ABSTRACT
Background: Healthcare workers (HCWs) have been identified as being at an increased risk for acquisition of SARS-CoV-2 infections, but there is a paucity of data pertaining to South African HCW related infection rates. Global and provincial disparities in these numbers necessitate local data in order to mitigate risks. We sought to ascertain the SARS-CoV-2 infection rates and outcomes among all hospital staff and further determined associations for the development of severe COVID-19 disease. Methods: This retrospective audit was conducted across three academic hospitals in the Tshwane District for the period from 1 June 2020 to 31 August 2020. De-identified data from Occupational Health and Safety Department (OHSD) was used to calculate infection rates. A more detailed analysis of one of the three hospitals included evaluation of demographics, work description, possible source of SARS-CoV-2 exposure (community or hospital), comorbidities and outcomes. Results: The period prevalence of SARS-CoV-2 infections ranged from 6.1% to 15.4% between the three hospitals, with the average period prevalence being 11.1%. The highest incidence of SARS-CoV-2 infections was observed among administrative staff (2.8 cases per 1 000 staff days), with medical doctors displaying the lowest incidence of 1.1 cases per 1 000 staff days. SARS-CoV-2 infections were either 'probable' community or healthcare facility acquired for 26.6% and 73.4% of the infections, respectively. Community acquisition was highest for the administrative group (41.8%) and lowest for doctors (6.1%). The mean age for mild and severe disease was 41 and 46.1 years, respectively (p = 0.004). The presence of comorbidities was significantly associated with the severity of the disease (p = 0.002). Conclusion: The period prevalence of 11.1% was comparable to similar international studies. This study highlights that hospitals staff, including the administrative staff, are clearly at a high risk of acquiring SARS-CoV-2 infections during a surge.
ABSTRACT
Background. Patients with severe COVID-19 may require endotracheal intubation. Unique adjustments to endotracheal intubation and extubation practices are necessary to decrease the risk of SARS-CoV-2 transmission to healthcare workers (HCWs) while avoiding complications of airway management. Objectives. To investigate the practice of endotracheal intubation and extubation, resources available and complications encountered by clinicians performing endotracheal intubation and extubation of COVID-19 and suspected COVID-19 patients in South Africa (SA). Method. A cross-sectional observational study was conducted during the initial surge of COVID-19 cases in SA. Data were collected by means of a self-administered questionnaire completed by clinicians in the private and public healthcare sectors after performing an endotracheal intubation and/or extubation of a patient with confirmed or suspected COVID-19. Results. Data from 135 endotracheal intubations and 45 extubations were collected. Anaesthetists accounted for 87.0% (n=120) of the study participants, specialist clinicians in their respective fields for 59.4% (n=82), and public HCWs for 71.0% (n=98). Cases from Gauteng Province made up 76.8% (n=106) of the database. Haemoglobin desaturation was the most frequent complication encountered during endotracheal intubation (40.0%;n=54). Endotracheal intubations performed at private healthcare institutions were associated with a significantly lower complication rate of 17.5% (n=7) compared with 52.6% (n=50) in the public healthcare sector (p<0.001). Endotracheal intubations performed in theatre had the lowest complication rate of 10.4% (n=5;p<0.001). Propofol was used in 90 endotracheal intubations (66.7%), and its use was associated with fewer complications relative to other induction agents. Minimising the number of intubation attempts (p=0.009) and the use of checklists (p=0.013) significantly reduced the frequency of complications encountered during endotracheal intubation. Intravenous induction technique, neuromuscular blocking agent used, intubating device used and time at which intubation was performed did not affect the incidence of complications. The majority of endotracheal extubations were uncomplicated (88.9%). Conclusions. The study provides valuable insight into the resources used by clinicians and complications encountered when endotracheal intubations and/or extubations were performed. Data from this study may be used to guide future clinical practice and research, especially in resource-limited settings.