Abstract
Identifying health care settings and professionals at increased risk of SARS-CoV-2 infection is crucial to defining appropriate strategies, resource allocation, and protocols to protect health care workers (HCWs) and patients. Moreover, such information is crucial to decrease the risk that HCWs and health care facilities become amplifiers for SARS-CoV-2 transmission in the community. To assess the association of different health care professional categories and operational units, including in-hospital wards, outpatient facilities, and territorial care departments, with seroprevalence and odds of SARS-CoV-2 infection. This cross-sectional study was conducted using IgG serological tests collected from April 1 through May 26, 2020, in the Lombardy region in Italy. Voluntary serological screening was offered to all clinical and nonclinical staff providing any health care services or support to health care services in the region. Data were analyzed from June 2020 through April 2021. Employment in the health care sector. Seroprevalence of positive IgG antibody tests for SARS-CoV-2 was collected, and odds ratios of experiencing infection were calculated. A total of 140 782 professionals employed in the health sector were invited to participate in IgG serological screening, among whom 82 961 individuals (59.0% response rate) were tested for SARS-CoV-2 antibodies, with median (interquartile range [IQR]; range) age, 50 (40-56; 19-83) years and 59 839 (72.1%) women. Among these individuals, 10 115 HCWs (12.2%; 95% CI, 12.0%-12.4%) had positive results (median [IQR; range] age, 50 [39-55; 20-80] years; 7298 [72.2%] women). Statistically significantly higher odds of infection were found among health assistants (adjusted odds ratio [aOR], 1.48; 95% CI, 1.33-1.65) and nurses (aOR, 1.28; 95% CI, 1.17-1.41) compared with administrative staff and among workers employed in internal medicine (aOR, 2.24; 95% CI, 1.87-2.68), palliative care (aOR, 1.84; 95% CI, 1.38-2.44), rehabilitation (aOR, 1.59; 95% CI, 1.33-1.91), and emergency departments (aOR, 1.56; 95% CI, 1.29-1.89) compared with those working as telephone operators. Statistically significantly lower odds of infection were found among individuals working in forensic medicine (aOR, 0.40; 95% CI, 0.19-0.88), histology and anatomical pathology (aOR, 0.71; 95% CI, 0.52-0.97), and medical device sterilization (aOR, 0.54; 95% CI, 0.35-0.84) compared with those working as telephone operators. The odds of infection for physicians and laboratory personnel were not statistically significantly different from those found among administrative staff. The odds of infection for workers employed in intensive care units and infectious disease wards were not statistically significantly different from those of telephone operators. These findings suggest that professionals partially accustomed to managing infectious diseases had higher odds of SARS-CoV-2 infection. The findings further suggest that adequate organization of clinical wards and personnel, appropriate personal protective equipment supply, and training of all workers directly and repeatedly exposed to patients with clinical or subclinical COVID-19 should be prioritized to decrease the risk of infection in health care settings.
Highlights
Health care workers (HCWs) are essential for the functioning of modern societies
Significantly higher odds of infection were found among health assistants and nurses compared with administrative staff and among workers employed in internal medicine, palliative care, rehabilitation, and emergency departments compared with those working as telephone operators
The findings further suggest that adequate organization of clinical wards and personnel, appropriate personal protective equipment supply, and training of all workers directly and repeatedly exposed to patients with clinical or subclinical COVID-19 should be prioritized to decrease the risk of infection in health care settings
Summary
Health care workers (HCWs) are essential for the functioning of modern societies. During the first phase of the COVID-19 pandemic, health care professionals were at high risk of SARSCoV-2 infection, possibly owing to insufficient preparedness for managing a rapid increase in the number of patients seeking primary care and inadequate access to or use of personal protective equipment (PPE).[1,2,3] The capability of SARS-CoV-2 to be transmitted from individuals who are asymptomatic and presymptomatic[4,5] likely contributed to increased risk among HCWs, as a consequence of a high number of contacts with undiagnosed infections in clinical settings.Estimates based on pooled serological studies carried out in different countries suggest that 7% to 8.7% of HCWs were infected by SARS-CoV-2.6,7 the seroprevalence among people employed in the health sector shows a high variability across countries, ranging from 4% in Denmark to more than 13% in the US.[7,8,9,10,11,12,13] Heterogeneous infection risks across different categories of hospital wards and health care professions have emerged as well, suggesting that frontline HCWs had greater exposure to SARS-CoV-2 infection compared with nonclinical staff.[6,7,8,11,12,13,14,15,16] Infection risks in different clinical settings may be associated with how these settings were organized, equipped, and prepared in different geographical areas to face the increase in number of patients during the COVID-19 pandemic. Health care workers (HCWs) are essential for the functioning of modern societies. During the first phase of the COVID-19 pandemic, health care professionals were at high risk of SARSCoV-2 infection, possibly owing to insufficient preparedness for managing a rapid increase in the number of patients seeking primary care and inadequate access to or use of personal protective equipment (PPE).[1,2,3] The capability of SARS-CoV-2 to be transmitted from individuals who are asymptomatic and presymptomatic[4,5] likely contributed to increased risk among HCWs, as a consequence of a high number of contacts with undiagnosed infections in clinical settings. A comprehensive analysis of the relative risk of SARS-CoV-2 infection across different health departments and professional categories is still lacking
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