Risk of SARS-CoV-2 infection among front-line healthcare workers in Northeast Brazil: a respondent-driven sampling approach

Abstract

ObjectivesWe assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW).Design, setting and participantsUsing respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil.Outcome measuresThe criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test.ResultsWe analysed 1525 HCW: 527 physicians, 471 registered nurses, 263 nursing assistants and 264 physical therapists. Women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%). Nurses were older with more comorbidities (hypertension and overweight/obesity) than the other staff. The overall prevalence of SARS-CoV-2 infection was 61.8% (95% CI: 55.7% to 67.5%) after adjustment for the cluster random effect, weighted by network, and the reference population size. Risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56; 95% CI: 1.42 to 4.61), not always using all recommended PPE while assisting patients with COVID-19 (OR adj: 2.15; 95% CI: 1.02 to 4.53) and reporting a splash of biological fluid/respiratory secretion in the eyes (OR adj: 3.37; 95% CI: 1.10 to 10.34).ConclusionsThis study shows the high frequency of SARS-CoV2 infection among HCW presumably due to workplace exposures. In our setting, nursing assistant comprised the most vulnerable category. Our findings highlight the need for improving healthcare facility environments, specific training and supervision to cope with public health emergencies.

Exposure risk management: Personal protective equipment and the risk of accidents occurring during aerosol generating procedures applied to COVID-19 patients

“…We found in the literature that COVID-19 could be spread through aerosol/ aerated solids, fluid from human secretions, droplets from normal breathing, coughing, sneezing and surface contact, and, thus, it is considered to be very contagious [ 3 ], and that nurses are extremely exposed to COVID-19 since they have a direct contact with COVID-19 patients, especially in the context of AGPs [ 9 , 12 , 31 ]. In managing the health workers exposure risk, and to avoid any contamination with COVID-19 during aerosols, the use of PPE is recommended for eye, face and head protection, together with reusable equipment (glasses, visors or face shields) [ 17 , 20 ].…”

“…The case of South America was analysed in one study. The rates of SARS-CoV-2 infection among HCW in São Paulo city ranged from 5.5% (IgG ELISA) in a private hospital to 14% (IgG/IgM antibody, WONDFO) in a large public hospital in 2020 due to adoption of high-quality hospital infection control and provision of complete PPE in the early stages of the COVID-19 pandemic [ 31 ].…”

Sars-CoV-2 infection rate in employees of a medium and high complexity hospital

“…In Brazil, a study on 1,525 health workers reported a distribution of 525 medical doctors, 471 registered nurses, 263 nursing assistants, and 264 physiotherapists (19) . Although the authors found that women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%), their percentages are much higher than the ones observed in this study (63.6%; 95% CI: 59.9-67.3).…”

“…The coronavirus disease 2019 (COVID- 19) was originally identified in the city of Wuhan, China, in December 2019. Current evidence indicates that the COVID-19-causing virus is transmitted person-toperson through direct contact and droplets.…”

Employing Respondent Driven Sampling (RDS) to recruit people who inject drugs (PWID) and other hard-to-reach populations during COVID-19: Lessons learned

“…Given the unprecedented nature of COVID-19, there are very few studies describing the challenges of conducting RDS during the pandemic. Yet evidence suggests that RDS was effectively used during COVID-19 to recruit men that have sex with men in Portugual (MSM) ( 13 ); isolated positive COVID-19 cases in Finland ( 14 ); and frontline care workers in Vietnam ( 15 ), Canada ( 16 ) and Brazil ( 17 ). Although Stark et al employed RDS to recruit a sample of people who inject drugs (PWID) in the rural United States during the pandemic to document the impact on substance use behaviors and overdose risk perception ( 18 ), to our knowledge, no study of PWID or HIV populations has been conducted employing RDS methods.…”