Decision letter: Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study

ObjectiveTo describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit.DesignProspective observational study of RPE fit testing according to health and safety, and occupational health requirements.SettingA large tertiary referral UK healthcare facility.Population1443 healthcare workers undergoing quantitative fit testing.Main outcome measuresQuantitative fit test success (pass/fail) and the count of tests each participant required before successful fit.ResultsHealthcare workers were fit tested a median (IQR) 2 (1–3) times before successful fit was obtained. Males were tested a median 1 (1–2) times, while females were tested a median 2 (1–2) times before a successful fit was found. This difference was statistically significant (p<0.001). Modelling each fit test as its own independent trial (n=2359) using multivariable logistic regression, male healthcare workers were significantly more likely to find a well-fitting respirator and achieve a successful fit on first attempt in comparison to females, after adjusting for other factors (adjusted OR=2.07, 95% CI): 1.66 to 2.60, p<0.001). Staff who described their ethnicity as White were also more likely to achieve a successful fit compared with staff who described their ethnicity as Asian (OR=0.47, 95% CI: 0.38 to 0.58, p<0.001), Black (OR=0.54, 95% CI: 0.41 to 0.71, p<0.001), mixed (OR=0.50 95% CI: 0.31 to 0.80, p=0.004) or other (OR=0.53, 95% CI: 0.29 to 0.99, p=0.043).ConclusionsMale and White ethnicity healthcare workers are more likely to achieve RPE fit test success. This has broad operational implications to healthcare services with a large female and Black, Asian and minority ethnic group population. Fit testing is imperative in ensuring RPE effectiveness in protecting healthcare workers during the COVID-19 pandemic and beyond.

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Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study

eLife ◽

10.7554/elife.60675 ◽

2020 ◽

Vol 9 ◽

Cited By ~ 9

Author(s):

David W Eyre ◽

Sheila F Lumley ◽

Denise O'Donnell ◽

Mark Campbell ◽

Elizabeth Sims ◽

...

Keyword(s):

Healthcare Workers ◽

Prospective Observational Study ◽

Household Contact ◽

Questionnaire Data ◽

Igg Antibodies ◽

Acute Medicine ◽

Intensive Care Unit Staff ◽

Occupational Risks ◽

Potential Risk Factors ◽

Positive Results

We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034 (11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45–6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99–3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07–2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28–0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25–2.21]) and Asian (1.51 [1.28–1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34–3.15]).

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Differential occupational risks to healthcare workers from SARS-CoV-2: A prospective observational study

10.1101/2020.06.24.20135038 ◽

2020 ◽

Cited By ~ 2

Author(s):

David W Eyre ◽

Sheila F Lumley ◽

Denise O’Donnell ◽

Mark Campbell ◽

Elizabeth Sims ◽

...

Keyword(s):

Risk Factors ◽

Healthcare Workers ◽

Prospective Observational Study ◽

Contact Tracing ◽

Acute Medicine ◽

Case Identification ◽

Occupational Risks ◽

Increased Risk ◽

Potential Risk Factors ◽

Positive Results

AbstractBackgroundPersonal protective equipment (PPE) and social distancing are designed to mitigate risk of occupational SARS-CoV-2 infection in hospitals. Why healthcare workers nevertheless remain at increased risk is uncertain.MethodsWe conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using nasopharyngeal PCR testing and immunoassays for IgG antibodies. A positive result by either modality determined a composite outcome. Risk-factors for Covid-19 were investigated using multivariable logistic regression.Results1083/9809(11.0%) staff had evidence of Covid-19 at some time and provided data on potential risk-factors. Staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.63 [95%CI 3.30-6.50]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (21.2% vs. 8.2% elsewhere) (aOR 2.49 [2.00-3.12]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.50 [1.05-2.15]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit (ICU) staff were relatively protected (0.46 [0.29-0.72]). Positive results were more likely in Black (1.61 [1.20-2.16]) and Asian (1.58 [1.34-1.86]) staff, independent of role or working location, and in porters and cleaners (1.93 [1.25-2.97]). Contact tracing around asymptomatic staff did not lead to enhanced case identification. 24% of staff/patients remained PCR-positive at ≥6 weeks post-diagnosis.ConclusionsIncreased Covid-19 risk was seen in acute medicine, among Black and Asian staff, and porters and cleaners. A bundle of PPE-related interventions protected staff in ICU.

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An Integrated Strategy for the Prevention of SARS-CoV-2 Infection in Healthcare Workers: A Prospective Observational Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165785 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5785 ◽

Cited By ~ 2

Author(s):

Anna Maria Cattelan ◽

Lolita Sasset ◽

Eugenia Di Meco ◽

Silvia Cocchio ◽

Francesco Barbaro ◽

...

Keyword(s):

Observational Study ◽

Infection Control ◽

Control Strategy ◽

Healthcare Workers ◽

Prospective Observational Study ◽

Secondary Endpoint ◽

University Hospital ◽

Healthcare Personnel ◽

North East ◽

Hospital Infection Control

Background: Since the beginning of SARS-CoV-2 outbreak, a large number of infections have been reported among healthcare workers (HCWs). The aim of this study was to investigate the occurrence of SARS-CoV-2 infection among HCWs involved in the first management of infected patients and to describe the measures adopted to prevent the transmission in the hospital. Methods: This prospective observational study was conducted between February 21 and April 16, 2020, in the Padua University Hospital (north-east Italy). The infection control policy adopted consisted of the following: the creation of the “Advanced Triage” area for the evaluation of SARS-CoV-2 cases, and the implementation of an integrated infection control surveillance system directed to all the healthcare personnel involved in the Advance Triage area. HCWs were regularly tested with nasopharyngeal swabs for SARS-CoV-2; body temperature and suggestive symptoms were evaluated at each duty. Demographic and clinical data of both patients and HCWs were collected and analyzed; HCWs’ personal protective equipment (PPE) consumption was also recorded. The efficiency of the control strategy among HCWs was evaluated identifying symptomatic infection (primary endpoint) and asymptomatic infection (secondary endpoint) with confirmed detection of SARS-CoV-2. Results: 7595 patients were evaluated in the Advanced Triage area: 5.2% resulted positive and 72.4% was symptomatic. The HCW team was composed of 60 members. A total of 361 nasopharyngeal swabs were performed on HCWs. All the swabs resulted negative and none of the HCWs reached the primary or the secondary endpoint. Conclusions: An integrated hospital infection control strategy, consisting of dedicated areas for infected patients, strict measures for PPE use and mass surveillance, is successful to prevent infection among HCWs.

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