Adherence to personal protective equipment use among healthcare workers caring for confirmed COVID-19 and alleged non-COVID-19 patients

Neuwirth, Meike Maria; Mattner, Frauke; Otchwemah, Robin

doi:10.21203/rs.3.rs-42553/v2

Cited by 6 publications

(6 citation statements)

References 3 publications

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“…[40] Additionally, a lower perceived risk of exposure to SARS-CoV-2 has been associated with decreased adherence to PPE use. [41,42] In accordance with this observation, PPE use among healthcare staff in our study appeared to be less stringent in non-COVID areas. Our study revealed a strong dichotomy between perceived risk and actual risk of exposure to SARS-CoV-2 across healthcare spaces, which appears to be heavily modulated by viral emission rate and timing of disease course.…”

Section: Discussionsupporting

confidence: 87%

Ventilation and detection of airborne SARS-CoV-2: elucidating high-risk spaces in naturally ventilated healthcare settings

Styczynski

Hemlock

Hoque

et al. 2021

Preprint

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Background: In healthcare settings in low- and middle-income countries, which frequently rely upon natural ventilation, the risk of aerosol transmission of SARS-CoV-2 remains poorly understood. We aimed to evaluate the risk of exposure to SARS-CoV-2 in naturally-ventilated hospital settings by measuring parameters of ventilation and comparing these findings with results of bioaerosol sampling. Methods: We measured outdoor and room CO2 to estimate absolute ventilation (liters per second [L/s]) from 9 hospitals in Bangladesh during October 2020 - February 2021. We estimated infectious risk across different spaces using a modified Wells-Riley equation. We collected air samples from these same spaces at 12.5 L/min over 30 minutes and performed RT-qPCR to detect SARS-CoV-2 N-gene. We used multivariable linear regression and calculated elasticity to identify characteristics associated with ventilation. Results: Based on ventilation of 86 patient care areas and COVID-19 case numbers, we found that over a 40-hour exposure period, outpatient departments posed the highest median risk for infection (5.4%), followed by COVID intensive care units (1.8%). We detected SARS-CoV-2 RNA in 18.6% (16/86) of air samples. Ceiling height and total open area of doors and windows were found to have the greatest impact on ventilation. Conclusion: Our findings provide evidence that naturally-ventilated healthcare settings may pose a high risk for exposure to SARS-CoV-2, particularly among non-COVID designated spaces, but improving parameters of ventilation can mitigate this risk.

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Section: Discussionsupporting

confidence: 87%

Ventilation and detection of airborne SARS-CoV-2: elucidating high-risk spaces in naturally ventilated healthcare settings

Styczynski

Hemlock

Hoque

et al. 2021

Preprint

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“…However, we considered this overestimate as the use of all PPE would reduce the risk of infection among healthcare workers during care encounters. Furthermore, existing evidence supports a zero to low healthcare worker infection rates in countries with stringent PPE compliance [ 42 ]. Third, there is a chance that the COVID-19 related mortality in Kenya may be higher than predicted in the model we used as a result of a likely underreporting of COVID-19 deaths in Kenya.…”

Section: Discussionmentioning

confidence: 99%

Examining the cost-effectiveness of personal protective equipment for formal healthcare workers in Kenya during the COVID-19 pandemic

Kazungu

Munge²,

Werner

et al. 2021

BMC Health Serv Res

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Background Healthcare workers are at a higher risk of COVID-19 infection during care encounters compared to the general population. Personal Protective Equipment (PPE) have been shown to protect COVID-19 among healthcare workers, however, Kenya has faced PPE shortages that can adequately protect all healthcare workers. We, therefore, examined the health and economic consequences of investing in PPE for healthcare workers in Kenya. Methods We conducted a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model following the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. We examined two outcomes: 1) the incremental cost per healthcare worker death averted, and 2) the incremental cost per healthcare worker COVID-19 case averted. We performed a multivariate sensitivity analysis using 10,000 Monte Carlo simulations. Results Kenya would need to invest $3.12 million (95% CI: 2.65–3.59) to adequately protect healthcare workers against COVID-19. This investment would avert 416 (IQR: 330–517) and 30,041 (IQR: 7243 – 102,480) healthcare worker deaths and COVID-19 cases respectively. Additionally, such an investment would result in a healthcare system ROI of $170.64 million (IQR: 138–209) – equivalent to an 11.04 times return. Conclusion Despite other nationwide COVID-19 prevention measures such as social distancing, over 70% of healthcare workers will still be infected if the availability of PPE remains scarce. As part of the COVID-19 response strategy, the government should consider adequate investment in PPE for all healthcare workers in the country as it provides a large return on investment and it is value for money.

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“…[26][27][28] In the setting of a pandemic, heightened awareness of personal risk during COVID-19 patient care results in high compliance with PPE and hand hygiene, further decreasing the likelihood of direct patient care exposures. [29][30][31][32] HCPs spend comparatively more time in communal settings, often in con ned and shared spaces such as nursing stations, physician workrooms, breakrooms, and conference rooms. 33,34 Further exacerbating coworker exposure risk is the propensity to work while actively ill, an unintended consequence of strong work ethics that lead to working long hours despite physical discomfort or sickness.…”

Section: Discussionmentioning

confidence: 99%

Infection Prevention Strategies in COVID-19 Units Highly Protective While Primary Risks to Healthcare Professionals Come From Coworkers and the Community

Gohil

Quan

Madey

et al. 2021

Preprint

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Background: Early evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks.Methods: Prior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP 1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to 2) dedicated COVID-19 units, 3) units with a COVID-19 HCP outbreak, or 4) control units from 01/01/2020-04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology.Results: Of 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N=52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05-3.04, p=0.03), working in a HCP-outbreak unit (OR 2.21, CI 1.28-3.81, p<0.01), living in a community with low owner-occupied housing (OR=1.63, CI=1.00-2.64, p=0.05), and ethnically Latino (OR 2.10, CI 1.12-3.96, p=0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI=0.30-0.94, p=0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p<0.01).Conclusions: Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.

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Adherence to personal protective equipment use among healthcare workers caring for confirmed COVID-19 and alleged non-COVID-19 patients

Cited by 6 publications

References 3 publications

Ventilation and detection of airborne SARS-CoV-2: elucidating high-risk spaces in naturally ventilated healthcare settings

Ventilation and detection of airborne SARS-CoV-2: elucidating high-risk spaces in naturally ventilated healthcare settings

Examining the cost-effectiveness of personal protective equipment for formal healthcare workers in Kenya during the COVID-19 pandemic

Infection Prevention Strategies in COVID-19 Units Highly Protective While Primary Risks to Healthcare Professionals Come From Coworkers and the Community

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