Non-clinical Healthcare Workers Research Articles

The implementation of a “safety officer” program: an innovative approach to improve infection prevention and control practices in Ethiopia

BackgroundEffective infection prevention and control (IPC) was central to keeping healthcare workers (HCWs) safe during the COVID-19 pandemic. However, as the pandemic continued, the maintenance of high-quality IPC practices waned, placing HCWs at increased risk of infection. A COVID-19 Safety Officer (SO) program was piloted by the United States Agency for International Development (USAID)-funded Reaching Impact, Saturation and Epidemic Control (RISE) project across two health facilities in Ethiopia, which trained clinical and non-clinical HCWs on IPC protocols to promote safe practices in patient care areas. We sought to evaluate the implementation and effectiveness of the SO program in improving IPC practices within the clinical setting.MethodsThis is a post-implementation evaluation of the SO program, implemented in two hospitals in Ethiopia between May 2022 and December 2022. Participants completed a 4-day course on COVID-19 epidemiology, IPC, safety communication, and learning theory as a part of the Training of Trainers component (n = 23), and were posted in clinical wards to provide staff training and support to maintain IPC protocols. The program was evaluated at 6 months using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using direct observation of IPC practices across intervention sites. Implementation outcomes were measured using surveys and qualitative interviews to capture training cascade, knowledge, comfort, acceptability, and maintenance.ResultsParticipants were able to cascade training to an additional 167 clinical (67.6%) and 80 non-clinical (32.3%) staff across both sites. Direct observation of clinical staff at 6 months showed that 95% (59/62) wore at least a surgical mask with patients and were compliant with masking and/or distancing protocol. Clinical interviews revealed that SOs contributed to increased perceived comfort with screening and isolation procedures and environmental cleaning procedures.ConclusionThe SO training program was widely adopted, and effective in improving the implementation and comfort of maintaining IPC practices in clinical settings.

Knowledge of Stroke, Its Symptoms or Signs, Risk Factor and Practice of Prevention among Healthcare Workers in a Tertiary Hospital in Nigeria

Purpose: Stroke is a leading cause of disability globally. Deaths from stroke and stroke-related disability occur more in low-income and middle-income countries. However, most studies narrated a lack of public knowledge and practice related to stroke. This study aims to investigate stroke-related knowledge, associated factors, and prevention practices among Healthcare workers. Materials and Methods: This was a cross-sectional study among 200 Healthcare workers from the Federal Medical Centre, Asaba Nigeria. They were selected by systematic sampling technique to participate in the study. A semi-structured questionnaire was used to collect data on the research variables. Data were analyzed using the IBM SPSS version 25 statistical package Findings: The mean age of respondents was 36.20 ± 10.60 years and they were predominantly females (56.5%). The respondents had good aggregate knowledge of stroke (84%), its warning signs or symptoms (72%), and risk factors (78%). However, the aggregate practice of stroke prevention among healthcare workers was poor (61%). There was a significant association (p < 0.0001) between good knowledge of stroke and Clinical Healthcare when compared with Non-Clinical Health Care workers [Chi-squares =27.1, 95%CI= (0.029-0.256)] but this did not affect their practice [Chi-square =3.570, p-value = 0.02, 95%CI= (0.321-1.023)] Implications to Theory, Practice and Policy: There is a need for healthcare workers to encourage health educational programs on Knowledge and behavior-changing strategies toward stroke prevention practices.

Perceived stress from social isolation or loneliness among clinical and non-clinical healthcare workers during COVID-19

BackgroundWorkplace social isolation and loneliness have been found to result in a decline in job satisfaction and an increase in burnout among working individuals. The COVID-19 pandemic exacerbated feelings of loneliness and social isolation among healthcare workers. The majority of research on healthcare worker experiences is conducted in siloes which does not reflect the shared experiences of interprofessional teams. The purpose of this study is to understand stress from social isolation or loneliness across the entire clinical and non-clinical healthcare team over the course of the pandemic.MethodsData was acquired using a cross-sectional survey distributed to healthcare workers once a year at a large academic medical center in the Southeastern United States during the COVID-19 pandemic (2020–2022). Information pertaining to job role, work location, and demographic factors was collected. Participants were also asked to assess individual well-being and resilience, in addition to reporting stress derived from various sources including job demands and social isolation or loneliness. Descriptive statistics and bivariate analyses were conducted to assess the association between stress from social isolation or loneliness and individual characteristics.ResultsStress from social isolation or loneliness was found to decrease over the survey period across all measured variables. Trainees and physician-scientists were found to report the highest rates of this stressor compared to other job roles, while Hospital-Based ICU and Non-ICU work locations reported the highest rates of loneliness and social isolation stress. Younger workers and individuals from marginalized gender and racial groups were at greater risk for stress from social isolation or loneliness.ConclusionsGiven the importance of social connections for well-being and job performance, organizations have a responsibility to create conditions and mechanisms to foster social connections. This includes establishing and reinforcing norms of behavior, and developing connection mechanisms, particularly for groups at high risk of loneliness and social isolation.

Post-vaccination SARS-CoV-2 IgG spike antibody responses among clinical and non-clinical healthcare workers at a tertiary facility in Kenya.

Following the coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, vaccination became the main strategy against disease severity and even death. Healthcare workers were considered high-risk for infection and, thus, were prioritised for vaccination. A follow-up to a SARS-CoV-2 seroprevalence study among clinical and non-clinical HCWs at the Aga Khan University Hospital, Nairobi, we assessed how vaccination influenced SARS-CoV-2 anti-spike IgG antibody responses and kinetics. Blood samples were drawn at two points spanning 6 to 18 months post-vaccination, and SARS-CoV-2 spike antibody levels were determined by enzyme-linked immunosorbent assay. Almost all participants, 98% (961/981), received a second vaccine dose, and only 8.5% (83/981) received a third dose. SARS-CoV-2 spike IgG antibodies were detected in 100% (961/961) and 92.7% (707/762) of participants who received two vaccine doses, with the first and second post-vaccine test, respectively, and in 100% (83/83) and 91.4% (64/70) of those who received three vaccine doses at the first and second post-vaccine test, respectively. Seventy-six participants developed mild infections, not requiring hospitalisation even after receiving primary vaccination. Receiving three vaccine doses influenced the anti-spike S/Co at both the first (p<0.001) and second post-vaccination testing (p<0.001). Of those who tested SARS-CoV-2 positive, the anti-spike S/Co ratio was significantly higher than those who were seronegative at the first post-vaccine test (p = 0.001). Side effects were reported by almost half of those who received the first dose, 47.3% (464/981), 28.9% (278/961) and 25.3% (21/83) of those who received the second and third vaccine doses, respectively. Following the second dose of primary vaccination, all participants had detectable anti-spike antibodies. The observed mild breakthrough infections may have been due to emerging SARS-CoV-2 variants. Findings suggest that although protective antibodies are induced, vaccination protected against COVID-19 disease severity and not necessarily infection.

Perception of personal protective equipment availability and mental health outcomes in workers from two national hospitals during the COVID-19 pandemic

BackgroundDuring the first wave of the pandemic, a constant concern of healthcare workers, who are more vulnerable to contagion, is their personal safety. This is directly related to the availability of adequate PPE, which led to a perception of dissatisfaction and inequality with government responses. We aim t o determines whether perception of adequate PPE availability is associated with depressive, anxiety, and stress symptoms in different types of healthcare workers. MethodsAnalytical cross-sectional study surveyed clinical and non-clinical healthcare workers in two third-level hospitals in Lima, Peru. An online self-survey assessed the perception of adequate PPE availability, using a Likert scale question, which was then dichotomized for the analysis. In addition, we assessed the depressive, anxiety, and stress symptoms using validated questionnaires. Results563 participants were included. In general, there is no association between perception of PPE availability and three mental health outcomes. However, in the subgroup analysis, physicians with better perception of PPE availability had less moderate-severe outcomes in mental health; in contrast, nurses had higher moderate-severe outcomes. The type of profession in healthcare workers may modify the effect of this association. ConclusionThe association between perception of PPE availability and mental health outcomes is complex in healthcare workers from two third-level hospitals. This association can vary according to the type of work.

Burnout, Moral Distress, and Compassion Fatigue as Correlates of Posttraumatic Stress Symptoms in Clinical and Nonclinical Healthcare Workers

Goal: Research has highlighted psychological distress resulting from the COVID-19 pandemic on healthcare workers (HCWs), including the development of posttraumatic stress symptoms (PTSS). However, the degree to which these conditions have endured beyond the pandemic and the extent to which they affect the entire healthcare team, including both clinical and nonclinical workers, remain unknown. This study aims to identify correlates of PTSS in the entire healthcare workforce with the goal of providing evidence to support the development of trauma-informed leadership strategies. Methods: Data were collected from June to July 2022 using a cross-sectional anonymous survey in a large academic medical center setting. A total of 6,466 clinical and nonclinical employees completed the survey (27.3% response rate). Cases with at least one missing variable were omitted, for a total sample size of 4,806, the evaluation of which enabled us to understand individual, organizational, and work-related and nonwork-related stressors associated with PTSS. Data were analyzed using ordinal logistic regression and dominance analyses to identify predictors of PTSS specific to clinical and nonclinical workers. Principal Findings: While previous studies have shown that HCWs in different job roles experience unique stressors, our data indicate that the top correlates of PTSS among both clinical and nonclinical HCWs are the same: burnout, moral distress, and compassion fatigue. These three factors alone explained 45% and 44.4% of the variance in PTSS in clinical and nonclinical workers, respectively. PTSS was also associated with a lower sense of recognition and feeling mistreated by other employees at work in the clinical workforce. Concerningly, women and sexual minorities in the clinical sample exhibited a higher incidence of PTSS. In nonclinical workers, social isolation or loneliness and lower trust and confidence in senior leadership were associated with PTSS. Nonwork-related factors, such as exhaustion from caregiving responsibilities and financial strain, were also significantly associated with PTSS. Even after controlling for discrimination at and outside of work in both samples, we found that non-White populations were more likely to experience PTSS, highlighting a deeply concerning issue in the healthcare workforce. Practical Applications: The primary objective of this article is to help healthcare leaders understand the correlates of PTSS across the entire healthcare team as organizations recover from the COVID-19 pandemic. Understanding which factors are associated with PTSS will help healthcare leaders develop best practices that aim to reduce HCW distress and strategies to circumvent trauma derived from future crises. Our data indicate that leaders must address the correlates of PTSS in the workforce, focusing attention on both those who work on the frontlines and those who work behind the scenes. We urge leaders to adopt a trauma-informed leadership approach to ensure that the entire healthcare workforce is recognized, supported, and cared for as each HCW plays a unique role in the care of patients.

Healthcare Worker Characteristics Associated with SARS-CoV-2 Vaccine Uptake in Ireland; a Multicentre Cross-Sectional Study.

The prevention of SARS-CoV-2 acquisition and transmission among healthcare workers is an ongoing challenge. Vaccination has been introduced to mitigate these risks. Vaccine uptake varies among healthcare workers in the absence of vaccine mandates. We investigated engagement with SARS-CoV-2 vaccination among healthcare workers and identified characteristics associated with lower vaccine uptake. This multi-site cross-sectional study recruited n = 1260 healthcare workers in both clinical and non-clinical roles over a three-month period from November 2022. Participants reported their engagement with the primary SARS-CoV-2 vaccination programme and subsequent booster programmes, as well as providing demographic, occupational and personal medical history information. Multivariable linear regression identified characteristics associated with vaccine uptake. Engagement with vaccination programmes was high, with 88% of participants receiving at least one booster dose after primary vaccination course. Younger age and female sex were associated with reduced vaccine uptake. Healthcare workers in non-clinical roles also had reduced vaccine uptake. These findings should inform vaccination strategies across healthcare settings and target populations with reduced vaccine uptake directly, in particular young, female, and non-clinical healthcare workers, both for SARS-CoV-2 and other healthcare-associated vaccine-preventable infections.

The Interplay of Job Demands–Resources: Experiences of Public Health Inspectors of Sri Lanka During the First and Second Waves of the COVID-19 Pandemic

The COVID-19 pandemic posed unprecedented challenges to healthcare employees worldwide. As part of combatting the disease, they were often confronted with numerous physical and psychological job demands. Studies have explored the experiences of and responses to a COVID-19-related job demand–resource (JD-R) interplay of Western hospital-based healthcare staff. However, whether community-based, non-clinical healthcare workers experienced and responded to the COVID-19-related JD-R interplay similarly to hospital-based clinical healthcare employees is severely under-researched. This article explores how Sri Lanka’s public health inspectors (PHIs), a group of community-based, non-clinical healthcare workers experienced and responded to the COVID-19-related JD-R interplay. Using 18 in-depth interviews, this study found that PHIs were confronted with COVID-19-specific physical and psychological job demands including work pressure, workload, ambiguities in authority and job responsibilities, fear of contracting and passing on the disease to family members and social rejection which they managed with limited training, minimal rewards and less recognition. This JD-R incompatibility led to stress, exhaustion and coping inflexibility to which PHIs responded through approach and avoidance coping. While most coping strategies enabled PHIs to ease their stress and exhaustion, there were others that exacerbated the feelings of burnout.

Acceptance, Intent, Hesitance, and Attitudes Towards SAR-CoV-2 Vaccines Among Healthcare Workers in Michigan, USA.

Healthcare workers (HCWs) are critical infrastructure workers for whom COVID-19 vaccination was prioritized. It is believed that healthcare workers would have little or no hesitancy to take the COVID-19 vaccines given the risks of the pandemic to them, their families, and their patients. The study aims to understand the acceptance and attitudes toward COVID-19 vaccines among the HCWs in Michigan. A cross-sectional survey was fielded from January 11, 2021, through February 28, 2021. We obtained a representative sample of HCWs at MidMichigan Health. The participants were approximately 1500 clinical and non-clinical HCWs. COVID-19 vaccination acceptance and the intent to be vaccinated were measured with a questionnaire. HCWs indicating hesitance were asked to enter their reasons for hesitance as a free text response. A total of 1,467 HCWs responded to the survey. Overall, 62% indicated they had received both shots; 19.7% reported that they had received the first shot and would take the second; 2.3% noted that they were yet to receive the vaccine but would take both shots; 0.4% reported that they had received the first shot but would not take the second; 5.7% noted that they were unsure; and 9.9% indicated they did not intend to take the vaccine. Factors associated with vaccine hesitance included being female, younger age, having administrative staff or other health workers, having a larger household size, and having received no vaccines in the past year. Vaccine hesitancy concerns included safety, efficacy, antivaccine beliefs, the need for additional information, and a lack of trust. This survey revealed that 16% of HCWs in central and northern Michigan were hesitant about COVID-19 vaccines. Vaccine education is needed to increase the acceptance of COVID-19 vaccines among HCWs.

Validation of Depression, Anxiety and Stress Scale (DASS-21) among healthcare workers during the outbreak of delta variant of SARS-CoV-2 in Ghana

Background: Today COVID-19 is having a dire effect on the mental and physical health of the general population. Although the long-term psychological effects of COVID-19 remain unknown, studies have shown increasing depression, anxiety and stress among healthcare workers. The aim of the study was to examine the psychometric properties and validation of the Depression, Anxiety, and Stress Scale (DASS-21) and evaluate the level of depression, anxiety, and stress among healthcare workers in a tertiary hospital during the SARS-CoV-2 delta variant outbreak. Methods: Using an online questionnaire, we conducted a cross-sectional study on 1201 healthcare workers in a tertiary hospital. The validation of DASS-21 was performed by examining the factorial structure (construct validity) using confirmatory factor analysis (CFA), internal consistency (reliability), convergent validity, discriminate validity and measurement invariance. Results: Cronbach's Alpha was acceptable for depression (0.88), anxiety (0.81), and stress (0.86). CFA provides support for the three-factor oblique model with the following fit indexes: (Chi-Square χ2/ (degrees of freedom) = 1628.5/(186), p &lt; 0.001), comparative fit index (CFI = 0.923), Tucker-Lewis index (TLI = 0.901), standardized root mean square residual (SRMR = 0.0452) and root mean square error of approximation (RMSEA = 0.07). DASS-21 achieved both configural and metric invariance. Conclusions: Our results indicate that DASS-21 is a reliable and valid self-reporting screening tool for depression, anxiety and stress among healthcare workers. This tool is also invariant across sex, doctors, nurses, and non-clinical healthcare workers. Thus DASS-21 is an essential screening tool to identify healthcare workers at a higher risk of developing work-related mental health disorders.

Perception of Risk and Compliance With COVID-19 Safety Guidelines: A Cross-Sectional Survey Among Healthcare Workers in Ghana.

Although healthcare professionals are on the "frontline" of providing effective and quality healthcare delivery, they face several occupational risks when giving care, particularly during a global health crisis. This study examines healthcare workers' compliance with COVID-19 safety protocols and identifies factors associated with their perceived risk of COVID-19. Between October and December 2020, this cross-sectional survey utilized online and paper-type questionnaires in data collection. Non-probability sampling techniques were used in selecting clinical and non-clinical healthcare workers in various health facilities within 4 regions of Ghana. Logistic regression analysis was performed to identify the factors associated with the perceived risk of COVID-19. The results showed that healthcare workers are highly compliant with hand hygiene practices and wearing PPE. The category of health professional, number of working years, type of health facility, region of work, frequency of COVID-19 test, and compliance with hand hygiene practices were significantly associated with healthcare workers' perception of risk of COVID-19 at P < .05. Findings suggest that both individual and health system factors are significant in increasing the risk of COVID-19 among healthcare workers. Efforts at enforcing strict compliance with infection prevention should be implemented to protect all healthcare personnel.

Healthcare workers' perspectives on the COVID-19 vaccine and boosters for themselves, their patients, and their communities: a mixed methods study.

To examine experiences and attitudes of a diverse sample of clinical and non-clinical healthcare workers regarding COVID-19 vaccines and boosters for themselves, their patients, and their communities. We conducted a sequential exploratory mixed methods study; 52 healthcare workers participated in qualitative interviews between April 22 and September 7, 2021, and 209 healthcare workers completed surveys between February 17 and March 23, 2022. Interviews and survey questions asked about personal attitudes toward COVID-19 vaccination and boosters and experiences discussing vaccination with patients. Participants were predominantly White (56% and 73%, respectively) and female (79% and 81%, respectively). Factors motivating healthcare workers to take the vaccine were the belief that vaccination would protect themselves, their families, patients, and communities. Healthcare workers were accepting of and had high receipt of the booster, though some had diminished belief in its effectiveness after becoming infected with SARS-CoV-2 after initial vaccination. Race related mistrust, misinformation related to vaccine safety, and concerns about vaccine effects during pregnancy were the most common barriers that providers encountered among their patients and communities. Healthcare workers' primary motivation to receive COVID-19 vaccines was the desire to protect themselves and others. Healthcare workers' perception was that concerns about safety and misinformation were more important barriers for their patients than themselves. Race-related medical mistrust amplified concerns about vaccine safety and hindered communication efforts.

Risk Factors for COVID-19 Infection among Healthcare Workers in North-East Nigeria.

Healthcare workers (HCWs) face an unprecedented higher risk of COVID-19 infection due to their work and exposure. In this study, we aim to examine the associated risk factors for COVID-19 infection among HCWs in North-East Nigeria. We used data collected retrospectively among a cohort of clinical and non-clinical HCWs in six healthcare facilities in Adamawa State, Nigeria. We estimated the marginal probability of COVID-19 infection among HWCs using alternating logistic regression via the generalized estimating equations (GEE) approach. Among the 318 HCWs, 178 (55.97%) were males, mean (±SD) age was 36.81 (±8.98), 237 (74.76%) were clinical, and 80 (25.24) were non-clinical staff. The overall prevalence of COVID-19 was 16.67% among HCWs. After adjusting for other variables in the model, our results showed that clinical staff had a 5-fold higher risk of COVID-19 infection than non-clinical staff (aOR = 5.07, 95% CI: 1.32–19.52). Moreover, significant exposure risk factors for COVID-19 infection for HCWs increase with age, time spent attending to patients, caring for COVID-19 patients, and having worked with COVID-19 samples, while the risk decreases with the use of an N95 mask. Our findings suggested that the burden of COVID-19 infection is higher for clinical staff than non-clinical staff, and increasing age contributed to the increased risk.

Enhancing Healthcare Workers’ Capacity in Cancer and Other Non-Communicable Diseases (NCDs) Care in Sub-Saharan Africa (SSA) Through e-Health Innovations: A Case of International Cancer Institute (ICI), Eldoret, Kenya

PURPOSE Sub-Saharan Africa (SSA) hosts 11% of the world’s population yet bears 24% of the global disease burden with only 3% of the world’s health workforce at the frontline. The new threat of NCDs is worsened by the challenge of infrastructure, access to care and health workforce capacity. E-health bridges the gap of formal education and training through telemedicine and virtual e-learning platforms. METHODS International Cancer Institute (ICI) leveraged on telemedicine to build capacity of Health Care Providers (HCPs) in the COVID era. Through bi-weekly virtual multi-disciplinary tumour boards, on-line preceptorship training programs and tele-consultations between healthcare providers across Kenya and SSA, access to quality and timely cancer care was evaluated. RESULTS Between May 2020 and April 2021, ICI conducted 95 virtual multi-disciplinary tumour boards which were attended by 7,483 health care workers from 21 countries across the world, 16 from countries in SSA. ICI also conducted 27 virtual unique training programs in cancer and other NCDs care which attracted 578 participants from across the globe, 95% of which were from SSA. The training participants distribution included 77% clinical healthcare providers; 17% non-clinical health care workers and 6% allied healthcare workers. The online training platform provided the opportunity for HCPs to be trained from their locality thus bridging the gap of cost and distance to advance their training. The innovative e-learning platform has made it possible to reach more healthcare workers across SSA without the limitation of restricted classroom sessions. CONCLUSION Capacity building of HCPs in SSA in cancer and other NCDs care and control goes beyond formal training. On-going peer to peer mentorship and on-job skills training have proved to be effective in building HCP capacity in improved standard of care across the cancer and other NCDs care. Use of a multi-disciplinary approach to care while leveraging on e-health solutions contributes to positive patient outcomes in resource limited settings.

Factors Associated with Mental Health Outcomes in Hospital Workers during the COVID-19 Pandemic: A Mixed-Methods Study.

Background: We investigated some of the factors associated with depression, perceived stress, and anxiety in clinical and nonclinical healthcare workers of two hospitals. Methods: A mixed-methods approach was used. The sample included clinical (physicians, nurses, and others) and nonclinical (security and cleaning staff) healthcare workers of two tertiary hospitals in Peru. Participants completed an online self-survey. In the qualitative analysis, data were subjected to thematic analysis. Results: We analyzed data from 613 participants, of which 8.6%, 9.0%, and 78.2% had moderate-to-severe anxiety, depression, and perceived stress, respectively. Having a previous mental health problem, being concerned about losing one’s job, having at least two COVID-19 symptoms in the preceding two weeks, and being afraid of infecting family members increased the prevalence of experiencing moderate-to-severe depression and anxiety. The qualitative analysis allowed us to identify five recurring factors that caused a negative impact on workers’ lives during the pandemic: emotional distress linked to hospital experiences of suffering and death, modification of routines, fear of COVID-19, exacerbation of mental disorders, and physical problems associated with emotional distress. Conclusions: Clinical and nonclinical healthcare workers in Peru have experienced depression, anxiety, and stress during the COVID-19 pandemic. Future research and interventions are necessary to improve psychological support for hospital workers.

High SARS-CoV-2 Prevalence among Healthcare Workers in Cochabamba, Bolivia.

Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection. The aim of the study was to estimate the SARS-CoV-2 seroprevalence among HCWs in Cochabamba, Bolivia and to determine the potential risk factors. In January 2021, a cross-sectional SARS-CoV-2 seroprevalence study was conducted in 783 volunteer clinical and non-clinical HCWs in tertiary care facilities. It was based on IgG detection using ELISA, chemiluminiscence, and seroneutralisation tests from dried blood spots. Analysis revealed a high seroprevalence (43.4%) of SARS-CoV-2 IgG antibodies. The combination of anosmia and ageusia (OR: 68.11; 95%-CI 24.83–186.80) was predictive of seropositivity. Belonging to the cleaning staff (OR: 1.94; 95%-CI 1.09–3.45), having more than two children in the same house (OR: 1.74; 95%-CI 1.12–2.71), and having been in contact with a close relative with COVID-19 (OR: 3.53; 95%-CI 2.24–5.58) were identified as risk factors for seropositivity in a multivariate analysis. A total of 47.5% of participants had received medication for COVID-19 treatment or prevention, and only ~50% of symptomatic subjects accessed PCR or antigenic testing. This study confirms a massive SARS-CoV-2 attack rate among HCWs in Cochabamba by the end of January 2021. The main risk factors identified are having a low-skilled job, living with children, and having been in contact with an infected relative in the household.

Differences in Attitudes of Front-Line Clinicians, Healthcare Workers, and Non-Healthcare Workers Toward COVID-19 Safety Protocols

BackgroundThe advent of the coronavirus disease 2019 (COVID-19) has generated varying opinions toward adhering to safety protocols among public health experts. With decreasing restrictions on public gatherings, lax protective behaviors, distortion of facts, and increasing availability of COVID-19 vaccines, response to public health guidelines vary greatly. Personal experiences with COVID-19, education, and work environment may influence decisions on safety recommendations and vaccination protocols among the public and healthcare professionals alike. To better understand how individuals process and make decisions regarding COVID-19 safety measures, this study investigated the attitudes among clinical and non-clinical healthcare workers and non-healthcare workers toward COVID-19 safety protocols.MethodologyCross-sectional data were collected from Florida residents using an online, 20-item anonymous questionnaire. Participants were recruited using the Florida Department of Health database for physician emails, social media, and snowball sampling strategies. The survey consisted of demographic items and questions regarding patient attitudes toward safety protocols for COVID-19 (e.g., likeliness to wear a mask in public despite state regulations being lifted, maintaining a distance of at least 6 feet between close friends and family, dining at restaurants/bars, gathering in groups larger than 10 people, getting a COVID-19 vaccine if one becomes available). Data were analyzed using one-way analysis of variance and chi-square test using SPSS version 27 (IBM Corp., Armonk, NY, USA).ResultsOf the 373 participants who completed the survey, 183 (49.1%) worked in the healthcare field, with 100 (28.6%) providing direct patient care. The rest (n = 190; 50.9%) reported that they do not work in the healthcare industry. Findings suggest that those working in healthcare with direct involvement in patient care were more likely to get the COVID-19 vaccine than those not working in healthcare. Additionally, those working in healthcare and providing direct patient care were more likely to think that masks were effective in reducing the spread of COVID-19 compared to those who worked in healthcare but did not provide direct patient care.ConclusionsThis study provides new insights into the attitudes of front-line clinicians, non-clinical healthcare workers, and the general population. Increasing health promotion efforts and debunking myths about COVID-19 may prove useful in mitigating the spread of the disease.

375. High Laboratory-confirmed SARS-CoV-2 Attack Rate in Lima Health Care Personnel During August 2020-March 2021 Suggests Role for Improved Infection Control

BackgroundPeru has one of the highest per capita SARS-CoV-2 death rates in Latin America. Healthcare workers (HCW) are a critical workforce during the COVID-19 pandemic but are themselves often at increased risk of infection. We evaluated SARS-CoV-2 attack rate and risk factors among frontline HCWs.MethodsWe performed a prospective cohort study of HCW serving two acute care hospitals in Lima, Peru from Aug 2020 to Mar 2021. Participants had baseline SARS-CoV-2 serology using the CDC ELISA, active symptom monitoring, and weekly respiratory specimen collection with COVID-19 exposure/risk assessment for 16-weeks regardless of symptoms. Respiratory specimens were tested by real-time reverse transcriptase PCR (rRT-PCR).ResultsOf 783 eligible, 667 (85%) HCW were enrolled (33% nurse assistants, 29% non-clinical staff, 26% nurses, 7% physicians, and 6% other). At baseline and prior to COVID-19 vaccine introduction, 214 (32.1%; 214/667) were reactive for SARS-CoV-2 antibodies. In total, 72 (10.8%; 72/667) HCWs were found to be rRT-PCR positive during weekly follow-up. Of the rRT-PCR positive HCWs, 37.5% (27/72) did not report symptoms within 1-week of specimen collection. During follow up, HCW without detectable SARS-CoV-2 antibodies at baseline were significantly more likely to be rRT-PCR positive (65/453, 14.3%) compared to those with SARS-CoV-2 antibodies at baseline (4/214, 1.9%) (p-value: < 0.001). Three HCW were both serologically reactive and rRT-PCR positive at baseline. Looking only at HCW without SARS-CoV-2 antibodies, nurse assistants (rRT-PCR positive: 18.6%; 27/141) and non-clinical healthcare workers (16.5%; 21/127) were at greater risk of infection compared to nurses (8.5%; 10/118), physicians (7.9%; 3/38), and other staff (10.3%; 4/29) (RR 1.95;95%CI 1.2,3.3; p-value: 0.01).ConclusionBaseline SARS-CoV-2 prevalence and 16-week cumulative incidence were substantial in this pre-vaccination Peruvian HCW cohort. Almost 40% of new infections occurred in HCW without complaint of symptoms illustrating a limitation of symptom-based HCW screening for COVID-19 prevention. Nurse assistants and non-clinical healthcare workers were at greater risk of infection indicating a role for focused infection prevention and risk reduction strategies for some groups of HCW.Disclosures Fernanda C. Lessa, MD, MPH, Nothing to disclose

Mental Health of Emergency Department Healthcare Workers During COVID-19 in Brooklyn, New York, United States

Background: Mental health symptoms in Emergency Department healthcare workers were measured in Brooklyn, New York, a COVID-19 epicenter.Methods: An email-distributed survey of Emergency Department healthcare workers was conducted September–December, 2020. Primary outcomes included symptoms of depression, psychological distress, perceived stress, and post-traumatic stress disorder (PTSD). Primary predictors included gender, age, race, healthcare worker status, SARS-CoV-2 testing, number of people to talk to, COVID-19-related home problems, mental health care interruption during COVID-19, loneliness, and survey date. Multivariable-adjusted linear regression analyses predicted continuous scores (b-coefficient, p-value). Multivariable-adjusted logistic regression analyses modelled likelihoods of clinically-relevant symptom burdens (Odds Ratio (OR) 95%Confidence Interval (95%CI)).Findings: Of 774 healthcare workers, 247 (31.9%) responded (mean age, 38.2±10.8 years; 59.4% White; 52.5% men; 80.1% clinical; 61.6% SARS-CoV-2 tested). Clinically-relevant symptom burdens were observed for psychological distress (35.8% clinical vs 13.8% non-clinical healthcare workers (p=0.019); and suggested for depression (53.9% clinical vs 35.7% non-clinical, p=0.072); perceived stress (63.6% clinical vs 44.8% non-clinical, p=0.053); and PTSD (18.2% clinical vs 3.6% non-clinical, p=0.064). Higher odds of clinically-relevant depression, perceived stress, and PTSD symptoms were observed for clinical vs non-clinical healthcare workers (ORs>1.0, 95%CI>1.00 lower limit). Increasing age, number of COVID-19-related home problems and people to talk to, loneliness and mental health care interruption were adversely associated with mental health (pInterpretation: COVID-19-related mental health burden was amplified among Emergency Department healthcare workers in Brooklyn.Funding: Maimonides Research Foundation; the NIH/National Heart, Lung and Blood Institute/National Institute on Aging, 3U01 HL146202 02S2.Declaration of Interest: None to declare. Ethical Approval: This protocol was approved by the Maimonides Medical Center institutional review board, and deemed exempt because the survey was anonymous and did not contain personal identifiers.

Knowledge, Attitudes, and Practices Regarding COVID-19 among Healthcare Workers in Uganda: A Cross-Sectional Survey.

Healthcare workers (HCWs) are at high risk of COVID-19. However, data on HCWs’ knowledge, attitudes, and practices (KAP) toward COVID-19 are limited. Between September and November 2020, we conducted a questionnaire-based COVID-19 KAP survey among HCWs at three hospitals in Uganda. We used Bloom’s cut-off of ≥80% to determine sufficient knowledge, good attitude, and good practice, and multivariate Poisson regression with robust variance for statistical analysis. Of 717 HCWs invited to participate, 657 (91.6%) agreed and were enrolled. The mean age (standard deviation) of enrollees was 33.2 (10.2) years; most were clinical HCWs (64.7%) and had advanced secondary school/other higher-level education (57.8%). Overall, 83.9% had sufficient knowledge, 78.4% had a positive attitude, and 37.0% had good practices toward COVID-19. Factors associated with KAP were: Knowledge: being a clinical HCW (aRR: 1.12; 95% CI: 1.02–1.23) and previous participation in health research (aRR: 1.10; 95% CI: 1.04–1.17); Attitude: age > 35 years (aRR: 0.88; 95% CI: 0.79–0.98); Practice: being a clinical HCW (aRR: 1.91; 95% CI: 1.41–2.59). HCWs in Uganda have good knowledge and positive attitude but poor practices towards COVID-19. Differences in COVID-19 KAP between clinical and non-clinical HCWs could affect uptake of COVID-19 interventions including vaccination.