COVID-19 in health-care workers: Testing and outcomes at a Victorian tertiary children's hospital.

Abstract

In this global pandemic, health-care workers are an invaluable resource.1 With the state of Victoria, Australia experiencing increasing numbers of COVID-19 cases, the proportion of affected health-care workers remains unclear; as is the source of infection.2 Health-care workers providing care to children are in a unique situation, primarily because children are less likely to acquire COVID-19 infection, show symptoms and have milder disease compared to adults.3 To date, children comprise 1891/12 335 (15%) of positive cases in Victoria with those <10 years being the lowest affected age group at 49 cases per 100 000.4 Specific efforts to minimise exposure to SARS-CoV-2 are critical to protect against nosocomial transmission and front-line health-care workers.5 The Royal Children's Hospital Melbourne implemented infection prevention and control strategies to reduce the risk of COVID-19 among staff. Individual focused strategies included access to supports such as a dedicated clinic with prioritised testing and result notification, a well-being programme and COVID-19 leave. Campus transmission reduction strategies included regular COVID-19 updates from hospital executive on use of personal protective equipment (PPE), access to appropriate PPE, daily staff temperature and symptom screening, supporting work from home, cohorting staff into teams and creating patient zones to reduce unnecessary interaction, as well as expedient internal contact tracing when appropriate. This study aimed to describe COVID-19 testing and infection in health-care workers at the Melbourne Children's Campus, encompassing Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne (Paediatrics) during the first 5 months of the pandemic. Health-care workers presenting for testing to the emergency department or the respiratory infection clinic were asked to complete a web-based questionnaire to report risk factors (defined as close contact with SARS-CoV-2 or overseas travel in the previous 14 days), symptoms and comorbidities. Institutional ethics approval was obtained. Health-care workers who underwent testing externally and informed the research team were included. Demographic data and SARS-CoV-2 test results were extracted from the hospital medical records. Descriptive data were presented as mean (standard deviation) for continuous variables and number (%) for categorical variables. Continuous variables were compared using t tests and mean differences presented; categorical variables were compared using χ2 test and risk differences presented. A two-sided α less than 0.05 was considered statistically significant. Over 5 months, 1964 health-care workers were tested for SARS-CoV-2 with 2796 tests performed (Table 1). There were 1387 (71%) who tested once, 322 (16%) tested twice and 255 (13%) tested three or more times. Of 2796 tests, 11 (0.4%) were positive, consistent with 11/1964 (0.6%) of healthcare-workers with COVID-19, nine of whom were clinical staff. Eight were aged under 50 years and none had comorbidities. During March/April, three of four staff with COVID-19 were returned travellers (Fig. 1). In May, a single case was detected during asymptomatic testing with no known risk factors. During June/July, five of six had no risk factors. The remaining health-care worker tested positive during asymptomatic testing of all staff in the neonatal unit, where a patient and two parents were infected. Nine staff recovered at home without hospital admission, with two still recovering. Seventy-three staff were placed into 14 days of quarantine following close contact with a SARS-CoV-2 positive patient or other staff member. This assessment of SARS-CoV-2 testing in a children's hospital, including a recent outbreak identified a low rate of infection in health-care workers. This is consistent with early data at our institution that showed a low proportion of children testing positive at <1%.6 Measures were taken when an outbreak was identified to reduce, contain and limit nosocomial infection including temporarily closing the neonatal unit to admissions (diverted to the paediatric intensive care unit), allocating single-rooms for all patients, widespread testing and furloughing of all potentially exposed staff. Our current positive test rate of 0.4% is similar to the overall Victorian rate (0.7%).7 Those affected recently were less likely to have a source identified despite contact tracing which reflects growing community transmission. Exposure to relatively few COVID-19 cases in children, together with measures currently in place support a safe environment for staff, patients and their families. Ongoing vigilance and a rapid response to evolving outbreaks, with strict adherence to the use of PPE, hand hygiene and physical distancing continue to be important with rising community case numbers. Ethics approval was obtained from the Royal Children's Hospital Human Research Ethics Committee (63013). LF Ibrahim is supported in part by a Melbourne Campus Clinician Scientist Fellowship. PA Bryant is in part supported by a National Health and Medical Research Council Investigator grant. FE Babl was supported in part by a National Health and Medical Research Council Practitioner Fellowship, Canberra, Australia.