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Infect Control Hosp Epidemiol ; 43(6): 757-763, 2022 06.
Article in English | MEDLINE | ID: covidwho-1751560

ABSTRACT

OBJECTIVE: To determine the effect of 2 regulations issued by the Israel Ministry of Health on coronavirus disease 2019 (COVID-19) infections and quarantine among healthcare workers (HCWs) in general hospitals. DESIGN: Before-and-after intervention study without a control group (interrupted time-series analysis). SETTING: All 29 Israeli general hospitals. PARTICIPANTS: All HCWs. INTERVENTIONS: Two national regulations were issued on March 25, 2020: one required universal masking of HCWs, patients, and visitors in general hospitals and the second defined what constitutes HCW exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and when quarantine is required. RESULTS: Overall, 283 HCWs were infected at work or from an unknown source. Before the intervention, the number of HCWs infected at work increased by 0.5 per day (95% confidence interval [CI], 0.2-0.7; P < .001), peaking at 16. After the intervention, new infections declined by 0.2 per day (95% CI, -0.3 to -0.1; P < .001). Before the intervention, the number of HCWs in quarantine or isolation increased by 97 per day (95% CI, 90-104; P < .001), peaking at 2,444. After the intervention, prevalence decreased by 59 per day (95% CI, -72 to -46; P < .001). Epidemiological investigations determined that the most common source of HCW infection (58%) was a coworker. CONCLUSIONS: Universal masking in general hospitals reduced the risk of hospital-acquired COVID-19 among HCWs. Universal masking combined with uniform definitions of HCW exposure and criteria for quarantine limited the absence of HCWs from the workforce.


Subject(s)
COVID-19 , Health Policy , Masks , Personnel, Hospital , COVID-19/epidemiology , COVID-19/prevention & control , Cross Infection/epidemiology , Cross Infection/prevention & control , Hospitals, General , Humans , Israel , Quarantine , SARS-CoV-2
6.
Clin Infect Dis ; 73(6): e1329-e1336, 2021 09 15.
Article in English | MEDLINE | ID: covidwho-1411883

ABSTRACT

BACKGROUND: Healthcare personnel (HCP) are at increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We posit that current infection control guidelines generally protect HCP from SARS-CoV-2 infection in a healthcare setting. METHODS: In this retrospective case series, we used viral genomics to investigate the likely source of SARS-CoV-2 infection in HCP at a major academic medical institution in the Upper Midwest of the United States between 25 March and 27 December 2020. We obtained limited epidemiological data through informal interviews and review of the electronic health record and combined this information with healthcare-associated viral sequences and viral sequences collected in the broader community to infer the most likely source of infection in HCP. RESULTS: We investigated SARS-CoV-2 infection clusters involving 95 HCP and 137 possible patient contact sequences. The majority of HCP infections could not be linked to a patient or coworker (55 of 95 [57.9%]) and were genetically similar to viruses circulating concurrently in the community. We found that 10.5% of HCP infections (10 of 95) could be traced to a coworker. Strikingly, only 4.2% (4 of 95) could be traced to a patient source. CONCLUSIONS: Infections among HCP add further strain to the healthcare system and put patients, HCP, and communities at risk. We found no evidence for healthcare-associated transmission in the majority of HCP infections evaluated. Although we cannot rule out the possibility of cryptic healthcare-associated transmission, it appears that HCP most commonly become infected with SARS-CoV-2 via community exposure. This emphasizes the ongoing importance of mask wearing, physical distancing, robust testing programs, and rapid distribution of vaccines.


Subject(s)
COVID-19 , SARS-CoV-2 , Delivery of Health Care , Health Personnel , Humans , Retrospective Studies , United States/epidemiology
7.
Ann Emerg Med ; 77(1): 19-31, 2021 01.
Article in English | MEDLINE | ID: covidwho-1382201

ABSTRACT

STUDY OBJECTIVE: To synthesize the evidence regarding the infection risk associated with different modalities of oxygen therapy used in treating patients with severe acute respiratory infection. Health care workers face significant risk of infection when treating patients with a viral severe acute respiratory infection. To ensure health care worker safety and limit nosocomial transmission of such infection, it is crucial to synthesize the evidence regarding the infection risk associated with different modalities of oxygen therapy used in treating patients with severe acute respiratory infection. METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to April 1, 2020, for studies describing the risk of infection associated with the modalities of oxygen therapy used for patients with severe acute respiratory infection. The study selection, data extraction, and quality assessment were performed by independent reviewers. The primary outcome measure was the infection of health care workers with a severe acute respiratory infection. Random-effect models were used to synthesize the extracted data. RESULTS: Of 22,123 citations, 50 studies were eligible for qualitative synthesis and 16 for meta-analysis. Globally, the quality of the included studies provided a very low certainty of evidence. Being exposed or performing an intubation (odds ratio 6.48; 95% confidence interval 2.90 to 14.44), bag-valve-mask ventilation (odds ratio 2.70; 95% confidence interval 1.31 to 5.36), and noninvasive ventilation (odds ratio 3.96; 95% confidence interval 2.12 to 7.40) were associated with an increased risk of infection. All modalities of oxygen therapy generate air dispersion. CONCLUSION: Most modalities of oxygen therapy are associated with an increased risk of infection and none have been demonstrated as safe. The lowest flow of oxygen should be used to maintain an adequate oxygen saturation for patients with severe acute respiratory infection, and manipulation of oxygen delivery equipment should be minimized.


Subject(s)
Cross Infection/transmission , Infectious Disease Transmission, Patient-to-Professional , Oxygen Inhalation Therapy , Severe Acute Respiratory Syndrome/transmission , Cross Infection/therapy , Humans , Oxygen Inhalation Therapy/adverse effects , Risk Factors , Severe Acute Respiratory Syndrome/therapy
8.
MMWR Morb Mortal Wkly Rep ; 69(29): 960-964, 2020 07 24.
Article in English | MEDLINE | ID: covidwho-1389848

ABSTRACT

Population prevalence of persons infected with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), varies by subpopulation and locality. U.S. studies of SARS-CoV-2 infection have examined infections in nonrandom samples (1) or seroprevalence in specific populations* (2), which are limited in their generalizability and cannot be used to accurately calculate infection-fatality rates. During April 25-29, 2020, Indiana conducted statewide random sample testing of persons aged ≥12 years to assess prevalence of active infection and presence of antibodies to SARS-CoV-2; additional nonrandom sampling was conducted in racial and ethnic minority communities to better understand the impact of the virus in certain racial and ethnic minority populations. Estimates were adjusted for nonresponse to reflect state demographics using an iterative proportional fitting method. Among 3,658 noninstitutionalized participants in the random sample survey, the estimated statewide point prevalence of active SARS-CoV-2 infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing was 1.74% (95% confidence interval [CI] = 1.10-2.54); 44.2% of these persons reported no symptoms during the 2 weeks before testing. The prevalence of immunoglobulin G (IgG) seropositivity, indicating past infection, was 1.09% (95% CI = 0.76-1.45). The overall prevalence of current and previous infections of SARS-CoV-2 in Indiana was 2.79% (95% CI = 2.02-3.70). In the random sample, higher overall prevalences were observed among Hispanics and those who reported having a household contact who had previously been told by a health care provider that they had COVID-19. By late April, an estimated 187,802 Indiana residents were currently or previously infected with SARS-CoV-2 (9.6 times higher than the number of confirmed cases [17,792]) (3), and 1,099 residents died (infection-fatality ratio = 0.58%). The number of reported cases represents only a fraction of the estimated total number of infections. Given the large number of persons who remain susceptible in Indiana, adherence to evidence-based public health mitigation and containment measures (e.g., social distancing, consistent and correct use of face coverings, and hand hygiene) is needed to reduce surge in hospitalizations and prevent morbidity and mortality from COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Public Health Surveillance/methods , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Child , Coronavirus Infections/ethnology , Female , Humans , Indiana/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/ethnology , Prevalence , Young Adult
9.
Wellcome Open Res ; 6: 102, 2021.
Article in English | MEDLINE | ID: covidwho-1278725

ABSTRACT

There are important differences in the risk of SARS-CoV-2 infection and death depending on occupation. Infections in healthcare workers have received the most attention, and there are clearly increased risks for intensive care unit workers who are caring for COVID-19 patients. However, a number of other occupations may also be at an increased risk, particularly those which involve social care or contact with the public. A large number of data sets are available with the potential to assess occupational risks of COVID-19 incidence, severity, or mortality. We are reviewing these data sets as part of the Partnership for Research in Occupational, Transport, Environmental COVID Transmission (PROTECT) initiative, which is part of the National COVID-19 Core Studies. In this report, we review the data sets available (including the key variables on occupation and potential confounders) for examining occupational differences in SARS-CoV-2 infection and COVID-19 incidence, severity and mortality. We also discuss the possible types of analyses of these data sets and the definitions of (occupational) exposure and outcomes. We conclude that none of these data sets are ideal, and all have various strengths and weaknesses. For example, mortality data suffer from problems of coding of COVID-19 deaths, and the deaths (in England and Wales) that have been referred to the coroner are unavailable. On the other hand, testing data is heavily biased in some periods (particularly the first wave) because some occupations (e.g. healthcare workers) were tested more often than the general population. Random population surveys are, in principle, ideal for estimating population prevalence and incidence, but are also affected by non-response. Thus, any analysis of the risks in a particular occupation or sector (e.g. transport), will require a careful analysis and triangulation of findings across the various available data sets.

10.
Antimicrob Resist Infect Control ; 10(1): 86, 2021 06 03.
Article in English | MEDLINE | ID: covidwho-1259217

ABSTRACT

BACKGROUND: Knowledge of infection prevention and control (IPC) procedures among healthcare workers (HCWs) is crucial for effective IPC. Compliance with IPC measures has critical implications for HCWs safety, patient protection and the care environment. AIMS: To discuss the body of available literature regarding HCWs' knowledge of IPC and highlight potential factors that may influence compliance to IPC precautions. DESIGN: A systematic review. A protocol was developed based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis [PRISMA] statement. DATA SOURCES: Electronic databases (PubMed, CINAHL, Embase, Proquest, Wiley online library, Medline, and Nature) were searched from 1 January 2006 to 31 January 2021 in the English language using the following keywords alone or in combination: knowledge, awareness, healthcare workers, infection, compliance, comply, control, prevention, factors. 3417 papers were identified and 30 papers were included in the review. RESULTS: Overall, the level of HCW knowledge of IPC appears to be adequate, good, and/or high concerning standard precautions, hand hygiene, and care pertaining to urinary catheters. Acceptable levels of knowledge were also detected in regards to IPC measures for specific diseases including TB, MRSA, MERS-CoV, COVID-19 and Ebola. However, gaps were identified in several HCWs' knowledge concerning occupational vaccinations, the modes of transmission of infectious diseases, and the risk of infection from needle stick and sharps injuries. Several factors for noncompliance surrounding IPC guidelines are discussed, as are recommendations for improving adherence to those guidelines. CONCLUSION: Embracing a multifaceted approach towards improving IPC-intervention strategies is highly suggested. The goal being to improve compliance among HCWs with IPC measures is necessary.


Subject(s)
COVID-19/prevention & control , Health Personnel , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , COVID-19/transmission , Cross Infection/prevention & control , Databases, Factual , Guideline Adherence , Health Knowledge, Attitudes, Practice , Humans , SARS-CoV-2/isolation & purification
11.
BMJ Glob Health ; 6(6)2021 06.
Article in English | MEDLINE | ID: covidwho-1259005

ABSTRACT

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.


Subject(s)
COVID-19 , Health Personnel , Infectious Disease Transmission, Patient-to-Professional , Pandemics , Primary Health Care , Africa/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Primary Health Care/organization & administration
12.
J Hosp Infect ; 115: 44-50, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1258420

ABSTRACT

Hospital-onset COVID-19 infections (HOCIs) are associated with excess morbidity and mortality in patients and healthcare workers. The aim of this review was to explore and describe the current literature in HOCI surveillance. Medline, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Register of Controlled Trials, and MedRxiv were searched up to 30 November 2020 using broad search criteria. Articles of HOCI surveillance systems were included. Data describing HOCI definitions, HOCI incidence, types of HOCI identification surveillance systems, and level of system implementation were extracted. A total of 292 citations were identified. Nine studies on HOCI surveillance were included. Six studies reported on the proportion of HOCI among hospitalized COVID-19 patients, which ranged from 0 to 15.2%. Six studies provided HOCI case definitions. Standardized national definitions provided by the UK and US governments were identified. Four studies included healthcare workers in the surveillance. One study articulated a multimodal strategy of infection prevention and control practices including HOCI surveillance. All identified HOCI surveillance systems were implemented at institutional level, with eight studies focusing on all hospital inpatients and one study focusing on patients in the emergency department. Multiple types of surveillance were identified. Four studies reported automated surveillance, of which one included real-time analysis, and one included genomic data. Overall, the study quality was limited by the observational nature with short follow-up periods. In conclusion, HOCI case definitions and surveillance methods were developed pragmatically. Whilst standardized case definitions and surveillance systems are ideal for integration with existing routine surveillance activities and adoption in different settings, we acknowledged the difficulties in establishing such standards in the short-term.


Subject(s)
COVID-19 , Cross Infection , Cross Infection/epidemiology , Cross Infection/prevention & control , Hospitals , Humans , SARS-CoV-2 , Systematic Reviews as Topic
13.
Ann Clin Biochem ; 58(5): 487-495, 2021 09.
Article in English | MEDLINE | ID: covidwho-1255783

ABSTRACT

BACKGROUND: A number of immunoassays have been developed to measure antibodies specific to SARS-CoV-2. More data is required on their comparability, particularly among those with milder infections and in the general practice population. The aim of this study was to compare four high-throughput automated anti-SARS-CoV-2 assays using samples collected from hospitalized patients and healthcare workers with confirmed SARS-CoV-2 infection. In addition, we collected general practice samples to compare antibody results and determine seroprevalence. METHODS: Samples were collected from 57 hospitalized patients and nine healthcare workers at 14 days and at 28 days following confirmed SARS-CoV-2 infection. Samples were also collected from 225 patients presenting to general practice. Four assays were used: Abbott Architect IgG, Beckman Coulter DxI 800 IgG, Roche Cobas e801 total antibody and Siemens Advia Centaur XPT total antibody. RESULTS: All four assays showed concordance at 14 days in 83.9% of hospitalized patients and in 66.7% of healthcare workers. All four assays showed concordance at 28 days in 88.4% of hospitalized patients and 77.8% of healthcare workers. The sensitivity to detect recent infection was higher for the IgG assays than the total assays. All four assays showed concordance of 95.1% in the general practice population. Seroprevalence ranged from 4.9 to 5.8% depending on the assay used. CONCLUSIONS: All four assays showed excellent comparability, but it may be possible to obtain a negative result for any of the anti-SARS-CoV-2 assays in patients with confirmed previous SARS-CoV-2 infection. An equivocal range would be useful for all anti-SARS-CoV-2 assays.


Subject(s)
COVID-19 Serological Testing/methods , COVID-19/diagnosis , COVID-19/immunology , SARS-CoV-2/immunology , Adult , Aged , Aged, 80 and over , Antibodies, Viral/blood , COVID-19/epidemiology , COVID-19 Serological Testing/statistics & numerical data , Female , General Practice , Health Personnel , High-Throughput Screening Assays/methods , High-Throughput Screening Assays/statistics & numerical data , Hospitalization , Humans , Immunoassay/methods , Immunoassay/statistics & numerical data , Male , Middle Aged , Pandemics , Seroepidemiologic Studies , United Kingdom/epidemiology , Young Adult
14.
Front Public Health ; 9: 644008, 2021.
Article in English | MEDLINE | ID: covidwho-1247942

ABSTRACT

On December 31, 2019, an outbreak of lower respiratory infections was documented in Wuhan caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the beginning, SARS-CoV-2 has caused many infections among healthcare workers (HCWs) worldwide. Aims of this study were: a. to compare the distribution among the HCWs and the general population of SARS-CoV-2 infections in Western Sicily and Italy; b. to describe the characteristics of HCWs infected with SARS-CoV-2 in the western Sicilian healthcare context during the first wave of the epidemic diffusion in Italy. Incidence and mean age of HCWs infected with SARS-CoV-2 were comparable in Western Sicily and in the whole Italian country. The 97.6% of infections occurred in HCWs operating in non-coronavirus disease 2019 (COVID-19) working environments, while an equal distribution of cases between hospital and primary care services context was documented. Nurses and healthcare assistants, followed by physicians, were the categories more frequently infected by SARS-CoV-2. The present study suggests that healthcare workers are easily infected compared to the general population but that often infection could equally occur in hospital and non-hospital settings. Safety of HCWs in counteracting the COVID-19 pandemic must be strengthened in hospital [adequate provision of personal protective equipment (PPE), optimization of human resources, implementation of closed and independent groups of HCWs, creation of traffic control building and dedicated areas in every healthcare context] and non-hospital settings (influenza vaccination, adequate psychophysical support, including refreshments during working shifts, adequate rest, and family support).


Subject(s)
COVID-19 , Pandemics , Cross-Sectional Studies , Delivery of Health Care , Health Personnel , Humans , SARS-CoV-2 , Sicily/epidemiology
16.
Int J Environ Res Public Health ; 18(11)2021 May 24.
Article in English | MEDLINE | ID: covidwho-1244003

ABSTRACT

Efforts to limit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among hospital healthcare staff are crucial for controlling the Coronavirus Disease 19 (COVID-19) pandemics. The study aimed to explore the prevalence and clinical presentations of COVID-19 in healthcare workers (HCWs) at the University Clinical Hospital (UCH) in Wroclaw with 1677 beds. The retrospective study was performed in 2020 using a self-derived structured questionnaire in a sample of HCWs who were diagnosed with SARS-CoV-2 infection confirmed using a PCR double gene test and consented to be enrolled into the study. The significance level for all statistical tests was set to 0.05. The study showed that of the 4998 hospital workers, among 356 cases reported as COVID-19 infected, 70 consented to take part in the survey: nurses (48.5%), doctors (17.1%), HCWs with patient contact (10.0%), other HCWs without patient contact (7.1%), and cleaning personnel (5.7%). HCWs reported concurrent diseases such as hypertension (17.1%), bronchial asthma (5.7%), and diabetes (5.7%). Failure to keep 2 m distancing during contact (65.5%) and close contact with the infected person 14 days before the onset of symptoms or collection of biological material (58.6%) were identified as the increased risks of infection. A large part of infections in hospital healthcare staff were symptomatic (42.9%). The first symptoms of COVID-19 were general weakness (42.9%), poor mental condition (41.4%), and muscle pain (32.9%); whereas in the later stages of the illness, general weakness (38.6%), coughing (34.3%), lack of appetite (31.4%), and loss of taste (31.4%) were observed. In about 30% of the infected HCWs, there was no COVID-19 symptoms whatsoever. The vast majority of the patients were treated at home (85.7%). In conclusion, the majority of the SARS-CoV-2 infections in the hospital HCWs were asymptomatic or mildly symptomatic. Therefore, successful limitation of COVID-19 infection spread at hospitals requires a close attention to future cross-infections.


Subject(s)
COVID-19 , Health Personnel , Humans , Poland/epidemiology , Retrospective Studies , SARS-CoV-2 , Universities
17.
J Patient Saf ; 17(4): 323-330, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1231053

ABSTRACT

BACKGROUND: Although recommendations to prevent COVID-19 healthcare-associated infections (HAIs) have been proposed, data on their effectivity are currently limited. OBJECTIVE: The aim was to evaluate the effectivity of a program of control and prevention of COVID-19 in an academic general hospital in Spain. METHODS: We captured the number of COVID-19 cases and the type of contact that occurred in hospitalized patients and healthcare personnel (HCP). To evaluate the impact of the continuous use of a surgical mask among HCP, the number of patients with COVID-19 HAIs and accumulated incidence of HCP with COVID-19 was compared between the preintervention and intervention periods. RESULTS: Two hundred fifty-two patients with COVID-19 have been admitted to the hospital. Seven of them had an HAI origin (6 in the preintervention period and 1 in the intervention period). One hundred forty-two HCP were infected with SARS-CoV-2. Of them, 22 (15.5%) were attributed to healthcare (2 in the emergency department and none in the critical care departments), and 120 (84.5%) were attributed to social relations in the workplace or during their non-work-related personal interactions. The accumulated incidence during the preintervention period was 22.3 for every 1000 HCP and 8.2 for every 1000 HCP during the intervention period. The relative risk was 0.37 (95% confidence interval, 0.25 to 0.55) and the attributable risk was -0.014 (95% confidence interval, -0.020 to -0.009). CONCLUSIONS: A program of control and prevention of HAIs complemented with the recommendation for the continuous use of a surgical mask in the workplace and social environments of HCP effectively decreased the risk of COVID-19 HAIs in admitted patients and HCP.


Subject(s)
Academic Medical Centers , COVID-19/prevention & control , Cross Infection/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Adult , COVID-19/epidemiology , COVID-19/transmission , Cross Infection/epidemiology , Female , Humans , Incidence , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Male , Masks/statistics & numerical data , Middle Aged , Personnel, Hospital/statistics & numerical data , Program Evaluation , Risk Assessment/statistics & numerical data , SARS-CoV-2/isolation & purification , Spain/epidemiology
18.
Aust Crit Care ; 35(1): 28-33, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1225141

ABSTRACT

BACKGROUND: Healthcare workers (HCWs) have frequently become infected with severe acute respiratory syndrome coronavirus 2 whilst treating patients with coronavirus disease 2019 (COVID-19). A variety of novel devices have been proposed to reduce COVID-19 cross-contamination. OBJECTIVES: The aim of the study was (i) to test whether patients and HCWs thought that a novel patient isolation hood was safe and comfortable and (ii) to obtain COVID-19 infection data of hospital HCWs. METHODS: This is a prospective cohort study of 20 patients, entailing HCW/patient questionnaires and safety aspects of prototype isolation hoods. COVID-19 data of HCWs were prospectively collected. Assessment of the hood's safety and practicality and adverse event reporting was carried out. OUTCOME MEASURES: The outcome measures are as follows: questionnaire responses, adverse event reporting, rates of infections in HCWs during the study period (20/6/2020 to 21/7/2020), and COVID-19 infections in HCWs reported until the last recorded diagnosis of COVID-19 in HCWs (20/6/2020 to 27/9/2020). RESULTS: Of the 64 eligible individual HCW surveys, 60 surveys were overall favourable (>75% questions answered in favour of the isolation hood). HCWs were unanimous in perceiving the hood as safe (60/60), preferring its use (56/56), and understanding its potential COVID-19 cross-contamination minimisation (60/60). All eight patients who completed the questionnaire thought the isolation hood helped prevent COVID-19 cross infection and was safe and comfortable. There were no reported patient safety adverse events. The COVID-19 attack rate from 20/6/2020 to 27/9/2020 among registered nurses was as follows: intensive care units (ICUs), 2.2% (3/138); geriatric wards, 13.2% (26/197); and COVID-19 wards, 18.3% (32/175). The COVID-19 attack rate among medical staff was as follows: junior staff, 2.1% (24/932); senior staff, 0.7% (4/607); aged care/rehabilitation, 6.7% (2/30); and all ICU medical staff, 8.6% (3/35). CONCLUSIONS: The isolation hood was preferred to standard care by HCWs and well tolerated by patients, and after the study, isolation hoods became part of standard ICU therapy. There was an association between being an ICU nurse and a low COVID-19 infection rate (no causality implied). ICU HCWs feel safer when treating patients with COVID-19 using an isolation hood.


Subject(s)
COVID-19 , Aged , Humans , Pandemics , Patient Isolation , Prospective Studies , SARS-CoV-2
20.
J Hosp Med ; 16(5): 274-281, 2021 05.
Article in English | MEDLINE | ID: covidwho-1210021

ABSTRACT

BACKGROUND: SARS-CoV-2 infection (COVID-19) poses a tremendous challenge to healthcare systems across the globe. Serologic testing for SARS-CoV-2 infection in healthcare workers (HCWs) may quantify the rate of clinically significant exposure in an institutional setting and identify those HCWs who are at greatest risk. METHODS: We conducted a survey and SARS-CoV-2 serologic testing among a convenience sample of HCWs from 79 non-COVID and 3 dedicated COVID hospitals in District Srinagar of Kashmir, India. In addition to testing for the presence of SARS-CoV-2-specific immunoglobulin G (IgG), we collected information on demographics, occupational group, influenza-like illness (ILI) symptoms, nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) testing status, history of close unprotected contacts, and quarantine/travel history. RESULTS: Of 7,346 eligible HCWs, 2,915 (39.7%) participated in the study. The overall prevalence of SARS-CoV-2-specific IgG antibodies was 2.5% (95% CI, 2.0%-3.1%), while HCWs who had ever worked at a dedicated COVID-19 hospital had a substantially lower seroprevalence of 0.6% (95% CI, 0.2%-1.9%). Higher seroprevalence rates were observed among HCWs who reported a recent ILI (12.2%), a positive RT-PCR (27.6%), a history of being put under quarantine (4.9%), and a history of close unprotected contact with a person with COVID-19 (4.4%). Healthcare workers who ever worked at a dedicated COVID-19 hospital had a lower multivariate-adjusted risk of seropositivity (odds ratio, 0.21; 95% CI, 0.06-0.66). CONCLUSIONS: Our investigation suggests that infection-control practices, including a compliance-maximizing buddy system, are valuable and effective in preventing infection within a high-risk clinical setting. Universal masking, mandatory testing of patients, and residential dormitories for HCWs at COVID-19-dedicated hospitals is an effective multifaceted approach to infection control. Moreover, given that many infections among HCWs are community-acquired, it is likely that the vigilant practices in these hospitals will have spillover effects, creating ingrained behaviors that will continue outside the hospital setting.


Subject(s)
COVID-19/epidemiology , Health Personnel/statistics & numerical data , Hospitals/statistics & numerical data , Occupational Exposure/statistics & numerical data , Adult , COVID-19/prevention & control , COVID-19/transmission , Contact Tracing/statistics & numerical data , Female , Humans , Immunoglobulin G/immunology , India/epidemiology , Infection Control/organization & administration , Male , Middle Aged , Occupational Exposure/prevention & control , Quarantine/statistics & numerical data , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Seroepidemiologic Studies , Socioeconomic Factors , Travel/statistics & numerical data
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