Infection Control among Healthcare Workers and Management of a Scabies Outbreak in a Large Italian University Hospital.

This retrospective observational study describes the results of an ad-hoc designated prevention protocol aimed at containing the spread of the scabies infestation among healthcare workers (HCWs) of a large University Hospital in Italy. The outbreak started on October 2022 and a preventive protocol was set up thanks to a multidisciplinary approach. HCWs at high scabies risk were defined as subjects working in Operative Units with a scabies prevalence higher than 2%, close contacts of a confirmed case of scabies, or HCWs with signs and symptoms of the disease. All cases at high scabies risk underwent a dermatological examination, and the infested HCWs were suspended from work until definitive healing. Mass drug administration was established for all HCWs working in Operative Units with a scabies prevalence higher than 2%. Until March 2023, out of 183 screening dermatological examinations, 21 (11.5%) were diagnostic for scabies. Between 11 October 2022 (date of the first diagnosed scabies case) and 6 March 2023 (the end of incubation period related to the last case detected), the frequency of scabies was 0.35% (21 scabies cases/6000 HCWs). The duration of the outbreak in our hospital was 14.7 weeks. Statistical analysis shows a significant association between scabies and being a nurse and having an allergy to dust mites. We obtained a low frequency of scabies infection, limiting the duration of the outbreak and the related economic burden.

SARS-CoV-2 Breakthrough Infections in Health Care Workers: An Italian Retrospective Cohort Study on Characteristics, Clinical Course and Outcomes.

BACKGROUND: The aim of this study was to determine the characteristics, clinical course and outcomes of COVID-19 breakthrough infections (BIs) among healthcare workers (HCWs) of an Italian University Hospital. METHODS: A retrospective observational study was conducted on 6111 HCWs, from January 2021 to February 2022. The study population was offered the full vaccination with BNT162b2 mRNA COVID-19 vaccine. To allow return to work after BI, the protocol required one negative nasopharyngeal RT-PCR swab followed by a medical examination to assess the HCW's health status. Laboratory tests, instrumental tests and specialist evaluations were carried out if necessary. RESULTS: The cases of BIs observed numbered 582 (9.7%). The frequency of BIs was significantly higher in females than in males (67% vs. 33%; p = 0.03), and in nurses than in all other professional categories (p = 0.001). A total of 88% of the HCWs affected by BI were still symptomatic after the negative swab. None of the instrumental tests carried out showed any new findings of pathological significance. All cases showed progressive disappearance of symptoms, such that no cases of long COVID and no hospitalization or deaths were recorded. CONCLUSIONS: Our results confirm that SARS-CoV-2 infections occur even after a full vaccination course; however, the clinical course is favorable and severe outcomes are reduced.

Organizational wellbeing: A model of a new Apulian COVID-19 designated hospital.

Background: Work environment characteristics have an important impact on organizational wellbeing in health care facilities. In the Apulia Region, a new COVID-19 hospital was planned, designated and built in a few weeks for the treatment of patients infected with SARS-CoV-2. To our knowledge, this hospital, together with "Fiera Hospital" in Milan, are two of the few buildings worldwide that have been converted into new health care facilities with intensive care center units to treat COVID-19 patients, and this is the first study assessing organizational wellbeing in a newly designated COVID-19 hospital. Aims: To detect and assess the strong points, criticality, and perceptions of wellbeing/discomfort of health care workers engaged in the management of the current health emergency. Method: The study was conducted on 188 health care workers, with the "Multidimensional Organizational Health Questionnaire." Results: We found an overall positive level of organizational wellbeing. The more positive dimensions were "Collaboration between colleagues," "Organizational efficiency" and "Room Comfort." Conflict situations in the workplace were poorly perceived. A very low rate of absenteeism from work was also observed. Conclusions: Our results show the effectiveness of the organizational model adopted in the management of the COVID-19 hospital, especially in view of the work and emotional overload of the personnel called to face the epidemiological emergency on the frontline, which did not adversely affect the psychophysical conditions of the workers. The success of this model is related to the coexistence of all levels of care required during any type of health emergency in a single structure, paying particular attention to the architectural, functional, and procedural aspects of health care and to the so-called "humanization" of care.

SARS-CoV-2 Breakthrough Infections: Incidence and Risk Factors in a Large European Multicentric Cohort of Health Workers.

BACKGROUND: The research aimed to investigate the incidence of SARS-CoV-2 breakthrough infections and their determinants in a large European cohort of more than 60,000 health workers. METHODS: A multicentric retrospective cohort study, involving 12 European centers, was carried out within the ORCHESTRA project, collecting data up to 18 November 2021 on fully vaccinated health workers. The cumulative incidence of SARS-CoV-2 breakthrough infections was investigated with its association with occupational and social-demographic characteristics (age, sex, job title, previous SARS-CoV-2 infection, antibody titer levels, and time from the vaccination course completion). RESULTS: Among 64,172 health workers from 12 European health centers, 797 breakthrough infections were observed (cumulative incidence of 1.2%). The primary analysis using individual data on 8 out of 12 centers showed that age and previous infection significantly modified breakthrough infection rates. In the meta-analysis of aggregated data from all centers, previous SARS-CoV-2 infection and the standardized antibody titer were inversely related to the risk of breakthrough infection (p = 0.008 and p = 0.007, respectively). CONCLUSION: The inverse correlation of antibody titer with the risk of breakthrough infection supports the evidence that vaccination plays a primary role in infection prevention, especially in health workers. Cellular immunity, previous clinical conditions, and vaccination timing should be further investigated.

Comparison of Three Different Waves in Healthcare Workers during the COVID-19 Pandemic: A Retrospective Observational Study in an Italian University Hospital.

BACKGROUND: SARS-CoV-2 has infected many healthcare workers and (HCWs) worldwide. The aim of this study was to determine, analyze, and compare the frequency and characteristics of COVID-19 cases among HCWs of the University Hospital of Bari. METHODS: A retrospective observational study was conducted after preventive protocol implementation. The SARS-CoV-2 infection frequency was determined by real-time reverse transcription-polymerase chain reaction on nasopharyngeal samples. RESULTS: Overall, 519 HCWs (9%) tested positive among a total of 6030 HCWs during the three waves. The highest frequency of COVID-19 cases (n = 326; 63%) was observed during the 2nd wave, from September 2020 to December 2020, and the lowest (n = 34; 7%) was observed during the 1st wave, from March 2020 to August 2020 (p < 0.001). Working in a designated COVID-19 department was not a risk factor for infection. CONCLUSIONS: The correct use of personal protective equipment and the early identification of symptomatic workers are still essential factors to avoid nosocomial clusters, even in this current phase of vaccine availability.

Association between Long COVID and Overweight/Obesity.

BACKGROUND: Long COVID is a syndrome characterized by the persistence of SARS-CoV-2 infection symptoms. Among HCWs, prolonged COVID symptoms could lead to the inability to perform work tasks. The aim of this study is to investigate 35-day long-COVID (35-LC) characteristics and risk factors in a one-year period. METHODS: We carried out a retrospective cohort study during the COVID-19 pandemic at University Hospital of Bari. A total of 5750 HCWs were tested for close contact with a confirmed case, in the absence of personal protective equipment, or for symptom development. RESULTS: Each positive HCW was investigated for cardiovascular risk factors or respiratory diseases. An amount of 352 HCWs (6.1%) were infected by SARS-CoV-2, and 168 cases evolved to long COVID. The 35-LC group showed mean BMI values higher than the non-35-LC group (25.9 kg/m2 vs. 24.8 kg/m2, respectively), and this difference was significant (p-value: 0.020). Moreover, HCWs who suffered from pulmonary disease (OR = 3.7, CL 95%: 1.35-10.53; p-value = 0.007) or overweight (OR = 1.6 CL 95%: 1.05-2.56; p-value = 0.029) had an increased risk of developing 35-LC. CONCLUSIONS: Long COVID is an emerging problem for hospital managers as it may reduce the number of HCWs deployed in the fight against COVID-19. High BMI and previous pulmonary disease could be risk factors for 35-LC development in exposed HCWs.

Large-scale IgM and IgG SARS-CoV-2 serological screening among healthcare workers with a low infection prevalence based on nasopharyngeal swab tests in an Italian university hospital: Perspectives for public health.

BACKGROUND: Healthcare workers (HCWs) are highly exposed to SARS-CoV-2 infection given their specific tasks. The IgG-IgM serological assay has demonstrated good accuracy in early detection in symptomatic patients, but its role in the diagnosis of asymptomatic patients is uncertain. The aim of our study was to assess IgM and IgG prevalence in sera in a large cohort of HCWs previously subjected to Nasopharyngeal swab test (NST) after accurate risk assessment due to positive COVID-19 patient exposure during an observation period of 90 days. METHODS: 2407 asymptomatic HCWs that had close contact with COVID-19 patients in the period between April 8th and June 7th were screened with NST based on the RT-PCR method. In parallel, they underwent large-scale chemiluminescence immunoassays involving IgM-IgG serological screening to determine actual viral spread in the same cohort. RESULTS: During the 90-day observation period, 18 workers (0.75%) resulted positive for SARS-CoV-2 infection at the NST, whereas the positivity rates for IgM and IgG were 11.51% and 2.37%, respectively (277 workers). Despite high specificity, serological tests were inadequate for detecting SARS-CoV-2 infection in patients with previous positive NST results (IgM and IgG sensitivities of 27.78% and 50.00%, respectively). CONCLUSIONS: These findings indicate a widespread low viral load of SARS-CoV-2 among hospital workers. However, serological screening showed very low sensitivity with respect to NST in identifying infected workers, and negative IgG and IgM results should not exclude the diagnosis of COVID-19. IgG-IgM chemiluminescence immunoassays could increase the diagnosis of COVID-19 only in association with NST, and this association is considered helpful for decision-making regarding returning to work.

COVID-19 hospital outbreaks: Protecting healthcare workers to protect frail patients. An Italian observational cohort study.

OBJECTIVES: To determine the prevalence of SARS-CoV-2 infection among exposed healthcare workers (HCWs) after preventive protocol implementation. METHODS: A total of 5750 HCWs were included in the study. Those in contact with COVID-19 patients were allocated into a high-risk or a low-risk group based on contact type (PPE- or non-PPE-protected); high-risk workers underwent nasopharyngeal swab tests, while among low-risk workers, swab tests were carried out only for symptomatic workers (active surveillance). The prevalence was determined by real-time reverse transcriptase-polymerase chain reaction on nasopharyngeal samples. RESULTS: 3570 HCWs had contact with 1065 COVID-19 patients. Among them, 3494 were subjected to active surveillance (low-risk group); 2886 (82.60%) were subjected to a swab test; and 15 were positive (0.52%). Seventy-six HCWs (2.13% of exposed) were included in the high-risk group, and a swab test was mandatory for each participant. Overall, 66 (86.84% of high-risk) were negative, and 10 were positive (13.16%), resulting in a higher risk of infection than in the low-risk group [OR = 29.00; 95% CI:12.56-66.94; p < 0.0001]. CONCLUSION: To date, the SARS-CoV-2 infection prevalence is 0.70% among exposed HCWs and 0.435% among all HCWs working at the examined university hospital. The correct use of PPE and the early identification of symptomatic workers are essential factors to avoiding nosocomial clusters.