COVID-19 Infections In Healthcare Workers Research Articles

COVID-19 infection in healthcare workers in ancona, italy, 2020-2022: an observational longitudinal study

COVID-19 infection in healthcare workers in ancona, italy, 2020-2022: an observational longitudinal study

Factors Affecting Fear of COVID-19 Infection in Healthcare Workers in COVID-19 Dedicated Teams: Focus on Professional Quality of Life.

This study examined factors related to high fear of coronavirus disease 2019 (COVID-19) infection in healthcare workers (HCWs) in COVID-19 dedicated teams. We assigned 371 HCWs to low, medium, and high COVID-19 infection fear groups, and investigated factors associated with COVID-19 infection fear. High COVID-19 infection fear was significantly associated with being a woman and poor professional quality of life. High COVID-19 infection fear group had higher burnout levels and secondary traumatic stress scores than the low and medium fear groups. These findings deepen our understanding of risk factors for and psychological outcomes of COVID-19 infection fear in HCWs.

Primary SARS-CoV-2 Infections, Re-infections and Vaccine Effectiveness during the Omicron Transmission Period in Healthcare Workers of Trieste and Gorizia (Northeast Italy), 1 December 2021-31 May 2022.

Objective: To evaluate the incidence of primary and recurrent COVID-19 infections in healthcare workers (HCWs) routinely screened for SARS-CoV-2 by nasopharyngeal swabs during the Omicron wave. Design: Dynamic Cohort study of HCWs (N = 7723) of the University Health Agency Giuliano Isontina (ASUGI), covering health services of the provinces of Trieste and Gorizia (Northeast Italy). Cox proportional hazard model was employed to estimate the risk of primary as well as recurrent SARS-CoV-2 infection from 1 December 2021 through 31 May 2022, adjusting for a number of confounding factors. Results: By 1 December 2021, 46.8% HCWs of ASUGI had received the booster, 37.2% were immunized only with two doses of COVID-19 vaccines, 6.0% only with one dose and 10.0% were unvaccinated. During 1 March 2020-31 May 2022, 3571 primary against 406 SARS-CoV-2 recurrent infections were counted among HCWs of ASUGI, 59.7% (=2130/3571) versus 95.1% (=386/406) of which occurring from 1 December 2021 through 31 May 2022, respectively. All HCWs infected by SARS-CoV-2 during 1 December 2021 through 31 May 2022 presented mild flu-like disease. Compared to staff working in administrative services, the risk of primary as well as recurrent SARS-CoV-2 infection increased in HCWs with patient-facing clinical tasks (especially nurses and other categories of HCWs) and in all clinical wards but COVID-19 units and community health services. Regardless of the number of swab tests performed during the study period, primary infections were less likely in HCWs immunized with one dose of COVID-19 vaccine. By contrast, the risk of SARS-CoV-2 re-infection was significantly lower in HCWs immunized with three doses (aHR = 0.58; 95%CI: 0.41; 0.80). During the study period, vaccine effectiveness (VE = 1-aHR) of the booster dose declined to 42% against re-infections, vanishing against primary SARS-CoV-2 infections. Conclusions: Though generally mild, SARS-CoV-2 infections and re-infections surged during the Omicron transmission period. Compared to unvaccinated colleagues, the risk of primary SARS-CoV-2 infection was significantly lower in HCWs immunized just with one dose of COVID-19 vaccines. By Italian law, HCWs immunized only with one dose were either suspended or re-assigned to job tasks not entailing patient facing contact; hence, while sharing the same biological risk of unvaccinated colleagues, they arguably had a higher level of protection against COVID-19 infection. By contrast, SARS-CoV-2 re-infections were less likely in HCWs vaccinated with three doses, suggesting that hybrid humoral immunity by vaccination combined with natural infection provided a higher level of protection than vaccination only. In this stage of the pandemic, where SARS-CoV-2 is more infectious yet much less pathogenic, health protection measures in healthcare premises at higher biological risk seem the rational approach to control the transmission of the virus.

Recurrence of COVID-19 Infection in Healthcare Workers after complete Vaccination

Background: COVID-19 is a novel infection. Since its first case report in 2019, it has affected population globally. Healthcare workers are at most risk as they are in direct contact with patients. Aim: To record recurrence of symptomatic COVID 19 after complete doses of Sinopharm vaccine among healthcare workers. Study design: Descriptive case series Place and duration of study: Department of Gastroenterology, Holy Family Hospital, Rawalpindi from 12th December 2021 to 11th June 2022. Methodology: Twenty four healthcare workers and between 20-60 years who had COVID-19 infection previously and despite receiving two doses of Sinopharm vaccine, again developed symptomatic COVID-19 diseases were enrolled. The severity was graded as per guidelines provided by CEAG. The extent of exposure during work was documented. Results: No significant association was found with any of the healthcare workers with duration and extent of vaccination. Upto 66% of the front line workers got COVID at 5th month and no considerable variation was noticed in other months of the vaccination. Similarly, three PGs also got COVID at 5th month and at 5th month highest number of frontline workers got COVID-19. Conclusion: COVID-19 reinfection can occur even after vaccination though symptoms remain relatively mild and Sinopharm provides protection against severe infection for prevention of COVID-19. Keywords: COVID, Recurrence, Health workers, Vaccination, Infection

COVID-19 Serosurvey of Frontline Healthcare Workers in Western Australia

We aimed to study COVID-19 infection in healthcare workers (HCWs) during the first wave in a setting of low community incidence prior to HCW vaccination. We performed a cross-sectional study of frontline HCWs in two tertiary hospitals in Western Australia with questionnaire and testing for SARS-CoV-2 IgG antibodies, using a screening assay followed by confirmatory assays for initial reactive results. 799 Frontline HCWs were enrolled in the study, working in the emergency department (n = 194, 24.2%), ICU (n = 176, 22.0%), respiratory ward (n = 20, 2.5%), COVID clinic (n = 37, 4.6%), and theatre (n = 222, 28%). 189 (23.6%) were doctors, 327 (41.0%) nurses, and 283 (35.4%) other. Contact with a known COVID-19-positive patient occurred at work for 337 (42.1%), and outside work for 10 (1.2%). Four were diagnosed with COVID-19 by PCR, acquired overseas in two cases and related to healthcare work in two cases (one acquired from a colleague and one possibly acquired from patient contact in the healthcare setting). Nine HCWs had reactive screening serology, and three had confirmed positive IgG (these three were PCR-positive cases). Infection control procedures in the setting of low community incidence were effective at preventing HCW acquisition of COVID-19 infection.

Is Face Mask with Face Shield More Effective than Face Mask Alone in Reducing SARS-CoV-2 Transmission? A Systematic Review

Background. The use of face shield in addition to face mask is thought to reduce the transmission of SARS-CoV-2 by blocking respiratory droplets and by preventing one from touching facial orifices.
 Objective. To determine the effectiveness of face mask with face shield, compared to face mask alone, in reducing transmission of SARS-CoV-2.
 Methods. We searched MEDLINE, Cochrane Library, as well as trial registers, preprint sites and COVID-19 living evidence sites as of 30 September 2021. We included studies that used face shield with face mask versus face mask alone to prevent COVID-19. We screened studies, extracted data, assessed the risk of bias and certainty of evidence using the GRADE approach. Review Manager 5.4 was used to estimate pooled effects.
 Results. There is no available direct evidence for face shield plus face mask versus face mask alone in the general public. Five (5) observational studies with very low certainty of evidence due to serious risk of bias and indirectness were included. Participants in all the studies were health care workers (HCWs) who used the face shield with their standard personal protective equipment (PPE). Four (4) of the studies were in the hospital setting (three case control studies, one pre- and post-surveillance study); one was done in the community (one pre- and post-surveillance study) in which HCWs visited the residence of the contacts of SARS-CoV-2 positive patients. The case control studies done in the hospital setting showed a trend toward benefit with the use of face shield or goggle but this was inconclusive (OR 0.85, 95% CI 0.68-1.08) while the pre- and post-surveillance study showed significant benefit when face shield (OR 0.28, 95% CI 0.22-0.37) use became a requirement for HCWs upon hospital entry. In the study done in the community setting, significant protection for HCWs was noted with the use of face shield (OR 0.04, 95% CI 0.00-0.69) but the results were limited by serious risk of bias and imprecision.
 Conclusion. In the hospital setting, there was a lower likelihood of COVID-19 infection in HCWs who used a face shield or goggles on top of their PPE. For the general public in the community, there is presently no study on the use of face shield in addition to the face mask to prevent COVID-19 infection.

COVID-19 infection and the broader impacts of the pandemic on healthcare workers.

The severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease or COVID-19 pandemic is associated with more than 230 million cases and has challenged healthcare systems globally. Many healthcare workers (HCWs) have acquired the infection, often through their workplace, with a significant number dying. The epidemiology of COVID-19 infection in HCWs continues to be explored, with manifold exposure risks identified, leading to COVID-19 being recognised as an occupational disease for HCWs. The physical illness due to COVID-19 in HCWs is similar to the general population, with some HCWs experiencing a long-term illness, which may impact their ability to return to work. HCWs have also been affected by the immense workplace and psychosocial disruption caused by the pandemic. The impacts on the psychological well-being of HCWs globally have been profound, with high prevalence estimates for mental health symptoms, including emotional exhaustion. Globally, governments, healthcare organisations and employers have key responsibilities, including: to be better prepared for crises with comprehensive disaster response management plans, and to protect and preserve the health workforce from the physical and psychological impacts of the pandemic. While prioritising HCWs in vaccine rollouts globally has been critical, managing exposures and outbreaks occurring in healthcare settings remains challenging and continues to lead to substantial disruption to the health workforce. Safeguarding healthcare workforces during crises is critical as we move forward on the new path of 'COVID normal'.

Frequency of Infected Healthcare Workers and Factors Leading to Infection in Emergency Neurosurgical Trauma during COVID-19 Pandemic

Objective: The aim of this study was to know the frequency of COVID-19 infection in healthcare workers and to identify the risk factors leading to infection in emergency neurosurgical trauma during COVID-19 pandemic.
 Material and Methods: This descriptive cross-sectional study was conducted in the Department of Neurosurgery, Ayub Teaching Hospital. A total of 99 healthcare workers with an age range from 22 – 55 years attending or carry emergency procedures with both male and female gender were included in the study. Age, gender, sign and symptoms, safety measures and COVID PCR reports were recorded.
 Results: 12 (12.1%) out of 99 healthcare workers got an infection with COVID-19. 83.3% of the infected healthcare workers were male while 16.6% were females. A maximum of the healthcare workers infected with COVID-19 was in the age range 31 – 40 (50%). Most of them were Doctors (66.6%) followed by nursing staff (25%). Low-grade fever and cough were the most common symptoms. The most important factors which affect the transmission of infection to healthcare workers were improper use of personal protective equipment (PPE), masks, gloves by healthcare professionals, and inability to maintain social distancing with the patients.
 Conclusion: To protect healthcare workers from getting infections, proper personal protective equipment should be used. Early recognition of the infected patient and prompt isolation should be done to prevent or minimize the chain of transmission.

Healthcare Workers` Coronavirus (COVID-19) Infection during an Early Phase of the Pandemic: A Systematic Review and Meta-Analysis

Background: Infection and death of health care workers (HCWs) with COVID-19 is an important health problem and will lead to inadequate care of patients, causes more damage and more spread of this pandemic. This study aimed to combine data on COVID-19 infection among HCWs through a systematic review and meta-analysis study. Methods: We searched PubMed via MEDLINE, the SCOPUS, and Web of Science (ISI) to identify the studies on the prevalence of HCWs infection among COVID-19 patients. We used an eight-item checklist critically appraised to assess the quality of publications on the COVID-19 infection among HCWs. Random-effect models and meta-regression were used for the meta-analysis of the results. Results: Overall, 98 articles were retrieved from the databases, of which, seven met the eligibility criteria published between December 2019 to March 2020. The total sample size of the included studies contained 72677 COVID-19 confirmed cases, of which 3131 were HCWs. The pooled COVID-19 infection prevalence among HCWs was 4% (95% CI: 3% to 5%). Conclusions: According to the results, COVID-19 infection in HCWs was 4% of all cases in the early phase of the pandemic. So HCWs need special care including regular screening and appropriate, adequate, and standard personal protective equipment (PPE). Keywords: Novel Coronavirus, COVID-19, Health Care Workers, Medical Staff.

Occupational health and safety of the frontline healthcare workers in Nepal in COVID-19 pandemic

Occupational health and safety (OHS) is essential for every professional especially healthcare workers who work day and night serving patients. According to the WHO, health workers should not face any kind of workplace violence during their professional activities. Attention should also be paid to the mental and psychological health of healthcare workers and their protection should be of paramount importance. OHS related policies, rules and regulations have been formulated in Nepal. According to the law, the responsibility of the OHS of the employees has to be taken by the concerned organization.
 In Nepal, during the COVID-19 pandemic, health workers have to take the risk of infecting themselves while providing care for the patients. This has led to the infection of thousands of health workers and we have also lost quite a few healthcare workers in the line of duty in Nepal. On one hand, there is a psychological fear of acquiring COVID-19 infection in healthcare workers despite adopting health and safety measures, while on the other hand, in case of infection they will have to pay for the treatment from their own pockets. Sometimes ICU and ventilator services are not available not only in their working hospital but also in government referral health institutions which have given rise to incidences that healthcare workers themselves have to be admitted to other hospitals for the treatment. In such a situation, not just mental but also a financial burden has been added to the healthcare workers.

We'll Deal With That Later.

We'll Deal With That Later Lauren T. Southerland, Jennifer A. Frey, and Russell Williams The office was empty and all the plants were dead. And while it is not atypical to find plants struggling for life in my personal office, it is not normal to find them in everyone's offices. It was mid-April and we had been in quarantine for COVID-19 and working from home for over a month. Initially, I had been better about nipping into my office to get supplies and things I needed, but once I had permission to take my work desktop home, my bedroom became my primary research space. I hadn't realized until I walked back in that day in April that four weeks had passed of doing all our work from home and no one had been in to water the plants. Even the cactus was drooping and brown. My research team and I had been working on starting up an interventional study to try to reduce COVID-19 infections in healthcare workers, and we were meeting in person to put the final pieces in place. My research manager Jennifer Frey and I needed to process map every element of the study, from where we would meet with potential participants to where we would draw samples and swab nasal passages. Hopefully clinical research would be easier to resurrect than the wilted cacti and dried-up spider plants. On a whim I decided to take every plant I could find home with me to see what could be saved. For everyone in the world the pandemic has been difficult. For an emergency medicine physician who also does clinical research and just took on the leadership role of Director of Clinical Research for the Department, it was very difficult. Add in navigating remote schooling for 4 kids, including a 3 year old boy who is part-tornado, and work challenges were now work-life tournaments with both sides competing ferociously over every minute of time I had. The kids quickly adapted and developed shrewd attack plans: sneaking into the bedroom office to try to make crazy faces during work Zoom calls or nabbing my cell phone so I couldn't double-secure login to hospital websites. Even with my amazing husband at home full time, trying to sort through the 7 websites, (which means 21 different logins between the 3 school age kids) and figuring out how to upload things like "paragraph fluency readings" and kindergarten art projects, it was hard. I can't imagine how unmanageable it was for single parents. Who knows if they were learning anything. We'll worry about the gap in their education later. . . . When COVID hit, we had a team of paid undergrad students, clinical research assistants, research coordinators, and managers recruiting and running 11 different studies in the Emergency Department. In late March, all non-critical research was halted and employees were sent to work from home. We scrambled to find encrypted, HIPAA compliant laptops for everyone. We had several studies that required follow up phone calls to participants. The team figured out how to use the hospital operator service to mirror calls so patient participants only saw the hospital number and not their personal cell phones when they called from home. Jen ordered headsets for the team off Amazon. We'll figure out reimbursement later . . . Our studies ranged from the management of septic shock to identifying delirium in older patients to urine microbiomes. All those were halted as being non-critical and we quickly pivoted to starting up several COVID trials. We'll worry about the consequences to our other studies later . . . This was my first interventional drug trial. An interventional drug trial typically takes 12–18 months of work to ensure that all the appropriate regulations, permissions, and operating procedures are in place. We had to condense that down to 4–6 weeks. You could almost hear the echoing screech as the entire research mechanism at this large academic hospital switched gears to the all-COVID setting. The number of committee decisions, permissions, and signed contracts was amazing. It was lots of late nights, early mornings, and learning on the fly. The...

Prevalence and Pattern of COVID-19 among Healthcare Workers in Rivers State Nigeria

Introduction: The evaluation of COVID-19 prevalence among healthcare workers (HCW) within the general population of COVID-19 cases is an important epidemiologic variable. The objective of this study is to describe the prevalence and patterns of COVID-19 infection in HCWs amongst a group of patients receiving care for COVID-19 in Rivers state, Nigeria. Methods: This study was a prospective descriptive study of all consenting patients who received care through hospitals, designated for COVID-19 treatment in Rivers state either as in-patient or out-patient following a laboratory-confirmed diagnosis of COVID-19 based on a positive SARS-CoV-2 RT-PCR from April to September 2020. Results: A total number of 646 COVID-19 patients were enrolled over the study period with 98 (15.2%) HCWs in the patient population. The HCWs with COVID-19 consisted largely of Doctors 47 (47.9%), Nurses 30 (30.6%), and socio-sanitary and hygiene workers 10 (10.2%). There were 46 (46.9%) female HCWs, compared to Non-HCWs with 112 (21.1%), females, p = 0.000. Sixty-eight (69.4%) HCWs had a source of contact for infection established compared to Non-HCWs with an established source of contact in 181 (34.2%), p = 0.000. Eight (8.2%) HCWs had Severe disease compared to 52 (9.8%) Non-HCWs with severe disease, p = 0.670. The case fatality in HCWs was 1% compared to 1.9% in Non-HCWs, p = 0.554. Conclusion: The prevalence of COVID-19 among HCWs in the study location is high with clinical and clinical support staff particularly, doctors and nurses are at higher risk of COVID-19 infection. This calls for action to improve and prevent HCWs infections in hospital settings in addition to improving HCW infection prevention behaviour in the community. The intensification of risk communication, provision of protective equipment (PPE), and training on the appropriate use of PPE; in addition to routine surveillance for infection is recommended.

COVID-19 prevalence among healthcare workers in Jakarta and neighbouring areas in Indonesia during early 2020 pandemic

Background The COVID-19 disease has overwhelmed and disrupted healthcare services worldwide, particularly healthcare workers (HCW). HCW are essential workers performing any job in a healthcare setting who are potentially directly or indirectly exposed to infectious materials. Our retrospective cohort study aimed to determine the prevalence of COVID-19 infections among HCW in Jakarta and neighbouring areas during the first three months of the pandemic. Methods Nasopharyngeal/oropharyngeal swab specimens from HCW working at private and public hospitals in Jakarta and neighbouring areas were screened for SARS-CoV-2 between March and May 2020. Data on demography, clinical symptoms, contact history, and personal protective equipment (PPE) use were collected using standardised forms. Results Among 1201 specimens, 7.9% were confirmed positive for SARS-CoV-2 with the majority coming from medical doctors (48.4%) and nurses (44.2%). 64.2% of the positive cases reported to have contact with suspect/confirmed COVID-19 cases, including 32 (52.2%) with patient and 3 (6.6%) with co-worker. The symptomatic HCW had a significantly lower median Ct value as compared to their asymptomatic counterpart (p < .001). Tendency to have a higher prevalence of pneumonia was observed in the age group of 40 – 49 and ≥50 years old. Conclusion Our findings highlighted the necessity to implement proper preventive and surveillance strategies for this high-risk population including adherence to strict PPE protocol and appropriate training. Key Message Healthcare workers (HCW), defined as those handling any job in a healthcare setting, are at the frontline of risk of infection as SARS-CoV-2 is easily transmitted through airborne droplets and direct contact with contaminated surfaces. The aim of our study is to attain a more comprehensive and accurate picture of the impact of COVID-19 on HCW during the earlier phase of the outbreak in Indonesia to develop effective strategies that protect the health and safety of this workforce. Our findings highlighted that COVID-19 infections in HCW were mostly acquired in healthcare settings, with significant consequences of pneumonia and hospitalisation occurring across all age groups.

What influences the infection of COVID-19 in healthcare workers?

The outbreak of COVID-19 has spread worldwide. The evidence about risk factors of healthcare workers who infected COVID-19 is limited. This study aims to describe characteristics and influencing factors of the COVID-19 infection in healthcare workers. The study was performed among COVID-19 infected and uninfected healthcare workers in three hospitals in Wuhan. A total of 325 healthcare workers participated; among them 151 COVID-19-infected healthcare workers were included. Characteristics of infected healthcare workers, and influencing factors including exposure histories, the use of protective equipment in different risk conditions and areas, perceptions, emotions, satisfactions and educations were described and analyzed. Healthcare workers got infected clustered mostly in the physical examination center. When performing general operations on confirmed or suspected patients, the use of protective equipment including the effectiveness of masks (p < 0.001), gloves (p < 0.001); and the use of gloves (p < 0.001), suits (p < 0.001), gowns (p < 0.001), shoe covers (p < 0.001), and hats (p < 0.001) were protective factors. The use of protective equipment was a protective factor in most cases. Negative emotions and dissatisfaction to the hospital response were associated with the increased risk of infection. The use of protective equipment, emotions and satisfactions to hospital responses are key COVID-19-infected factors. The awareness, the supply and the use of protective equipment, the layout of departments and other environmental and management factors should be strictly equipped. In addition, hospitals should also pay attention to emotions and satisfaction of healthcare workers.

Diagnostic accuracy of two commercially available rapid assays for detection of IgG and IgM antibodies to SARS-CoV-2 compared to ELISA in a low-prevalence population.

Background: New commercially available point-of-care (POC) immunodiagnostic tests are appearing, which may yield rapid results for anti-SARS-CoV-2 antibodies. The aim of this study was to evaluate the diagnostic accuracy of rapid antibody detection tests compared to a validated laboratory-based enzyme-linked immunosorbent assay (ELISA) and to investigate infections amongst healthcare workers (HCWs) after unprotected close contact to COVID-19 patients. Methods: Blood serum and whole blood of 130 participants were tested with NADAL® COVID-19 IgG/IgM rapid test and mö-screen 2019-NCOV coronavirus test against a validated ELISA test. Infection status was evaluated using real-time polymerase-chain-reaction.Results: Acute COVID-19 infection was detected in 2.4% of exposed HCWs. Antibody tests showed an overall frequency of IgG and IgM in 5.3%, with 1.6% asymptomatic infections. The NADAL® test showed a sensitivity (IgM/IgG) of 100% (100%/100%), a specificity (IgM/IgG) of 98.8% (97.6%/100 %), a PPV of 76.9% (57.1%/100%), an NPV of 100% (100%/100%), and a diagnostic accuracy of 98.8% (97.7%/100%). The mö-screen test had a sensitivity (IgM/IgG) of 90.9% (80%/100%), a specificity (IgM/IgG) of 98.8% (97.6%/100%), a PPV of 76.9% (57.1%/100%), an NPV of 99.6% (99.2%/100%), and a diagnostic accuracy of 98.5% (96.9%/100%). Conclusions: The frequency of COVID-19 infections in HCWs after unprotected close contact is higher than in the general population of a low-prevalence country. Both POC tests were useful for detecting IgG, but did not perform well for IgM, mainly due to false positive results.

Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking aerosol-generating procedures (AGPs) on patients without suspected or confirmed COVID-19 infection.

COVID-19 infection poses a serious risk to patients and -due to its contagious nature -to those healthcare workers (HCWs) treating them. The risks of transmission of infection are greater when a patient is undergoing an aerosol-generating procedure (AGP). Not all those with COVID-19 infection are symptomatic, or suspected of harbouring the infection. If a patient who is not known to have orsuspected of having COVID-19 infection is to undergo an AGP, it would nonethelessbe sensible to minimise the risk to those HCWs treating them. If the mouth and nose of anindividual undergoing an AGPare irrigated with antimicrobial solutions, this may be a simple and safe method ofreducingthe risk of any covert infection being passed to HCWs through droplet transmission or direct contact. Alternatively, the use of antimicrobial solutions by the HCWmay decrease the chance of them acquiringCOVID-19 infection.However,the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves or alterations in the natural microbial flora of the mouth or nose. To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays administered to HCWs and/or patients when undertaking AGPs on patients without suspected or confirmed COVID-19 infection. Information Specialists from Cochrane ENT and Cochrane Oral Health searchedthe Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embaseand additional sources for published and unpublished trials. The date of the search was 1 June 2020. SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed RCTs. We therefore planned to include the following types of studies:randomised controlled trials (RCTs);quasi-RCTs;non-randomised controlled trials;prospective cohort studies;retrospective cohort studies;cross-sectional studies;controlled before-and-after studies. We set no minimum duration for the studies. We sought studies comparing any antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration, delivered to the patient or HCW before and/or after an AGP. We used standard Cochrane methodological procedures. Our primary outcomes were: 1) incidence of symptomatic or test-positive COVID-19 infection in HCWs or patients; 2) significant adverse event:anosmia (or disturbance in sense of smell).Our secondary outcomes were: 3)COVID-19 viral content of aerosol (when present); 4)change in COVID-19 viral load at site(s) of irrigation; 5)other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 6)other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion.We planned to use GRADE to assess the certainty of the evidence for each outcome. We found nocompleted studies to include in this review. AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review, nor any ongoing studies.The absence ofcompleted studiesis not surprising given the relatively recent emergence of COVID-19 infection. However, we are disappointed that this important clinical questionis notbeing addressed by ongoing studies.

COVID-19 infection among healthcare workers in a national healthcare system: The Qatar experience

BackgroundOur aim was to determine the prevalence of COVID-19 infection in healthcare workers (HCWs) in a national healthcare system and to understand the risk factors for infection. MethodsThe study was conducted at Hamad Medical Corporation (HMC) in Qatar, a national healthcare system with 14 hospitals and >28,000 employees, between March 10 and June 24, 2020. Data on COVID-19+ HCWs were retrieved from the electronic health records and employment records, followed by an email survey and a focused telephone interview. ResultsAmong 16,912 HCWs tested, 10.6% tested positive. Hospitalization rate was 11.6%, 1.3% required supplemental oxygen, 0.6% needed intensive care unit admission, and 0.3% required mechanical ventilation. There were no deaths. In a follow-up survey of 393 HCWs, 5% reported acquiring infection at a COVID-19-designated facility and 95% at a non-COVID-19 facility having acquired the infection through accidental exposure to a colleague (45%) or a patient (29%). Full personal protective equipment (PPE) adherence was 82% at COVID-19-designated facilities but only 68% at non-COVID-19 facilities. ConclusionsCOVID- 19 infection among HCWs often occurs among those not directly working with COVID-19 patients. PPE use is less stringent in such settings. Risk of exposure and need for strict PPE must be stressed upon all HCWs in all settings.

Use of antimicrobial mouthwashes (gargling) and nasal sprays by healthcare workers to protect them when treating patients with suspected or confirmed COVID-19 infection.

COVID-19 infection poses a serious risk to patients and -due to its contagious nature -to those healthcare workers (HCWs) treating them. If the mouth and nose of HCWs are irrigated with antimicrobial solutions, this may help reduce the risk of active infection being passed from infected patients to HCWs through droplet transmission or direct contact. However,the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves, or alterations in the natural microbial flora of the mouth or nose. Understanding these possible side effects is particularly important when the HCWs are otherwise fit and well. To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays used by healthcare workers (HCWs) to protect themselves when treating patients with suspected or confirmed COVID-19 infection. Information Specialists from Cochrane ENT and Cochrane Oral Health searchedthe Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embaseand additional sources for published and unpublished trials. The date of the search was 1 June 2020. SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed randomised controlled trials (RCTs). We therefore planned to include the following types of studies:RCTs;quasi-RCTs;non-randomised controlled trials;prospective cohort studies;retrospective cohort studies;cross-sectional studies;controlled before-and-after studies. We set no minimum duration for the studies. We sought studies comparing any antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration,delivered to HCWs, with or without the same intervention being given to the patients with COVID-19. We used standard Cochrane methodological procedures. Our primary outcomes were: 1) incidence of symptomatic or test-positive COVID-19 infection in HCWs; 2) significant adverse event: anosmia (or disturbance in sense of smell).Our secondary outcomes were: 3)viral content of aerosol, when present (if intervention administered to patients); 4) other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 5) other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion.We planned to use GRADE to assess the certainty of the evidence for each outcome. We found nocompleted studies to include in this review. We identified three ongoing studies (including two RCTs), which aim to enrol nearly 700participants. The interventionsincluded in these trials arepovidone iodine, nitric oxideand GLS-1200 oral spray (the constituent of this spray is unclear and may not be antimicrobial in nature). AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review. This is not surprising given the relatively recent emergence of COVID-19 infection. It is promising that the question posed in this review is being addressed by two RCTs and a non-randomised study. Weare concerned that only one of the ongoing studies specifically states that it will evaluate adverse events and it is not clear if this will include changes in the sense of smell or to the oral and nasalmicrobiota, and any consequences thereof. Very few interventions have large and dramatic effect sizes. If a positive treatment effect is demonstrated when studies are available for inclusion in this review,it may not be large. Inthese circumstances in particular, where those receiving theintervention are otherwise fit and well,it may be a challengeto weighup the benefits against the harms if the latter are of uncertain frequency and severity.

Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them.

COVID-19 infection poses a serious risk to patients and -due to its contagious nature -to those healthcare workers (HCWs) treating them. If the mouth and nose of patients with infection are irrigated with antimicrobial solutions, this may help the patients by killing anycoronavirus present at those sites. It may also reduce the risk of the active infection being passed to HCWs through droplet transmission or direct contact. However,the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves or alterations in the natural microbial flora of the mouth or nose. To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays administered to patients with suspected or confirmed COVID-19 infectionto both the patients and the HCWs caring for them. Information Specialists from Cochrane ENT and Cochrane Oral Health searchedthe Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embaseand additional sources for published and unpublished trials. The date of the search was 1 June 2020. SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed RCTs. We therefore planned to include the following types of studies:randomised controlled trials (RCTs);quasi-RCTs;non-randomised controlled trials;prospective cohort studies;retrospective cohort studies;cross-sectional studies;controlled before-and-after studies. We set no minimum duration for the studies. We sought studies comparing antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration, delivered with any frequency or dosage to suspected/confirmed COVID-19 patients. We used standard Cochrane methodological procedures. Our primary outcomes were: 1)RECOVERY* (www.recoverytrial.net)outcomes in patients (mortality;hospitalisation status;use of ventilation;use of renal dialysis or haemofiltration); 2)incidence of symptomatic or test-positive COVID-19 infection in HCWs; 3)significant adverse event: anosmia (or disturbance in sense of smell). Our secondary outcomes were: 4)change in COVID-19 viral load in patients; 5)COVID-19 viral content of aerosol (when present); 6)other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 7)other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion. We planned to use GRADE to assess the certainty of the evidence for each outcome. We found nocompleted studies to include in this review. We identified 16 ongoing studies (including 14 RCTs), which aim to enrolnearly 1250participants.The interventionsincluded in these trials areArtemiC (artemisinin, curcumin, frankincense and vitamin C),Citrox(a bioflavonoid),cetylpyridiniumchloride,chlorhexidine,chlorine dioxide,essential oils,hydrogen peroxide,hypertonic saline,Kerecis spray (omega 3 viruxide-containingneem oil and St John's wort),neem extract,nitricoxide releasing solution,povidone iodine andsaline with baby shampoo. AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review. This is not surprising given the relatively recent emergence of COVID-19 infection. It is promising that the question posed in this review is being addressed by a number of RCTs and other studies. Weare concerned that few of the ongoing studies specifically state that they will evaluate adverse events such aschanges in the sense of smell or to the oral and nasalmicrobiota, and any consequences thereof. Very few interventions have large and dramatic effect sizes. If a positive treatment effect is demonstrated when studies are available for inclusion in this review,it may not be large.Inthese circumstances in particularit may be a challengeto weighup the benefits against the harms if the latter are of uncertain frequency and severity.