SARS-Coronavirus-2 cases in healthcare workers may not regularly originate from patient care: lessons from a university hospital on the underestimated risk of healthcare worker to healthcare worker transmission

Abstract Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents an unprecedented healthcare challenge. Various SARS-CoV-2 outbreaks in healthcare facilities have been reported. Healthcare workers (HCWs) may play a critical role in the spread of the virus, particularly when asymptomatic. We examined four healthcare-associated outbreaks of SARS-CoV-2 infections that occurred at a university hospital in Berlin, Germany. We aimed to describe and analyze the spread of the virus in order to draw conclusions for effective containment of SARS-CoV-2 in healthcare facilities. Methods Healthcare-associated outbreaks of SARS-CoV-2 infections were defined as two or more laboratory confirmed infections with SARS-CoV-2 where an epidemiological link within the healthcare setting appeared likely. We focused our analysis on one of three sites of the Charité-University Medicine hospital within a 2 month period (March and April 2020). Results We observed four healthcare-associated outbreaks of SARS-CoV-2 infections, with a total of 24 infected persons (23 HCWs and one patient). The outbreaks were detected in the departments of nephrology and dialysis (n = 9), anesthesiology (n = 8), surgical pediatrics (n = 4), and neurology (n = 3). Each outbreak showed multiple unprotected contacts between infected HCWs. A combination of contact tracing, testing, physical distancing and mandatory continuous wearing of face masks by all HCWs was able to contain all four outbreaks. Conclusions HCW to HCW transmission represented the likely source of the four outbreaks. Ensuring proper physical distancing measures and wearing of protective equipment, also when interacting with colleagues, must be a key aspect of fighting COVID-19 in healthcare facilities.

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Risk Factors for Occupational Transmission of Tuberculosis among Healthcare Workers in Zambia

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2020/v41i1130335 ◽

2020 ◽

pp. 59-65

Author(s):

Namaunga Kasumu Chisompola ◽

Kapambwe Mwape Kamanga ◽

Pipina Vlahakis Matafwali

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Healthcare Workers ◽

Critical Role ◽

Nosocomial Transmission ◽

Infection Prevention And Control ◽

Original Research ◽

Healthcare Facilities ◽

Prolonged Contact ◽

And Control

Healthcare workers (HCWs) play a critical role in the management and control of nosocomial transmission of tuberculosis (TB). At the same time, working in TB healthcare facilities such as hospital wards, diagnostic and treatment facilities increases the risk of acquiring TB due to occupational exposure in HCWs. The risk is further heightened in high TB prevalence populations, such as Zambia, as HCWs are exposed both occupationally and in the community. This review aims to provide a better understanding of the risk factors associated with occupational transmission of TB in HCWs in Zambia, by synthesising available data on TB in HCWs in Zambia and the surrounding region. A search of peer reviewed original research on the transmission of TB among HCWs in Zambia was conducted in PubMed and Google Scholar. Studies were eligible for inclusion in the analysis if they described TB amongst HCWs in Zambia, risk factors for TB in HCWs, and nosocomial transmission of TB in Zambia and the surrounding region. The prevalence of TB in HCWs has been demonstrated to be higher than that of the general population. Transmission of TB in healthcare facilities is driven by several factors centred on the lack of adherence to TB infection prevention and control (IPC) practices. Nosocomial transmission of TB in HCWs is further driven by the HIV epidemic and the rise in lifestyle diseases such as diabetes mellitus. However, there is very scarce data on the association of diabetes mellitus and TB among HCWs in Zambia. Prolonged contact with TB patients on wards has been demonstrated to play a vital role in occupational transmission of TB amongst nurses in Zambia. To curb the transmission of TB in HCWs several measures will require implementation such as; administrative support, IPC training and annual TB and HIV screening for all HCWs.

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Breakthrough Varicella Infection in a Healthcare Worker Despite Immunity After Varicella Vaccination

Infection Control and Hospital Epidemiology ◽

10.1086/501670 ◽

1999 ◽

Vol 20 (8) ◽

pp. 561-562 ◽

Cited By ~ 4

Author(s):

Rebecca Wurtz ◽

Irene J. Check

Keyword(s):

Healthcare Worker ◽

Healthcare Workers ◽

Healthcare Setting ◽

Varicella Vaccination ◽

Varicella Infection ◽

Breakthrough Infection

AbstractAlthough varicella vaccination is recommended for varicella-susceptible healthcare workers (HCWs), breakthrough infection after vaccination is not unusual, especially following household exposures. We report breakthrough varicella in a vaccinated HCW and review the data on breakthrough infection and concerns for the healthcare setting.

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Patients' Beliefs and Perceptions of Their Participation to Increase Healthcare Worker Compliance with Hand Hygiene

Infection Control and Hospital Epidemiology ◽

10.1086/599118 ◽

2009 ◽

Vol 30 (9) ◽

pp. 830-839 ◽

Cited By ~ 61

Author(s):

Yves Longtin ◽

Hugo Sax ◽

Benedetta Allegranzi ◽

Stéphane Hugonnet ◽

Didier Pittet

Keyword(s):

Hand Hygiene ◽

Healthcare Worker ◽

Patient Participation ◽

Healthcare Workers ◽

Patient Empowerment ◽

Healthcare Associated Infections ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Active Involvement ◽

Healthcare Associated

Background.Research suggests that patients could improve healthcare workers' compliance with hand hygiene recommendations by reminding them to cleanse their hands.Objective.To assess patients' perceptions of a patient-participation program to improve healthcare workers' compliance with hand hygiene.Design.Cross-sectional survey of patient knowledge and perceptions of healthcare-associated infections, hand hygiene, and patient participation, defined as the active involvement of patients in various aspects of their health care.Setting.Large Swiss teaching hospital.Results.Of 194 patients who participated, most responded that they would not feel comfortable asking a nurse (148 respondents [76%]) or a physician (150 [77%]) to perform hand hygiene, and 57 (29%) believed that this would help prevent healthcare-associated infections. In contrast, an explicit invitation from a healthcare worker to ask about hand hygiene doubled the intention to ask a nurse (from 34% to 83% of respondents; P < .001) and to ask a physician (from 30% to 78%; P < .001). In multivariate analysis, being nonreligious, having an expansive personality, being concerned about healthcare-associated infections, and believing that patient participation would prevent healthcare-associated infections were associated with the intention to ask a nurse or a physician to perform hand hygiene (P < .05). Being of Jewish, Eastern Orthodox, or Buddhist faith was associated also with increased intention to ask a nurse (P < .05), compared with being of Christian faith.Conclusions.This study identifies several sociodemographic characteristics associated with the intention to ask nurses and physicians about hand hygiene and underscores the importance of a direct invitation from healthcare workers to increase patient participation and foster patient empowerment. These findings could guide the development of future hand hygiene-promotion strategies.

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The Impact of the Protective Measures on Healthcare Workers During Covid-19 Pandemic in Tertiary University Hospital

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm.06.02.01 ◽

2021 ◽

Vol 6 (2) ◽

Keyword(s):

Infection Rate ◽

Healthcare Workers ◽

Transmission Rate ◽

Critical Role ◽

Working Hours ◽

Infection Risk ◽

University Hospital ◽

Personal Protection ◽

Healthcare Staff ◽

Protective Measures

Background: A novel coronavirus “SARS-CoV-2” causes the disease COVID-19. A high transmission rate within healthcare workers was reported. We aimed to determine effect of our protective measures on infection rate, related risk factors and measures that can be taken among healthcare professionals in our university hospital. Methods: We conducted a retrospective cohort study to analyse the data of infected healthcare providers. Demographic data of the patients, computed tomography (CT) scan findings, laboratory parameters and any symptoms related with Covid-19 disease were recorded. The real‐time reverse transcription Polymerase Chain Reaction (PCR) results were evaluated. Results: The infection rate was 3.8% (143 of 3700 healthcare workers). Of 143 infected healthcare workers, 91 were female and 52 were male. Mean age of these patients was 32.5±8.6 years (Table 1). First PCR tests of 99 symptomatic healthcare staff were positive. Second tests of 84 of them were negative. The most common symptom was dry cough (47 patients, 32.8%). Treatment of 117 healthcare staff has been completed and they returned to work. Mortality or intensive care unit stay have not been observed. Conclusion: The transmission rate was relatively low in our university hospital. Our protective measures of increased awareness of personal protection, adherence to algorithms, supportive attitudes of hospital management, proper preparation and intervention play a critical role in reducing infection risk for healthcare workers. Public Interest Summary. Corona Virus (COVID 19) pandemic may continue for more time. To prevent its spread within health workers personnel, should follow a strict preventive measure. Increased awareness of personal protection equipment, adherence to algorithms, supportive attitudes of hospital management, proper preparation and intervention play a critical role in reducing infection risk for healthcare workers. Supportive behaviours of hospital administration and managers are essential to increase the enthusiasm of the staff. The Ministry of Health (MOH) should design a flexible working hours system and prevent long working hours under extreme pressure. All meetings are better to be held with a teleconference to prevent face-to-face transmission.

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A qualitative study of barriers and facilitators to adequate environmental health conditions and infection control for healthcare workers in Malawi

H2Open Journal ◽

10.2166/h2oj.2022.139 ◽

2022 ◽

Author(s):

Raymond Tu ◽

Hayley Elling ◽

Nikki Behnke ◽

Jennifer Mmodzi Tseka ◽

Holystone Kafanikhale ◽

...

Keyword(s):

Environmental Health ◽

Healthcare Workers ◽

Barriers And Facilitators ◽

Infection Prevention And Control ◽

Structured Interviews ◽

Middle Income ◽

Healthcare Facilities ◽

Management Procedures ◽

Water Provision ◽

Healthcare Associated

Abstract The burden of healthcare-associated infections (HAIs) is greater in low- and middle-income countries than in high-income countries. Inadequate environmental health (EH) conditions and work systems contribute to HAIs in countries like Malawi. We collected qualitative data from 48 semi-structured interviews with healthcare workers (HCWs) from 45 healthcare facilities (HCFs) across Malawi and conducted a thematic analysis. The facilitators of infection prevention and control (IPC) practices in HCFs included disinfection practices, patient education, and waste management procedures. HCWs reported barriers such as lack of IPC training, bottlenecks in maintenance and repair, hand hygiene infrastructure, water provision, and personal protective equipment. This is one of the most comprehensive assessments to date of IPC practices and environmental conditions in Malawian HCFs in relation to HCWs. A comprehensive understanding of barriers and facilitators to IPC practices will help decision-makers craft better interventions and policies to support HCWs to protect themselves and their patients.

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Implementation of a COVID-19 surveillance programme for healthcare workers in a teaching hospital in an upper-middle-income country

PLoS ONE ◽

10.1371/journal.pone.0249394 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249394

Author(s):

Kim Sui Wan ◽

Peter Seah Keng Tok ◽

Kishwen Kanna Yoga Ratnam ◽

Nuraini Aziz ◽

Marzuki Isahak ◽

...

Keyword(s):

High Risk ◽

Sore Throat ◽

Healthcare Worker ◽

Teaching Hospital ◽

Healthcare Workers ◽

Contact Tracing ◽

Risk Category ◽

Cross Sectional ◽

Middle Income ◽

Surveillance Programme

Introduction The reporting of Coronavirus Disease 19 (COVID-19) mortality among healthcare workers highlights their vulnerability in managing the COVID-19 pandemic. Some low- and middle-income countries have highlighted the challenges with COVID-19 testing, such as inadequate capacity, untrained laboratory personnel, and inadequate funding. This article describes the components and implementation of a healthcare worker surveillance programme in a designated COVID-19 teaching hospital in Malaysia. In addition, the distribution and characteristics of healthcare workers placed under surveillance are described. Material and methods A COVID-19 healthcare worker surveillance programme was implemented in University Malaya Medical Centre. The programme involved four teams: contact tracing, risk assessment, surveillance and outbreak investigation. Daily symptom surveillance was conducted over fourteen days for healthcare workers who were assessed to have low-, moderate- and high-risk of contracting COVID-19. A cross-sectional analysis was conducted for data collected over 24 weeks, from the 6th of March 2020 to the 20th of August 2020. Results A total of 1,174 healthcare workers were placed under surveillance. The majority were females (71.6%), aged between 25 and 34 years old (64.7%), were nursing staff (46.9%) and had no comorbidities (88.8%). A total of 70.9% were categorised as low-risk, 25.7% were moderate-risk, and 3.4% were at high risk of contracting COVID-19. One-third (35.2%) were symptomatic, with the sore throat (23.6%), cough (19.8%) and fever (5.0%) being the most commonly reported symptoms. A total of 17 healthcare workers tested positive for COVID-19, with a prevalence of 0.3% among all the healthcare workers. Risk category and presence of symptoms were associated with a positive COVID-19 test (p<0.001). Fever (p<0.001), cough (p = 0.003), shortness of breath (p = 0.015) and sore throat (p = 0.002) were associated with case positivity. Conclusion COVID-19 symptom surveillance and risk-based assessment have merits to be included in a healthcare worker surveillance programme to safeguard the health of the workforce.

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Correlation of National and Healthcare Workers COVID-19 Infection Data; Implications for Large-scale Viral Testing Programs

10.1101/2020.08.21.20179283 ◽

2020 ◽

Author(s):

Dan Wu ◽

Pol Mac Aonghusa ◽

Donal O'Shea

Keyword(s):

Time Series ◽

Disease Progression ◽

Healthcare Workers ◽

Large Scale ◽

Pathogen Transmission ◽

Entire Population ◽

Contact Tracing ◽

Smoothing Function ◽

Healthcare Facilities ◽

National Population

Time analysis of the course of an infectious disease epidemic is a critical way to understand the dynamics of pathogen transmission and the effect of population scale interventions. Computational methods have been applied to the progression of the COVID-19 outbreak in five different countries (Ireland, Germany, UK, South Korea and Iceland) using their reported daily infection data. A Gaussian convolution smoothing function constructed a continuous epidemic line profile that was segmented into longitudinal time series of mathematically fitted individual logistic curves. The time series of fitted curves allowed comparison of disease progression with differences in decreasing daily infection numbers following the epidemic peak being of specific interest. A positive relationship between rate of declining infections and countries with comprehensive COVID-19 testing regimes existed. In contrast, extended epidemic timeframes were recorded for those least prepared for large scale testing and contact tracing. As many countries continue to struggle to implement population wide testing it is prudent to explore additional measures that could be employed. Comparative analysis of healthcare worker (HCW) infection data from Ireland shows it closely related to that of the entire population with respect to trends of daily infection numbers and growth rates over a 57-day period. With 31.6% of all test-confirmed infections in healthcare workers (all employees of healthcare facilities), they represent a concentrated 3% subset of the national population which if exhaustively tested (regardless of symptom status) could provide valuable information on disease progression in the entire population (or set). Mathematically, national population and HCWs can be viewed as a set and subset with significant influences on each other, with solidarity between both an essential ingredient for ending this crisis.

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Methicillin-ResistantStaphylococcus aureusOutbreak at a Veterans' Affairs Medical Center: Importance of Carriage of the Organism by Hospital Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/646174 ◽

1990 ◽

Vol 11 (6) ◽

pp. 291-296 ◽

Cited By ~ 21

Author(s):

Annette C. Reboli ◽

Joseph F. John ◽

Christel G. Platt ◽

J. Robert Cantey

Keyword(s):

Infection Control ◽

Healthcare Workers ◽

Medical Center ◽

Veterans Affairs ◽

Control Measures ◽

University Hospital ◽

Contact Tracing ◽

Hospital Personnel ◽

Surgical Resident ◽

Number Of Patients

AbstractThe reported prevalence of nasal carriage of methicillin-resistantStaphylococcus aureus (MRSA) by hospital personnel averages 2.5%. From August 1985 to September 1987, 155 patients at our Veterans' Affairs Medical Center (VAMC) were colonized or infected with MRSA. In December 1986, only two (2.1%) of 94 healthcare workers were identified as nasal carriers. Prompted by a sharp increase in the number of patients with MRSA in early 1987, contact tracing identified 450 employees, of whom 36 (8%) were nasal carriers. Thirty-five percent of surgical residents (7 of 20) were nasal carriers. Prior to being identified as a nasal carrier, one surgical resident was associated with the inter-hospital spread of the VAMC MRSA strain to the burn unit of the affiliated university hospital. Three family members of two employee carriers were also found to harbor the epidemic strain. All 36 carriers were decolonized with various antimicrobial combinations. Vigorous infection control measures were effective in controlling the epidemic. The frequency of MRSA carriage by hospital personnel at our medical center during the epidemic proved higher than previously appreciated. Thus, healthcare workers may comprise a sizable MRSA reservoir. During an MRSA epidemic, infection control should attempt to identify and decolonize this hospital reservoir, as these individuals can disseminate MRSA both within the hospital as well as into the community.

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Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.290 ◽

2018 ◽

Vol 40 (1) ◽

pp. 79-88 ◽

Cited By ~ 14

Author(s):

Khalid H. Alanazi ◽

Marie E. Killerby ◽

Holly M. Biggs ◽

Glen R. Abedi ◽

Hani Jokhdar ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Outpatient Clinic ◽

Index Case ◽

Middle East Respiratory Syndrome ◽

Contact Tracing ◽

Care Hospital ◽

Healthcare Facilities ◽

Healthcare Associated ◽

Unique Index

AbstractObjectiveTo investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.DesignOutbreak investigation.SettingCases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.MethodsContact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.ResultsIn total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.ConclusionsWe describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.

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Measles outbreak in a tertiary level hospital, Porto, Portugal, 2018: challenges in the post-elimination era

Eurosurveillance ◽

10.2807/1560-7917.es.2018.23.20.18-00224 ◽

2018 ◽

Vol 23 (20) ◽

Cited By ~ 7

Author(s):

Rita Sá Machado ◽

Mariana Perez Duque ◽

Soraia Almeida ◽

Ivo Cruz ◽

Ana Sottomayor ◽

...

Keyword(s):

Healthcare Workers ◽

Healthcare Setting ◽

Northern Region ◽

Control Measures ◽

Tertiary Level ◽

Central Hospital ◽

Measles Outbreak ◽

Public Health Challenges ◽

Epidemiological Link ◽

Level Hospital

A measles outbreak has been occurring in a healthcare setting in Porto, Portugal, since early March 2018, posing public health challenges for a central hospital and the community. Up to 22 April, 96 cases were confirmed, 67 in vaccinated healthcare workers, mostly between 18-39 years old. Following identification of the first cases, control measures were rapidly implemented. Concomitantly, other measles cases were notified in the Northern Region of the country. No common epidemiological link was identified.

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