Screening Of Healthcare Workers Research Articles

Workplace Safety and Screening of Healthcare Workers for SARS-CoV-2 at a Tertiary Care Hospital in the Northern Emirates of United Arab Emirates

Background: Coronavirus disease 2019 (COVID-19) was first reported in December 2019 in Wuhan, People’s Republic of China, and caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), As the virus took hold in the world, health experts paced efforts to solve the unknown nature of this threat. Methodology: We studied the clinical characteristics, laboratory biomarkers of healthcare workers in the single center, analytical cross-sectional study conducted in tertiary care hospital of the UAE. Sample size of 600 HCWs were screened for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (rRT-PCR) assay using Seegene Allplex and Andis FAST SARS-CoV-2 RT-qPCR detection kits for a period of 6 months. Findings: All the health care workers (HCWs) were vaccinated for the SARS-CoV-2. Out of these, 240 HCWs were reported to be positive. rRT-PCR with a Ct value of <38 was taken as positive >38. The laboratory investigations of the positive cases were collected and analysed further. A comparison of the laboratory tests was made between (I) COVID severe (Ct < 25) and nonsevere (Ct > 25) groups and (II) frontline workers and non-frontline workers. Besides finding short-term and sudden relief, investigators directed their efforts to provide a long-term solution for an ensuing pandemic that influenced all areas of life in unprecedented ways. Conclusion: Awareness among healthcare workers and further long-term studies focusing on their mental health the overall wellness and especially the psychological burden on doctors have received heightened awareness in media and research publications. This information can assist in developing surveillance and infection and control policies and preparedness for future COVID epidemics in similar scenarios in the future.

Outcome of Ophthalmic Screening of Healthcare Workers at a Medical College Hospital

Outcome of Ophthalmic Screening of Healthcare Workers at a Medical College Hospital

Outbreak of postpartum group a Streptococcus infections on a labor and delivery unit.

A healthcare-associated group A Streptococcus outbreak involving six patients, four healthcare workers, and one household contact occurred in the labor and delivery unit of an academic medical center. Isolates were highly related by whole genome sequencing. Infection prevention measures, healthcare worker screening, and chemoprophylaxis of those colonized halted further transmission.

Incidence of Adverse Maternal Outcomes Among Pregnant Health Care Workers [ID 2683462

INTRODUCTION: The objective of this study was to examine whether pregnant health care workers at are increased risk for adverse maternal outcomes in pregnancy. METHODS: A retrospective cohort study from 2008 to 2023 was conducted using TriNetX Research platform (de-identified patient data from a network of health care organizations) to identify pregnant health care workers. Using ICD codes, CPT codes, and LOINC codes, individuals were diagnosed with the presence or absence of the following conditions: fetal growth restriction, gestational diabetes mellitus, chronic hypertension, gestational hypertension, preeclampsia (with and without severe features), and postpartum depression. Descriptive statistics were used to analyze the data. The University of Texas Medical Branch IRB approved this study as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. RESULTS: Among 1,553,793 patients, 34,099 were health care workers. Health care workers had increased incidences for the following adverse maternal outcomes: diet-controlled gestational diabetes (12.88% versus 9.95%; P<.001), oral hypoglycemic agent-controlled gestational diabetes (1.56% versus 1.02%; P<.001), insulin-controlled gestational diabetes (2.88% versus 1.73%; P<.001), gestational hypertension (3.04% versus 2.73%; P<.001), and preeclampsia with severe features (5.95% versus 4.23%; P<.001). Health care workers were at decreased incidences for fetal growth restriction, preeclampsia without severe features, and postpartum hemorrhage. CONCLUSION: Given that health care workers are at increased risk of several adverse maternal outcomes, it may be important for providers to screen health care workers more frequently for these adverse outcomes. Additional studies will need to be conducted using current identifiable electronic medical records.

Nasal Screening of Health Care Workers (Nursing staff) to Study the Prevalence of Methicillin Resistant Staphylococcus Aureus (MRSA) Carriage and its Antibiotic Sensitivity Profile in a Rural Tertiary Health Care Center

Nasal Screening of Health Care Workers (Nursing staff) to Study the Prevalence of Methicillin Resistant Staphylococcus Aureus (MRSA) Carriage and its Antibiotic Sensitivity Profile in a Rural Tertiary Health Care Center

Evaluating pooled testing for asymptomatic screening of healthcare workers in hospitals

BackgroundThere is evidence that during the COVID pandemic, a number of patient and HCW infections were nosocomial. Various measures were put in place to try to reduce these infections including developing asymptomatic PCR (polymerase chain reaction) testing schemes for healthcare workers. Regularly testing all healthcare workers requires many tests while reducing this number by only testing some healthcare workers can result in undetected cases. An efficient way to test as many individuals as possible with a limited testing capacity is to consider pooling multiple samples to be analysed with a single test (known as pooled testing).MethodsTwo different pooled testing schemes for the asymptomatic testing are evaluated using an individual-based model representing the transmission of SARS-CoV-2 in a ‘typical’ English hospital. We adapt the modelling to reflect two scenarios: a) a retrospective look at earlier SARS-CoV-2 variants under lockdown or social restrictions, and b) transitioning back to ‘normal life’ without lockdown and with the omicron variant. The two pooled testing schemes analysed differ in the population that is eligible for testing. In the ‘ward’ testing scheme only healthcare workers who work on a single ward are eligible and in the ‘full’ testing scheme all healthcare workers are eligible including those that move across wards. Both pooled schemes are compared against the baseline scheme which tests only symptomatic healthcare workers.ResultsIncluding a pooled asymptomatic testing scheme is found to have a modest (albeit statistically significant) effect, reducing the total number of nosocomial healthcare worker infections by about 2%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\%$$\\end{document} in both the lockdown and non-lockdown setting. However, this reduction must be balanced with the increase in cost and healthcare worker isolations. Both ward and full testing reduce HCW infections similarly but the cost for ward testing is much less. We also consider the use of lateral flow devices (LFDs) for follow-up testing. Considering LFDs reduces cost and time but LFDs have a different error profile to PCR tests.ConclusionsWhether a PCR-only or PCR and LFD ward testing scheme is chosen depends on the metrics of most interest to policy makers, the virus prevalence and whether there is a lockdown.

Effect of a latent tuberculosis infection programme for healthcare workers in a country with an intermediate tuberculosis burden

Management of latent tuberculosis infection (LTBI) among healthcare workers (HCWs) is crucial for the prevention of nosocomial tuberculosis (TB) transmission. We aimed to determine the effect of an LTBI programme for HCWs in a tertiary care hospital in a country with an intermediate TB burden. In 2013, baseline LTBI screening was implemented for newly hired doctors and nurses, along with annual screening of HCWs in high-risk departments. HCWs with LTBI were also provided with treatment. Since 2017, all HCWs without an LTBI test result have been tested for LTBI. We assessed the annual incidence of active TB among HCWs between 2013 and 2020. Additionally, we evaluated the incidence of active TB among HCWs employed at the hospital in 2020, with a specific focus on those who had undergone LTBI tests between 2013 and 2018, considering their LTBI test results and treatment status. The incidence of active TB among HCWs significantly decreased between 2013 and 2020. The average risk reduction for pulmonary TB was 10.2% per year (95% CI, 1.0-19.0; P=0.034). Among HCWs employed at the hospital in 2020, 4354 individuals underwent LTBI tests between 2013 and 2018. Of them, 927 (21.3%) tested positive. Nine (1.5%) of 588 without LTBI treatment developed active TB. Among the 1285 HCWs who underwent follow-up testing, 62 (4.8%) converted, and one (4.3%) of the 23 without treatment developed active TB. None of those who received treatment were diagnosed with active TB. The LTBI programme significantly reduced the incidence of active TB in HCWs. LTBI screening and treatment should be implemented, particularly in countries with a high or intermediate TB burden.

Right to Occupational Safety: Prevalence of Latent Tuberculosis Infection in Healthcare Workers. A 1-Year Retrospective Survey Carried out at Hospital of Lecce (Italy).

Prevention of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) to ensure the "Right to Occupational Safety" is a special challenge globally, as HCWs have a higher risk of acquiring the infection in hospital settings because of frequent close exposure to patients suffering from tuberculosis (TB). Aretrospective study was performed with the aim of assessing the prevalence of LTBI related to demographical and occupational risk factors among HCWs employed in a large hospital in Italy. The study involved 1461 HCWs screened for LTBI by Mantoux tuberculin skin test (TST) and then confirmed with Interferon Gamma Release Assay (IGRA) test in case of positivity. Immunosuppressed and BGC-vaccinated workers were tested directly with IGRA. LTBI was diagnosed in 4.1% of the HCWs and the prevalence resulted lower than other studies conducted in low TB incidence countries. The variables significantly linked with higher frequency of the infection were: age ≥40 years (OR = 3.14; 95% CI: 1.13-8.74; p < 0.05), length of service ≥15 years (OR = 4.11; 95% CI: 1.48-11.43; p < 0.05) and not being trained on TB prevention (OR = 3.46; 95% CI: 1.85-6.46; p < 0.05). Not trained HCWs presented a higher risk of LTBI also after adjustment for age and length of service, compared to trained HCWs. screening of HCWs for LTBI should be always considered in routinely occupational surveillance in order to early diagnose the infection and prevent its progression. Safety policies in hospital settings centered on workers' training on TB prevention is crucial to minimize LTBI occurrence in HCWs.

Parenting stress and associated factors in healthcare workers after the second wave of COVID-19 in India: a two-center cross-sectional study.

High parenting stress (PS) in members of the general population during the COVID-19 pandemic was exacerbated by work-, family-, and child-related factors. However, the negative effects of PS on the mental health and work participation of healthcare workers (HCWs) have received limited attention. This study aimed to examine the proportion of severe PS among HCWs and identify its contributory factors. This cross-sectional survey was conducted in two COVID-19-care hospitals attached to medical colleges in India between November 1 and December 24, 2021, following the delta variant-driven second wave of COVID-19. The study recruited 662 HCW parent and child dyads (aged 1.5-18 years) and assessed workplace, family, and child-related characteristics. The Parenting Stress Scale (PSS) and Child Behavior Checklist (CBCL) were used to identify severe PS and child behavioral issues, respectively. Univariable and multivariable logistic regression analyzes were used to identify the significant and independent risk factors associated with severe PS, respectively. Equal proportions of medical and paramedical HCWs completed the survey [mean age: 36.96 ± 5.89; female: 466 (70%)]. The median PSS score of HCWs was 33 [interquartile range (IQR): 28-39], and 23% (155/662) of the HCW parents experienced severe PS. The independent predictors of severe PS included the female sex [adjusted odds ratio (aOR): 3.31; 95% confidence interval (CI): 1.74-6.29], HCWs with >15-day postings in COVID-19 care (aOR: 3.74; 95% CI: 1.53-9.16), having children with behavioral issues (aOR: 3.49; 95% CI: 1.29-9.48), HCWs at the Dehradun center (aOR: 2.25; 95% CI: 1.24-4.10), having an HCW spouse simultaneously working in COVID-19 care (aOR: 1.88; 95% CI: 1.01-3.49), and HCWs with joint families (aOR: 1.93; 95% CI: 1.17-3.18). Overall, 23% of the cohort of HCWs continued to experience severe PS after the second COVID-19 wave driven by the delta variant in India. Routine screening of HCWs for PS using the PSS or similar measures, anticipatory guidance for parenting, and targeting at-risk HCWs with appropriate supportive measures may help reduce the incidence of severe PS and optimize the participation of HCWs in the fight against current and future pandemic-like situations.

COVID-19 burden and influencing factors in Swiss long-term-care facilities: a cross-sectional analysis of a multicentre observational cohort

To describe the burden of COVID-19 in Swiss long-term care facilities in 2020, to identify its influencing factors, and to assess vaccination rates among residents and healthcare workers at the end of the vaccine campaign in Switzerland in May 2021. Cross-sectional survey. Long-term care facilities from two Swiss cantons (St. Gallen / Eastern Switzerland and Vaud / Western Switzerland). We collected numbers of COVID-19 cases and related deaths and all-cause mortality for 2020, potential risk factors at the institutional level (e.g. size, infection prevention and control measures, and resident characteristics), and vaccination rates among residents and healthcare workers. Univariate and multivariate analyses were used to identify factors associated with resident mortality in 2020. We enrolled 59 long-term care facilities with a median of 46 (interquartile range [IQR]: 33-69) occupied beds. In 2020, the median COVID-19 incidence was 40.2 (IQR: 0-108.6) per 100 occupied beds, with higher rates in VD (49.9%) than in SG (32.5%; p = 0.037). Overall, 22.7% of COVID-19 cases died, of which 24.8% were COVID-19-related deaths. In the univariate analysis, higher resident mortality was associated with COVID-19 rates among residents (p < 0.001) and healthcare workers (p = 0.002) and age (p = 0.013). Lower resident mortality was associated with the proportion of single rooms (p = 0.012), isolation of residents with COVID-19 in single rooms (p = 0.003), symptom screening of healthcare workers (p = 0.031), limiting the number of visits per day (p = 0.004), and pre-scheduling visits (p = 0.037). In the multivariate analysis, higher resident mortality was only associated with age (p = 0.03) and the COVID-19 rate among residents (p = 0.013). Among 2936 residents, 2042 (69.9%) received ≥1 dose of the COVID-19 vaccine before 31 May 2021. Vaccine uptake among healthcare workers was 33.8%. COVID-19 burden was high but also highly variable in Swiss long-term care facilities. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers was a modifiable factor associated with increased resident mortality. Symptom screening of healthcare workers appeared to be an effective preventive strategy and should be included in routine infection prevention and control measures. Promoting COVID-19 vaccine uptake among healthcare workers should be a priority in Swiss long-term care facilities.

Prevalence of Stress and Insomnia among Health Care Workers in India during COVID-19 Pandemic: A Systematic Review and Meta-analysis.

Health care workers (HCWs) are prone to stress and insomnia because of pandemic situations. Assessment of the actual burden of this stress and insomnia is essential to form preventive strategies. The study's objective was to find out the pooled prevalence of stress and insomnia among HCWs in India during the coronavirus disease (COVID-19) pandemic. We conducted a systematic review and meta-analysis to determine the prevalence of stress and insomnia among HCWs during the COVID-19 pandemic in India. Cross-sectional studies conducted in India regarding stress and insomnia among HCWs were searched from PubMed, Scopus, Embase, and Google Scholar. These studies were published after the declaration of the COVID-19 pandemic till August 31, 2021. Articles were searched independently by both authors. Data were extracted in an Excel sheet and analyzed using the 'Meta' package of the 'R' software version 4.1.0. A total of 23 and 16 studies were included in the final pooled analysis of stress and insomnia, respectively, following preferred reporting items for systematic review and meta-analysis guidelines. A random-effects model was used to determine the pooled prevalence of stress and insomnia. This study is registered in Prospero. The registration number is CRD42021253917. The total numbers of HCWs from India included were 8125 and 4974, respectively, for finding out the pooled prevalence of stress and insomnia. The pooled prevalence of stress and insomnia among HCWs is 43% [95% confidence interval (CI) 30-56%] and 35% (95% CI 28-44%), respectively. Two out of five and one in three Indian HCWs have stress and insomnia, respectively, during the COVID-19 pandemic. Human resource development should be prioritized to decrease the workload among HCWs. The findings from this study will be useful in preparing policy guidelines on mental health screening of HCWs during the pandemic.

SARS-CoV-2 antigen tests for screening of healthcare workers; experience with over 48,000 combined antigen tests and RT-PCR tests.

To prevent spread to patients and co-workers, health care workers (HCWs) infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) should quickly be identified. Although real time polymerase chain reaction (RT-PCR) is the gold standard, this test takes several hours, during which a HCW is unable to work. Antigen (Ag) tests may be an efficacious means of screening HCWs since they are easy to perform and provide fast results. In this study, 48,010 paired results of Ag-testing and RT-PCR, performed on HCWs between January 2021 and April 2022, were evaluated to determine the diagnostic accuracy of SARS-CoV-2 Ag-tests in diagnosing potentially infectious individuals. This analysis was performed with cycling threshold values (Ct-values) ≤30 and ≤25 as cut-offs. Respectively 3.1% (n=1507) and 0.3% (n=140) of Ag-tests were positive or indeterminate, and thus indicative for SARS-CoV-2 infection. In total, 2479 (5.2%) RT-PCRs were positive, of which 1529 (61.7%) had a Ct-value ≤25 and 402 (16.2%) a Ct-value between 26 and 30. At Ct-value ≤30 as a cut-off, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Ag-tests were 79.0%, 99.8%, 93.8% and 99.1%, respectively. At Ct-value ≤25, sensitivity further improved to 92.0%, by which the NPV increased to 99.7%. To prevent transmission from HCWs to patients and co-workers, while maintaining workforce capacity, Ag-tests are a valuable addition to RT-PCR tests, as they have a quick turnaround time and excellent sensitivity for identifying individuals with high potential for transmission.

Performance evaluation of the bio-rad BioPlex 2200 multiplex system in the detection of measles, mumps, rubella, and varicella-zoster antibodies

BackgroundMeasles, mumps, rubella, and varicella-zoster (MMRV) immunity testing is important in occupational screening of healthcare workers and at-risk populations. ObjectivesThe goal of this study was to compare the performance of the Bio-Rad BioPlex 2200 MMRV multiplex fluorescence immunoassay (MFI) against two enzyme immunoassay (EIA) methods: the Bio-Rad Evolis Twin Plus measles, mumps, and varicella-zoster (MMV) IgG assay and the Abbott Architect Rubella IgG assay. Study DesignClinically uncharacterized serum specimens were obtained and analyzed using the Bio-Rad BioPlex assay and compared against the EIA methods. ResultsThe Bio-Rad BioPlex demonstrated total agreement of 85.5% (95% confidence interval (CI), 78.0 to 90.7%), 92.7% (95% confidence interval (CI), 86.7 to 96.1%), 92.4% (95% confidence interval (CI), 86.9 to 95.7%), and 98.8% (95% confidence interval (CI), 93.7 to 99.8%) for measles, mumps, varicella-zoster, and rubella, respectively, against the current EIA methods. Furthermore, precision testing agreed with the manufacturer's package insert in 10 of 13 pooled samples. ConclusionThese data indicate that the Bio-Rad BioPlex has comparable performance to the EIA methods.

The Implementation of a Health Care Worker Screening Program Based on the Advanta RT-qPCR Saliva Assay in a Tertiary Care Referral Hospital in Northern Greece.

Health care workers are at increased risk of acquiring SARS-CoV-2 infection due to different exposures in the community and in hospital settings. Interventions implemented to avoid nosocomial outbreaks include preventive testing strategies. In this report, we present results from the mass screening program applied in our hospital to all professionals, irrespective of symptoms or risk of exposure. We processed saliva specimens with real-time reverse transcription polymerase chain reaction. The total number of samples received was 43,726. Positive results were 672 and average positivity rate was 1.21%. The average positivity rate was similar to the positivity rate in the community in Greece and EU. More specifically, 80.5% of the positive participants care for patients in their daily activities, 31% experienced no symptoms before receiving the positive result, 46.1% reported a close contact with a patient or infected coworkers and 32.8% reported a close contact with infected family members. We believe that the identification of asymptomatic carriers has proved the effectiveness of the screening program by preventing the putative nosocomial spread of the virus and the depletion of workforce. In conclusion, in times of high incidence in the community, the periodic testing of health care personnel is wise and relevant for implementation costs.

Development of a Policy and Procedure for Random Drug Screening of Healthcare Workers at a Tertiary Care Children’s Hospital: Initial Implementation and Preliminary Results

During the past decade, substance abuse and addiction have continued to increase worldwide in both the general public and healthcare providers. Given the ongoing trend demonstrating an increase in the prevalence of drug diversion and its higher prevalence in various healthcare provider groups, several interventions have been initiated to decrease the availability of substances of abuse, as well as identify or uncover substance abuse in healthcare providers. This manuscript reviews techniques which have been implemented to prevent diversion in healthcare providers and outlines the steps taken in the development of a random drug screening program at our tertiary care children’s hospital. Additionally, we review outcomes and the potential impact after the first 24 months of the random drug screening program. Six faculty or staff have been screened each quarter over a 2-year period. To date, we have not had a positive result. Service issues regarding timely screening of faculty and staff upon arrival to Employee Health have been limited with the process generally taken less than 60 min. There have been no significant disruptions in the work process of the operating room or pharmacies. The use of random drug testing is important not only for the safety of our patients, but the integrity of both the fields of anesthesia and pharmacy. The process can be introduced without interruption of workflow or impact on employee privacy. We believe that this process is one of several interventions which may be helpful in decreasing drug diversion. Int J Clin Pediatr. 2022;11(3):69-75 doi: https://doi.org/10.14740/ijcp495

Combating Non- Communicable Disease Among HCW: The Broken Soldiers

Non communicable disease (NCD) has recently emerged as a major public-health concern, with prevalence rising over the world. As a submerged portion of the iceberg, the hidden burden of NCD is escalating and devouring the world. NCD affects HCW in the same way it affects other types of workers. Healthcare worker (HCW) should serve as role models in the community, raising NCD prevention knowledge and encouraging patients to adopt a healthier lifestyle. The Objective to the study to access the prevalence of non-communicable disease among healthcare workers. A cross sectional study was conducted in Johor state public health division with secondary data source from health screening of HCW from 2021. A total of 123 subjects participated in the study. Based on BMI calculation 26% were categorized normal, 42% were overweight and 30% were obese. Correlation and univariate analysis were conducted on BMI and blood screening. The results show a significant relationship between BMI towards Total Cholesterol and Fasting blood sugar level among HCW (P value &lt;0.01). The high prevalence of NCD risk factors and their significant association necessitate an appropriate risk-reduction strategy to reduce the possibility of chronic illness among them.

EPIDEMIOLOGICAL TOOL IN THE STUDY OF MRSA NASAL CARRIAGE AMONG HEALTH CARE WORKERS OF TERITARY CARE HOSPITAL - ITS UTILITY

Background And Objectives: Staphylococcus aureus is a common cause of community and hospital acquired infections. Methicillin resistant Staphylococcus aureus (MRSA) is a common nosocomial pathogen in the ICUs and other parts of the hospital and presents a challenge for all health care institutions. One of the important sources of MRSA in hospital setting is nasal carriage among health care workers (HCW's). Thus screening of health care workers for MRSA carriage will be helpful in preventing spread of MRSA from colonized health care workers to patients. The objective of the study is to to estimate the prevalence of nasal carriage of MRSA among health care workers of our institution. It is a prospective study done at Institute of Microbiology, Madurai Materials And Methods: Medical College, Madurai with the study period of two months. Nasal swabs collected from 100 healthcare workers working in different departments of our tertiary care hospital. All the swabs were inoculated on to Mannitol salt agar plates and incubated at 37°c for 24hrs to isolate Staphylococcus aureus. MRSA strains were identied by disc diffusion method using Cefoxitin (30฀g) disc. Results: Out of 100 HCWs, 21 (21%) were nasal carriers of S.aureus and among them 2(2/21) (9.5%) were carrier of MRSA. The overall nasal carriage rate of MRSA was 2%(2/100). S. aureus carriage rate was highest among Staff nurses 27.7 % (5/18) while MRSA carriage rate was highest among Interns 3.3%(1/30). In our study, nasal Conclusion: carriage of MRSA among the health care workers is 2 % with the rate being highest among Interns. Considering the fact that Health Care Workers are more involved in the patient care activities, it is necessary to sensitize them regarding this issue and we should emphasize the importance of hand washing on them.

Usefulness and Limitations of Anti-S IgG Assay in Detecting Previous SARS-CoV-2 Breakthrough Infection in Fully Vaccinated Healthcare Workers.

Introduction: The anti-spike (S) IgG assay is the most widely used method to assess the immunological response to COVID-19 vaccination. Several studies showed that subjects with perivaccination infection have higher anti-S IgG titers. However, a cut-off has not yet been identified so far for distinguishing infected subjects after vaccination. This study thus evaluates the performance of the anti-S IgG assay in identifying subjects with breakthrough infections (BIs) and its potential usefulness for screening healthcare workers (HCWs). Methods: Out of 6400 HCWs of the University Hospital of Verona vaccinated with two doses of BNT162b2, 4462 never infected before subjects who had completed primary vaccination were tested for IgG anti-S 6 to 9 months after the second dose. Of these, 59 (1.3%) had a BI. The discriminant power of IgG anti-S in detecting previous breakthrough infection was tested by constructing receiver operating characteristic (ROC) curves. Results: The discriminant power for BI was rather good (area under the curve (AUC), 0.78) and increased with decreasing time elapsed between antibody titer assessment and previous SARS-CoV-2 infection. Accuracy (AUC) sensitivity increased from 0.78 (95% CI 0.70–0.85) for BI in the previous six months to 0.83 (95% CI 0.67–0.99) for those in the previous two months, and from 0.68 to 0.80, respectively. The specificity (0.86) and optimal cut-off (935 BAU/mL) remained unchanged. However, BI were rather rare (1.3%), so the positive predictive value (PPV) was low. Only 40 of the 664 HCWs with antibody titer > 935 BAU/mL had previously confirmed BI, yielding a PPV of only 6.0%. When adopting as cut-off the 90th percentile (1180 BAU/mL), PPV increased to 7.9% (35/441). Conclusions: The anti-S IgG assay displayed good sensitivity and specificity in discriminating subjects with BI, especially in recent periods. However, BIs were rare among HCWs, so that the anti-S IgG assay may have low PPV in this setting, thus limiting the usefulness of this test as a screening tool for HCWs. Further studies are needed to identify more effective markers of a previous infection in vaccinated subjects.

Control of an outbreak of COVID-19 at a tertiary hospital in Taiwan.

BackgroundCoronavirus disease 2019 (COVID-19) has circulated in Taiwan since late 2019. Healthcare facilities are vulnerable to COVID-19 outbreaks due to clusters of symptomatic patients and susceptible hosts. Prompt control of outbreaks is crucial. In May 2021, an index case of COVID-19 was detected at Far Eastern Memorial Hospital (FEMH) in New Taipei City, Taiwan, 3 days after hospital admission, spreading to 26 patients and staff. Herein we evaluate control of this COVID-1 outbreak.MethodsTo control the outbreak, the index case ward was closed, and large-scale COVID-19 testing (RT PCR) was performed for all inpatients, caregivers and healthcare workers (HCWs). All exposed persons were quarantined. Thorough investigation was conducted to analyze the transmission route.ResultsThe outbreak comprised 12 patients, 12 caregivers, and 3 HCWs. Seven patients expired and the remaining cases recovered. Overall, 456 patients/caregivers and 169 HCWs were quarantined. Analysis showed that longer exposure time was the main cause of HCW infection; all three infected HCWs were primary-care nurses related to the index case. To diminish hidden cases, all hospitalized patients/caregivers received PCR examinations and all results were negative. Thereafter, all patients/caregivers routinely received PCR examination on admission. Hospital-wide PCR screening for HCW detected 4 positive HCWs unrelated to this outbreak, and a second-round of screening detected 2 more cases, with no additional cases during the following 6 months.ConclusionPrompt infection control measures and large-scale PCR screening can control a COVID-19 outbreak within 2 weeks. Exposure time is the major risk factor for HCW infection.

The role of routine SARS-CoV-2 screening of healthcare-workers in acute care hospitals in 2020: a systematic review and meta-analysis

BackgroundHealthcare workers (HCW) are at increased risk of infection with SARS-CoV-2. Vulnerable patient populations in particular must be protected, and clinics should not become transmission hotspots to avoid delaying medical treatments independent of COVID. Because asymptomatic transmission has been described, routine screening of asymptomatic HCW would potentially be able to interrupt chains of infection through early detection.MethodsA systematic search was conducted in the Cochrane COVID-19 Study Register, Web of Science and WHO COVID‐19 Global literature on coronavirus with regard to non-incident related testing of healthcare workers using polymerase chain reaction on May 4th 2021. Studies since January 2020 were included. An assessment of risk of bias and representativeness was performed.ResultsThe search identified 39 studies with heterogeneous designs. Data collection of the included studies took place from January to August 2020. The studies were conducted worldwide and the sample size of the included HCW ranged from 70 to 9449 participants. In total, 1000 of 51,700 (1.9%) asymptomatic HCW were tested positive for SARS-CoV-2 using PCR testing. The proportion of positive test results ranged between 0 and 14.3%. No study reported on HCW-screening related reductions in infected person-days.Discussion and conclusionsThe heterogeneous proportions might be explained by different regional incidences, lock-downs, and pre-analytical pitfalls that reduce the sensitivity of the nasopharyngeal swab. The very high prevalence in some studies indicates that screening HCW for SARS-CoV-2 may be important particularly in geographical regions and pandemic periods with a high-incidence. With low numbers and an increasing rate of vaccinated HCW, a strict cost–benefit consideration must be made, especially in times of low incidences. Since we found no studies that reported on HCW-screening related reductions in infected person-days, re-evaluation should be done when these are available.