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

BACKGROUND During the COVID-19 pandemic, many ambulatory clinics transitioned to telehealth, but it remains unknown how this may have exacerbated inequitable access to care. OBJECTIVE Given the potential barriers faced by different populations, we investigated whether telehealth use is consistent and equitable across age, race, and gender. METHODS Our retrospective cohort study of outpatient visits was conducted between March 2 and June 10, 2020, compared with the same time period in 2019, at a single academic health center in Boston, Massachusetts. Visits were divided into in-person visits and telehealth visits and then compared by racial designation, gender, and age. RESULTS At our academic medical center, using a retrospective cohort analysis of ambulatory care delivered between March 2 and June 10, 2020, we found that over half (57.6%) of all visits were telehealth visits, and both Black and White patients accessed telehealth more than Asian patients. CONCLUSIONS Our findings indicate that the rapid implementation of telehealth does not follow prior patterns of health care disparities.

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Healthcare personnel absenteeism, presenteeism, and staffing challenges during epidemics

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.453 ◽

2020 ◽

pp. 1-4

Author(s):

Douglas W. Challener ◽

Laura E. Breeher ◽

JoEllen Frain ◽

Melanie D. Swift ◽

Pritish K. Tosh ◽

...

Keyword(s):

Seasonal Influenza ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Healthcare Personnel ◽

Linear Regression Models ◽

Influenza Like Illness ◽

Healthcare Workforce ◽

Academic Medical ◽

Hourly Employees

Abstract: Objective: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans. Design: Retrospective cohort study. Setting: Large academic medical center in the United States. Participants: Employees of the academic medical center who were on payroll between the years of 2009 and 2019. Methods: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI. Results: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees. Conclusions: Organizations should target their messaging at encouraging salaried staff to stay home when ill.

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Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/1471-2393-13-168 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 23

Author(s):

Joyce K Edmonds ◽

Revital Yehezkel ◽

Xun Liao ◽

Tiffany A Moore Simas

Keyword(s):

Cohort Study ◽

Ethnic Differences ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

Academic Medical Center ◽

Racial And Ethnic Differences ◽

Cesarean Deliveries ◽

Academic Medical ◽

Primiparous Women

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Impact of Telemedicine Use on Blood Pressure Control During the Covid-19 Pandemic: A Cohort Study (Preprint)

10.2196/preprints.32403 ◽

2021 ◽

Author(s):

Siqin Ye ◽

D. Edmund Anstey ◽

Anne Grauer ◽

Gil Metser ◽

Nathalie Moise ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Retrospective Cohort ◽

Primary Outcome ◽

Medical Center ◽

Academic Medical Center ◽

Pressure Control ◽

Care Quality ◽

Academic Medical ◽

Cardiovascular Care

BACKGROUND Telemedicine use vastly expanded during the Covid-19 pandemic, with uncertain impact on cardiovascular care quality. OBJECTIVE We sought to examine the association between telemedicine use and blood pressure (BP) control. METHODS This is a retrospective cohort study of 32,727 adult patients with hypertension (HTN) seen in primary care and cardiology clinics at an urban, academic medical center from February to December, 2020. The primary outcome was poor BP control, defined as having no BP recorded OR if the last recorded BP was ≥140/90 mmHg. Multivariable logistic regression was used to assess the association between telemedicine use during the study period (none, 1 telemedicine visit, 2+ telemedicine visits) and poor BP control, adjusting for demographic and clinical characteristics. RESULTS During the study period, no BP was recorded for 486/20,745 (2.3%) patients with in-person visits only, for 1,863/6,878 (27.1%) patients with 1 telemedicine visit, and for 1,277/5,104 (25.0%) patients with 2+ telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (odds ratio [OR], 2.06, 95% confidence interval [CI] 1.94 to 2.18, p<.001 for 1 telemedicine visit, and OR 2.49, 95% CI 2.31 to 2.68, p<.001 for 2+ telemedicine visits; reference, in-person visit only). This effect disappears when analysis was restricted to patients with at least one recorded BP (OR 0.89, 95% CI 0.83 to 0.95, p=.001 for 1 telemedicine visit, and OR 0.91, 95% CI 0.83 to 0.99, p=.03 for 2+ telemedicine visits). CONCLUSIONS BP is less likely to be recorded during telemedicine visits, but telemedicine use does not negatively impact BP control when BP is recorded. CLINICALTRIAL NA

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Implementation of an Enhanced Safety-Engineered Sharp Device Oversight and Bloodborne Pathogen Protection Program at a Large Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1086/678417 ◽

2014 ◽

Vol 35 (11) ◽

pp. 1383-1390 ◽

Cited By ~ 3

Author(s):

Thomas R. Talbot ◽

Deede Wang ◽

Melanie Swift ◽

Paul St. Jacques ◽

Susan Johnson ◽

...

Keyword(s):

Program Analysis ◽

Medical Center ◽

Academic Medical Center ◽

Healthcare Personnel ◽

Safety Device ◽

Bloodborne Pathogens ◽

Academic Medical ◽

Online Submission ◽

Vanderbilt University ◽

Safe Practices

Objective.Exposure of healthcare personnel to bloodborne pathogens (BBPs) can be prevented in part by using safety-engineered sharp devices (SESDs) and other safe practices, such as double gloving. In some instances, however, safer devices and practices cannot be utilized because of procedural factors or the lack of a manufactured safety device for the specific clinical use. In these situations, a standardized system to examine requests for waiver from expected practices is necessaryDesign.Before-after program analysis.Setting.Large academic medical center.Interventions.Vanderbilt University Medical Center developed a formalized system for an improved waiver process, including an online submission and tracking site, and standards surrounding implementation of core safe practices. The program’s impact on sharp device injuries and utilization of double gloving and blunt sutures was examined.Results.Following implementation of the enhanced program, there was an increase in the amount of undergloves and blunt sutures purchased for surgical procedures, suggesting larger utilization of these practices. The rate of sharp device injuries of all at-risk employees decreased from 2.32% to 2.12%, but this decline was not statistically significant (P = .14). The proportion of reported injuries that were deemed preventable significantly decreased from 72.7% (386/531) before implementation to 63.9% (334/523; P = .002) after implementation of the enhanced program.Conclusions.An enhanced BBP protection program was successful at providing guidance to increase safe practices and at improving the management of SESD waiver requests and was associated with a reduction in preventable sharp device injuries.

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Real-world impact of vaccination on COVID-19 incidence in health care personnel at an academic medical center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.336 ◽

2021 ◽

pp. 1-21

Author(s):

Sarah E. Waldman ◽

Jason Y. Adams ◽

Timothy E. Albertson ◽

Maya M. Juárez ◽

Sharon L Myers ◽

...

Keyword(s):

Real World ◽

Medical Center ◽

Vaccination Campaign ◽

Academic Medical Center ◽

Vaccine Hesitancy ◽

Healthcare Personnel ◽

Frontline Employees ◽

Work Location ◽

Respiratory Therapists ◽

Academic Medical

Abstract Objective: COVID-19 vaccination effectiveness in healthcare personnel (HCP) has been established, however, questions remain about its performance in high-risk healthcare occupations and work locations. We describe the effect of a COVID-19 HCP vaccination campaign on SARS-CoV-2 infection by timing of vaccination, job type, and work location. Methods: A retrospective review of COVID-19 vaccination acceptance, incidence of post-vaccination COVID-19 infection, hospitalization, and mortality among 16,156 faculty, students, and staff at a large academic medical center was conducted. Data were collected 8 weeks prior to the start of Phase 1a vaccination of frontline employees and ended 11 weeks after campaign completion. Results: COVID-19 employee incidence rate at our institution decreased from 3.2% during the 8 weeks prior to the start of vaccinations to 0.38% by four weeks after campaign initiation. SARS-CoV-2 infection risk was reduced among individuals receiving a single vaccination (HR = 0.52 [0.40, 0.68], p<0.0001) and further reduced with 2 doses of vaccine (HR = 0.17 [0.09, 0.32], p<0.0001). By two weeks after the second dose, the observed case positivity rate was 0.04%. Among Phase 1a HCP, we observed a lower risk of SARS-CoV-2 infection among physicians and a trend toward higher risk for respiratory therapists independent of vaccination status. Rates of infection were similar in a sub-group of nurses when examined by work location. Conclusions: Our findings show the real-world effectiveness of COVID-19 vaccination in HCP. Despite these encouraging results, unvaccinated HCP remain at an elevated risk of infection highlighting the need for targeted outreach to combat vaccine hesitancy.

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The prevalence of COVID-19 in healthcare personnel in an adult and pediatric academic medical center

American Journal of Infection Control ◽

10.1016/j.ajic.2021.01.004 ◽

2021 ◽

Vol 49 (5) ◽

pp. 542-546

Author(s):

John Shepard ◽

Samantha M.R. Kling ◽

Grace Lee ◽

Frances Wong ◽

John Frederick ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Healthcare Personnel ◽

Academic Medical

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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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Occupational Exposure to SARS-CoV-2 and Risk of Infection Among Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.533 ◽

2022 ◽

pp. 1-13

Author(s):

Vishal P. Shah ◽

Laura E. Breeher ◽

Julie M. Alleckson ◽

David G. Rivers ◽

Zhen Wang ◽

...

Keyword(s):

Occupational Exposure ◽

Medical Center ◽

Academic Medical Center ◽

Occupational Exposures ◽

Healthcare Personnel ◽

Healthcare Settings ◽

Academic Medical ◽

Increased Risk ◽

Medium Risk ◽

The Impact

Abstract Objective: To assess the rate and factors associated with healthcare personnel (HCP) testing positive for SARS-CoV-2 after an occupational exposure Design: Retrospective cohort study Setting: Academic medical center with sites in Minnesota, Wisconsin, Arizona, and Florida Subjects: HCP with a high or medium risk occupational exposure to a patient or other HCP with SARS-CoV-2 Methods: We reviewed the records of HCP with significant occupational exposures from March 20th, 2020 through December 31st, 2020. We then performed regression analysis to assess the impact of demographic and occupational variables to assess their impact on the likelihood of testing positive for SARS-CoV-2 Results: A total of 2,253 confirmed occupational exposures occurred during the study period. Employees were the source for 57.1% of exposures. Overall, 101 (4.5%) HCP tested positive in the postexposure period. Of these, 80 had employee sources of exposure and 21 had patient sources of exposure. The post exposure infection rate was 6.2% when employees were the source, compared to 2.2% with patient sources. In a multivariate analysis, occupational exposure from an employee source had a higher risk of testing positive compared to a patient source (OR 3.22 95% CI (1.72-6.04)). Gender, age, high-risk exposure, and HCP role were not associated with increased risk of testing positive. Conclusions: The risk of acquiring COVID-19 following a significant occupational exposure is relatively low, even in the pre-vaccination era. Exposure to an infectious coworker carries a higher risk than exposure to a patient. Continued vigilance and precautions remain necessary in healthcare settings.

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