Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community

Shruti K Gohil ,Sherif Rezk ,Aarti Jain,Tom Tjoa,Usme Khusbu,Edwin S Monuki,Kathleen A Quan,Rafael Ramiro De Assis ,Delia F Tifrea ,Cassiana E Bittencourt,W Chang ,Lanny Hsieh,Robert Edwards,Sebastian Schubl ,Bridgit Crews ,Saahir Khan,Michael J Stamos,Philip L Felgner ,Donald N Forthal ,Neil Detweiler,Cesar Figueroa,Suzanne King-Adelsohn,William C Wilson,Lynn Willis,Antonella Saturno,Keith Madey ,Susan S Huang

doi:10.1186/s13756-021-01031-5

Abstract

BackgroundEarly evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks.MethodsPrior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology.ResultsOf 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05–3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28–3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00–2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12–3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30–0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01).ConclusionsPrior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.Article summaryPrior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.

Highlights

Exposure to transmissible diseases is a known occupational hazard for healthcare professionals (HCPs), which warrants robust infection prevention protocols
Article summary: Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission
We evaluated whether HCP roles, documented COVID-19 patient care, coworker exposures, and geocoded community characteristics were associated with the likelihood of polymerase chain reaction (PCR) or serology positive COVID-19, enriching for those presenting to Occupational Health (OH) with symptoms, those working in COVID-19-designated care units, those on units with COVID-19 HCP outbreaks, and control nonCOVID-19 designated units without HCP outbreaks

Summary

Introduction

Exposure to transmissible diseases is a known occupational hazard for healthcare professionals (HCPs), which warrants robust infection prevention protocols. Many currently available studies assess COVID-19 incidence or prevalence among randomly sampled HCPs and infer occupational risk by defining exposure broadly as having worked in healthcare or in a COVID-19 patient unit without addressing ongoing clusters/outbreaks related to coworkers working while ill or community exposures [2, 4, 5, 7,8,9]. Epidemiologic studies are needed that assess the added risk borne by HCPs due to COVID-19 patient care compared to exposures from coworker in the healthcare setting and the communities where they live. Evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks

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