ◽

Few Data ◽

Ig G

It is assumed that healthcare workers are at the highest risk to be infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, few data from healthcare workers who do not primarily take care of patients with SARS-CoV-2 infection support this assumption. We investigated the prevalence of immunoglobulin G (Ig G) against SARS-CoV-2 among healthcare workers who do not primarily take care of patients with SARS-CoV-2 infection and the general population in a well-defined geographical area. The first part of the study was conducted in May 2020 in Val Mesolcina (Southern Switzerland), a valley with ~8000 inhabitants. All healthcare workers were invited. All participants (n = 488) of the Swiss Longitudinal Cohort Study (SWICOS), a cohort representative of the general population, were also invited. Circulating Ig G against spike protein subunit 1 of SARS-CoV-2 were tested in each subject. Subjects with positive Ig G were tested again after 6 months. The condition of being a healthcare worker, rather than a part of the general population, was tested as a predictor of seroprevalence positivity by both simple and multiple (adjusted for age and sex) logistic regression. Eleven (2.6%) of the 423 SWICOS participants and 46 (16%) out of 289 healthcare workers were positive for antibodies against SARS-CoV-2. The seroprevalence OR was 7.01 (95% CI: 3.53–15.47) for healthcare workers as compared to SWICOS participants. After adjusting for age and gender, the seroprevalence OR was 5.13 (95% CI: 2.54–10.40). About three quarters of the subjects in the SWICOS (73%) and in healthcare (79%) group with a previous positive serology still presented positive Ig G against the SARS-CoV-2 after 6 months. The present seroprevalence data point out that the SARS-CoV-2 infection is seven times higher among healthcare workers than in the general population of Val Mesolcina. Efforts to effectively protect all the healthcare personnel are needed.

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‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

BMJ Global Health ◽

10.1136/bmjgh-2020-004360 ◽

2021 ◽

Vol 6 (4) ◽

pp. e004360

Author(s):

Dumisani MacDonald Hompashe ◽

Ulf-G Gerdtham ◽

Carmen S Christian ◽

Anja Smith ◽

Ronelle Burger

Keyword(s):

Health Systems ◽

Primary Healthcare ◽

Healthcare Workers ◽

Quality Care ◽

Public Healthcare ◽

Health Coverage ◽

Access To Health Services ◽

Healthcare Provision ◽

Healthcare Facilities ◽

Patients Experience

Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.

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Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003–2012: Results of the French National Network Survey, AES-RAISIN

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.80 ◽

2015 ◽

Vol 36 (8) ◽

pp. 963-968 ◽

Cited By ~ 5

Author(s):

N. Floret ◽

O. Ali-Brandmeyer ◽

F. L’Hériteau ◽

C. Bervas ◽

S. Barquins-Guichard ◽

...

Keyword(s):

Body Fluid ◽

Sharp Decrease ◽

Healthcare Personnel ◽

Significant Drop ◽

Healthcare Facilities ◽

National Network ◽

The Past ◽

Personnel Safety ◽

Voluntary Basis

OBJECTIVETo assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities.METHODRetrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008–12).FINDINGSReported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012.CONCLUSIONOf the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.Infect. Control Hosp. Epidemiol. 2015;36(8):963–968

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Quality of Life of Healthcare Workers Suffering from Occupational Contact Dermatitis

Recent Advances in Inflammation & Allergy Drug Discovery ◽

10.2174/1872213x14666210303155135 ◽

2021 ◽

Vol 15 ◽

Author(s):

Amira Omrane ◽

Asma Khedher ◽

Chayma Harrathi ◽

Maher Maoua ◽

Taoufik Khalfallah ◽

...

Keyword(s):

Quality Of Life ◽

Contact Dermatitis ◽

Healthcare Workers ◽

Female Gender ◽

Public Hospitals ◽

Healthcare Personnel ◽

Related Factors ◽

Cross Sectional ◽

Occupational Contact Dermatitis

Background: Healthcare workers are at a high risk of developing Occupational Dermatitis (OD). Affected workers often experience severe impairment of their Quality of Life (QoL). This study aimed to assess the skin-related QoL of healthcare workers with OD and to explore its related factors. Methods: A cross-sectional and exhaustive study was conducted among healthcare personnel of four public hospitals in the central region of Tunisia. All the cases of OD declared were included. Skin-related QoL was assessed using the validated Tunisian version of the “Dermatology Life Quality Index” (DLQI). Some related patents were discussed. Results: A total of 37 cases of OD were collected with an annual incidence of 4.2 cases per 10000 workers. The population was predominantly female (73%) and mean aged 44.7±9.4 years. Nurses were the most represented occupational category (38%). Allergic contact dermatitis was the most frequent diagnosis (96%). Use of gloves was the most frequently reported occupational hazard (86%). The most frequently affected sites were hands (97%). The median score of DLQI was five. Multivariate analysis showed an association between the impairment of skin-related QoL and female gender (p = 0.04; OR = 19.3,84), exposure to disinfecting chemicals in the workplace (p = 0.01; OR = 17,306) and the absence of occupational reclassification (p = 0.01; OR = 21,567). Conclusion: About one third of the population had an impaired quality of life. The score impairment was significantly related to female gender, exposure to disinfecting chemicals and the absence of occupational reclassification.

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