Occupational exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and risk of infection among healthcare personnel.

Vishal P Shah,Emily R Stratton,Julie M Alleckson,Laura E Breeher,David G Rivers,Zhen Wang,Caitlin M Hainy,Wigdan Farah,Melanie D Swift

doi:10.1017/ice.2021.533

Abstract

To assess the rate and factors associated with healthcare personnel (HCP) testing positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) after an occupational exposure. Retrospective cohort study. Academic medical center with sites in Minnesota, Wisconsin, Arizona, and Florida. HCP with a high or medium risk occupational exposure to a patient or other HCP with SARS-CoV-2. We reviewed the records of HCP with significant occupational exposures from March 20, 2020, through December 31, 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. In total, 2,253 confirmed occupational exposures occurred during the study period. Employees were the source for 57.1% of exposures. Overall, 101 HCP (4.5%) tested positive in the postexposure period. Of these, 80 had employee sources of exposure and 21 had patient sources of exposure. The postexposure 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 (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.72-6.04). Sex, age, high-risk exposure, and HCP role were not associated with an increased risk of testing positive. The risk of acquiring coronavirus disease 2019 (COVID-19) following a significant occupational exposure has remained relatively low, even in the prevaccination era. Exposure to an infectious coworker carries a higher risk than exposure to a patient. Continued vigilance and precautions remain necessary in healthcare settings.

Highlights

The incidence of asymptomatic infection after a known occupational exposure is not well understood. Given these discrepancies and gaps in the literature, we evaluated all reported occupational exposures to SARS-CoV-2 at a multistate, tertiary-care medical center to assess factors associated with infection, including Healthcare personnel (HCP) role and exposure source
This study is a retrospective analysis of all confirmed medium and high-risk occupational exposure incidents to other employees and patients documented in the occupational health service (OHS) COVID-19 database from March 20, 2020, through December 31, 2020, at a large, multisite US academic medical center
Multiple studies have shown an increased likelihood of contracting COVID-19 in community settings compared to occupational settings.[2,12]

Summary

Introduction

Every employee that tested positive for SARS-CoV-2 underwent an assessment for symptoms, source of infection, and secondary exposures to other HCP. Among SARS-CoV-2–positive HCP, employee sources of exposure were more likely to be high risk (83.8%) compared to patient sources (47.6%).

Results

Conclusion