Risk Of Infection For Healthcare Workers Research Articles

Pre-Endoscopy real-time PCR testing for SARS-CoV2 does not reduce health care workers infection and is associated with a higher reduction of endoscopic activity in an outpatient setting.

The role of pre-procedure SARS-CoV2 testing in digestive endoscopy is still debated. AGA guidelines recommend against pre-procedure testing considering low prevalence of SARS- CoV2 infection in the general population and low incidence of infection among endoscopy units Health Care Workers (HCWs). However, no studies have compared pre-procedure testing associated to symptom screening vs. symptom screening alone in reducing the risk of infection for HCWs. Main aim of the present study is to compare the risk of infection for HCWs in different Endoscopy Units adopting different pre-endoscopy screening and operating in two nearby hospital of the same region in Northern Italy in pre-vaccination period. For outpatients in the Endoscopy Unit of Trento (Unit 1) only pre-procedure symptom screening was performed, while in the Endoscopy Unit of Bolzano (Unit 2) pre-procedure symptom screening and negative pre-procedure real-time PCR were requested. Secondary aims were to assess the impact of pre-procedure real-time PCR testing on endoscopic activity and diagnostic delay. Retrospective data collection on a prospectively maintained database was performed, including outpatient endoscopy procedures performed between June 1st 2020 and February 28th 2021 in Unit 1 and Unit 2. No differences in terms of infection rate in HCWs have been identified in Unit 1 and Unit 2 (9.0 vs. 19.3% P=0.2) over a nine-month period. Moreover, in the unit performing pre- procedure real-time PCR before endoscopy a significantly higher reduction in endoscopic activity has been recorded (61.9% vs. 53.4%; P<0.01). In patients with positive real-time PCR, endoscopy was performed with a mean delay of 61.7 days (range 9-294) and 22.5% of them were lost at follow-up and did not undergo any endoscopic procedure in the following 12 months. This study supports the AGA recommendation suggesting that pre-endoscopy real-time PCR is an expensive and time-consuming procedure without proven benefits in an outpatient setting.

When personal protective equipment for health workers during COVID-19 outbreaks is missing: conclusions of the Catalan COVID-19 Workgroup

Frontline healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. The aim of this study is to ensure risk-based protection when there is a lack of personal protective equipment (PPE). At the beginning of the pandemic, it was suggested that PPE were necessary to protect HCWs from COVID-19. However, given supply shortage, PPE had to be replaced in some situations. Three levels of protection were established depending on the risk level of exposure to SARS-CoV-2. Best practices were reviewed and analysed, and subsequently implemented in all hospitals in Catalonia. As the first COVID-19 wave progressed, we became more knowledgeable with the behaviour of the virus, so PPE procedure tables and algorithms were modified and adapted to the changing scenarios. After airborne transmission was demonstrated as the main route of the virus transmission, we emphasized new measures to ensure respiratory tract protection. Three general tables were established based on low, medium, and high risk of infection for HCWs. These three scenarios are a subgroup of the very high-risk category, according to OSHA's pyramid of SARS-CoV-2 risk characterization. The most appropriate PPE for each task or job were identified and alternatives were given amid the shortage of PPE. Specific PPE are required for the healthcare sector. Many studies on PPE are based on the characteristics of industrial jobs, and do not consider the specificities of the healthcare sector, which requires close and prolonged contact with patients.

Droplet aerosols transportation and deposition for three respiratory behaviors in a typical negative pressure isolation ward

Negative pressure isolation wards could provide safety for health care workers (HCWs) and patients infected with SARS-CoV-2. However, respiratory behavior releases aerosols containing pathogens, resulting in a potential risk of infection for HCWs. In this study, the spatiotemporal distribution of droplet aerosols in a typical negative pressure isolation ward was investigated using a full-scale experiment. In this experiment, artificial saliva was used to simulate the breathing behavior, which can reflect the effect of evaporation on droplet aerosols. Moreover, numerical simulations were used to compare the transport of droplet aerosols released by the three respiratory behaviors (breathing, speaking, and coughing). The results showed that droplet aerosols generated by coughing and speaking can be removed and deposited more quickly. Because reduction in the suspension proportion per unit time was much higher than that in the case of breathing. Under the air supply inlets, there was significant aerosol deposition on the floor, while the breathing area possessed higher aerosol concentrations. The risk of aerosol resuspension and potential infection increased significantly when HCWs moved frequently to these areas. Finally, more than 20% of the droplet aerosols escaped from the ward when the number of suspended aerosols in the aerosol space was 1%.

The Impact of the First Wave of the COVID-19 Pandemic on Healthcare Workers: An Italian Retrospective Study.

Healthcare workers (HCWs) played an essential role in managing the COVID-19 pandemic. The Italian Workers’ Compensation Authority (INAIL) and the Italian National Institute of Health (ISS) developed a retrospective study to analyze and understand trends and characteristics of infections among HCWs during the first wave of the pandemic. Between May and September 2020, Italian Regions retrospectively collected anonymous data regarding HCWs infected from the beginning of the pandemic until 30 April 2020 from their administrative sources through a questionnaire asking for socio-demographic and occupational information about the characteristics of contagion and disease outcome. Almost 16,000 valid questionnaires were received. Logistic regression was performed to ascertain the effect of age, gender, geographical macro area, profession, and pre-existing health conditions on the likelihood of HCWs developing more severe forms of COVID-19 (at least hospitalization with mild symptoms). All predictor variables were statistically significant. HCWs at higher risk of developing a more severe disease were males (OR: 1.90; 95% CI: 1.44–2.51), older than 60 years of age (OR: 6.00; 95% CI: 3.30–10.91), doctors (OR: 4.22; 95% CI: 2.22–9.02), working in Lombardy (OR: 55.24; 95% CI: 34.96–87.29) and with pre-existing health conditions (OR: 1.90; 95% CI: 1.43–2.51). This study analyses the main reasons for the overload put on the National Health Service by the first wave of the pandemic and the risk of infection for HCWs by age, gender, occupational profile and pre-existing health conditions. Improved knowledge, availability of personal protective equipment (PPE) and a tight vaccination campaign for HCWs strongly changed the trend of infections among HCWs, with substantial elimination of serious and fatal cases.

COVID-19 Seroprevalence among Healthcare Workers in a University Hospital in Southeastern Turkey

Objective: In our study, IgG and IgA antibodies were investigated by using the ELISA method, especially in healthcare workers (HCWs) who were more likely to encounter infection as of June 2020, and it was aimed to determine the level of HCWs being affected by the pandemic. Methods: A total of 186 volunteer HCWs from different professions working in different departments were included in the study. Serum was obtained by taking 5 mL of blood samples from the volunteers. The presence of IgA and IgG antibodies against the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus was investigated in the sera by using the ELISA method. Results: The mean age of the participants in the study was 34.22 (67.85), and 71 (38.2%) were female. One hundred and eighty participants tested for SARS-CoV-2 IgA antibodies, and eight (4.4%) of them were found positive. One hundred and eighty-six participants tested for SARS-CoV-2 IgG antibodies, and five (2.7%) of them were found positive. The highest antibody positivity was detected in the intensive care unit and doctors. Conclusion: At the end of the study, low seropositivity rates were found. However, the risk of infection in HCWs increased in proportion to the continuation of the pandemic and the increase in cases. HCWs took the necessary precautions to minimize the infection. Investigating the presence of antibodies in HCWs at regular intervals will help to calculate the risk among HCWs.

Factors associated with the transmission of pandemic (H1N1) 2009 among hospital healthcare workers in Beijing, China

Background With the increase in patient activity during the 2009 H1N1 pandemic, came an associated increase in occupational infections of healthcare workers (HCWs). Objectives The aim of this study was to examine factors associated with the transmission of pandemic (H1N1) 2009 among HCWs. Methods A 1:4 matched case–control study by hospital, ward, age, and gender was conducted in HCWs from hospitals in Beijing during February 2010. Cases were diagnosed with pandemic (H1N1) 2009, and controls had neither influenza‐like illness nor diagnosis with pandemic (H1N1) 2009 during August 2009 to January 2010. Information during 7 days before symptom onset of case was collected, and controls were queried about the same period. Results A total of 51 cases identified via National Notifiable Infectious Disease Surveillance System participated in this study. Controls were matched to cases for a total of 255 individuals. About 19·6% (10/51) of cases and 26·0% (53/204) of controls recalled they had conducted a high‐risk procedure on a patient with pandemic (H1N1) 2009. 72·5% (37/51) of cases and 71·6% (146/204) of controls stated they wore medical masks in ≥80% of working time. Only 5·9% (3/51) and 36·3% (74/204) of cases and controls, respectively, reported receiving pandemic vaccination. Participants receiving pandemic vaccination had a significantly lower risk of infection during the pandemic (OR = 0·150, 95% CI: 0·047–0·479, P = 0·001). The estimated vaccine effectiveness was 85·0%. Conclusions We showed a high vaccine effectiveness of the pandemic vaccine and that vaccination was the only factor significantly associated with risk of infection in HCWs.