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

Abstract

Background: Reducing infection rates has been crucial to protect healthcare workers (HCWs) during the COVID-19 pandemic. Therefore, we determined the rates and potential risk factors for SARS-CoV-2 infection in HCWs. Methods: We searched MEDLINE, Embase, and Google Scholar from 1 December 2019 to 5 February 2024. The potential risk factors for SARS-CoV-2 infection in HCWs included occupational and household exposure to SARS-CoV-2; personal protective equipment (PPE) use, infection prevention and control (IPC) training; hand hygiene, aerosol generating procedures; quarantine; decontamination of high-touch areas; and working in environmental services. Odd ratios (ORs) for each risk factor were pooled from the selected studies in R. Results: From 498 initial records, 190 articles were reviewed, and 63 studies were eligible. Globally, 10% (95% confidence interval (CI): 8-12) of 279,590 HCWs were infected with SARS-CoV-2. Household exposure (OR: 7.07; 95% CI: 3.93-12.73), working as cleaner (OR: 2.72; 95% CI: 1.39-5.32), occupational exposure (OR:1.79; 95% CI: 1.49-2.14), inadequate IPC training (OR: 1.46; 95% CI: 1.14-1.87), inefficient use of PPE (OR: 1.45; 95% CI: 1.14-1.84), performing aerosol generating procedures (OR: 1.36; 95% CI: 1.21-1.52) and inadequate hand hygiene (OR: 1.17; 95% CI: 0.79-1.73) were associated with an increased SARS-CoV-2 infection. Conversely, history of quarantine and frequent decontamination of high touch areas were protective factors against SARS-CoV-2 infection (OR: 0.23; 95% CI: 0.08-0.60; and OR: 0.52; 95% CI: 0.42-0.64 respectively). These findings indicate a tiered risk of infection in HCWs. Conclusions and Relevance: We found high global SARS-CoV-2 infection rates of 10% among HCWs. Household exposures and working as cleaner were the strongest risk factors for SARS-CoV-2 infection, whereas history of quarantine and frequent decontamination of high touch areas were protective. We suggest a three-step strategy (minimising exposure and decontamination practices, IPC and aerosol-limiting procedure training, and PPE use) to mitigate the spread of SARS-CoV-2.