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Abstract
The seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG antibody was evaluated among employees of a Veterans Affairs healthcare system to assess potential risk factors for transmission and infection. All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or nonclinical duties. The initiative was conducted from June 8 to July 8, 2020. Of the 2,900 employees, 51% participated in the study, revealing a positive SARS-CoV-2 seroprevalence of 4.9% (72 of 1,476; 95% CI, 3.8%-6.1%). There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol-generating procedures, or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside work had a significantly higher seroprevalence at 14.8% (23 of 155) compared to those who did not 3.7% (48 of 1,296; OR, 4.53; 95% CI, 2.67-7.68; P < .0001). Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection. The seroprevalence of SARS-CoV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting that facility-wide infection control measures were effective. Employees who reported direct personal contact with COVID-19-positive persons outside work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside work may introduce infection into hospitals.
Highlights
The seroprevalence of SARS-CoV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting that facility-wide infection control measures were effective
Access to COVID19 testing by reverse transcriptase-polymerase chain reaction (RTPCR) during this time was limited to symptomatic individuals, so rates of infection in asymptomatic or minimally symptomatic employees have been difficult to determine
All personnel who worked on the COVID-19 wards were provided powered air purifying respirators (PAPRs) or N95 respirators along with personal protective equipment (PPE), which consisted of face shields, gowns, and gloves according to the Centers for Disease Control and Prevention (CDC) recommendations in the winter of 2020
Summary
All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or nonclinical duties. The VAAAHS is a tertiary-care referral facility within the VA healthcare system that encompasses 5 community-based outpatient clinics. It serves veteran patients in Michigan and Ohio and employs ~2,900 staff. The COVID-19 wards were converted to negative pressure environments on March 23, 2020, and negative pressure was verified by daily smoke testing. On this date, the State of Michigan implemented a stayat-home order. All other employees providing direct patient care and patients entering the Ann Arbor VA were required to wear a face mask at all times effective March 28, 2020. On April 16, 2020, there was a universal mask requirement for anyone entering the hospital (Fig. 1)
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