Assessing coronavirus disease 2019 (COVID-19) transmission to healthcare personnel: The global ACT-HCP case-control study

Abstract

Objective: To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection. Design: Case-control study. Setting: Data collected via online survey from international participants. Participants: 1130 HCP (244 cases with laboratory-confirmed COVID-19, 886 controls healthy throughout the pandemic) from 67 countries not meeting pre-specified exclusion (healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation). Methods: Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated with multivariable logistic regression and sensitivity analyses controlling for confounders and known biases. Results: HCP infection was associated with non-aerosol-generating contact with COVID-19 patients (adjusted OR 1.4, 95% CI 1.04–1.9, p=0.03) and extra-occupational exposures including gatherings of ten or more, patronizing restaurants or bars, and public transportation (adjusted ORs ranging 3.1-16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR 0.4, 0.2 to 0.8, p=0.005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted ORs ranging 0.4-0.7). Conclusions: COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, while exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.

SARS-CoV-2 infections among healthcare workers at Helsinki University Hospital, Finland, spring 2020: Serosurvey, symptoms and risk factors

“…Higher risk of contracting SARS-CoV-2 is reported in several investigations both for HCWs treating [ 16 , [18] , [19] , [20] , 22 ] and not treating Covid-19 patients [ 19 , 22 ], while many other researchers have found no such association [ 25 , 27 , 53 ]. In our data, of those working in ICUs caring for known/suspected COVID-19 patients, only one (0.9%) of the 111 HCWs was CoV(+), consistent with recent research among HCWs in ICUs [ 22 , 26 , 54 ]. Of our participants on non-ICU wards caring for known/suspected COVID-19 patients and wearing surgical masks 8 (9.1%) were positive.…”

“…Although our results do not associate number of household contacts (children or other adults) and risk of Cov(+), the data accord with previous studies [ 22 , 54 ] in showing significant association with CoV(+) cases at home, an obvious source of transmission.…”

“…No such increase was seen on a ward with cases among staff but no socializing after work day. This result brings HCW-HCW transmission to the fore, demonstrating that attention should also be paid to social distancing outside working hours [ 54 ].…”

Personal and professional factors influencing career choice regret during the COVID-19 pandemic

“…[15][16][17] HCWs are vulnerable to the disease too, though exposure is more likely to occur through community spread and when working outside of units designated for patients with COVID-19. [18] In the event of a COVID-19-related illness or death of a family member, friend, or coworker, HCWs may experience post-traumatic stress syndrome, [19] ongoing anxiety and depression, [20] and signs of burnout, [21] all of which are associated with greater risk of turnover or intent to leave the profession.…”

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“…The most important risk factors previously reported for HCW SARS-CoV-2 infections are community (i.e. restaurants, bars, and public transportation) and household exposures [25]. Further study is needed to better understand the nosocomial risk for SARS-CoV-2 infection among HCWs.…”