Risk factors for SARS-CoV-2 infection among health workers in India: a case control study

Abstract

BackgroundCOVID-19 was declared as a Public Health Emergency of International Concern on 30th January 2020. Compared to the general population, healthcare workers and their families have been identified to be at a higher risk of getting infected with COVID-19. Therefore, it is crucial to understand the risk factors responsible for the transmission of SARS-CoV-2 infection among health workers in different hospital settings and to describe the range of clinical presentations of SARS-CoV-2 infection among them.MethodologyA nested case–control study was conducted among healthcare workers who were involved in the care of COVID-19 cases for assessing the risk factors associated with it. To get a holistic perspective, the study was conducted in 19 different hospitals from across 7 states (Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Gujarat, and Rajasthan) of India covering the major government and private hospitals that were actively involved in COVID-19 patient care. The study participants who were not vaccinated were enrolled using the incidence density sampling technique from December 2020 to December 2021.ResultsA total of 973 health workers consisting of 345 cases and 628 controls were recruited for the study. The mean age of the participants was observed to be 31.17 ± 8.5 years, with 56.3% of them being females. On multivariate analysis, the factors that were found to be significantly associated with SARS-CoV-2 were age of more than 31 years (adjusted odds ratio [aOR] 1.407 [95% CI 1.53–1.880]; p = 0.021), male gender (aOR 1.342 [95% CI 1.019–1.768]; p = 0.036), practical mode of IPC training on personal protective equipment (aOR 1. 1.935 [95% CI 1.148–3.260]; p = 0.013), direct exposure to COVID-19 patient (aOR 1.413 [95% CI 1.006–1.985]; p = 0.046), presence of diabetes mellitus (aOR 2.895 [95% CI 1.079–7.770]; p = 0.035) and those received prophylactic treatment for COVID-19 in the last 14 days (aOR 1.866 [95% CI 0.201–2.901]; p = 0.006).ConclusionThe study was able to highlight the need for having a separate hospital infection control department that implements IPC programs regularly. The study also emphasizes the need for developing policies that address the occupational hazards faced by health workers.

SARS-CoV-2 infection rates and associated risk factors in healthcare settings: systematic review and meta-analysis

“…A quick and organised response will be needed to prevent the spread of respiratory viruses; therefore, we suggest a three-step hierarchy of controls including hazard elimination, IPC training, and ensuring fair PPE availability. studies was not available ( 33,47,52 ). We used "Plogit" method or logit transformation for pooling of studies.…”

“…During the COVID-19 pandemic, inadequate IPC training encompassed insu cient training in various ways such as depth, duration and resources available. Our meta-analyses showed that the pooled OR for inadequate IPC training was 1.46 (95% CI: 1.14-1.87; I 2 =59%) for SARS-CoV-2 infection, including data from 6,257 HCWs derived from 7 studies 27,28,[33][34][35][36][37] (Figure 4 and Supplementary Figure 4). Furthermore, the use of PPE as appropriate when in contact with patients or performing certain procedures is often included in IPC training for HCWs.…”

“…In practice, PPE may not be e ciently used. We retrieved data for occupational exposure with ine cient PPE use from 28 studies 8, [25][26][27]30,[32][33][34][35][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] including a total of 41,529 HCWs. In most studies, "ine cient PPE" encompasses two key areas: neglecting to wear PPE as recommended and/or utilizing the incorrect or malfunctioning type of PPE for the given hazard.…”

“…However, hand hygiene practices are often in reality not optimal. We included data on inadequate hand hygiene as a risk factor for SARS-CoV-2 infection from 10 studies 27,28,33,34,37,42,45,47,51,63 involving a total of 9,488 HCWs. The evaluation of hand hygiene practices differed across studies, with some adhering to the national or global 64 guidelines and others relying on single-question surveys such as consistency of hand washing.…”