ABSTRACT
ObjectiveHealthcare workers (HCW) are at high risk of SARS-CoV-2 infection due to exposure to potentially infectious material, especially during aerosol-generating procedures (AGP). We aimed to investigate the prevalence of infection among HCW in medical disciplines with AGP. DesignA nationwide questionnaire-based study in in- and outpatient settings was conducted between 12/16/2020 and 01/24/2021. Data on SARS-CoV-2 infections among HCW and potential risk factors were investigated. Results2,070 healthcare facilities with 25,113 employees were included in the study. Despite a higher rate of pre-interventional testing, clinics treated three times more confirmed SARS-CoV-2 cases than private practices (28.8% vs. 88.4%, p<0.001). Overall infection rate among HCW accounted for 4.7%. Multivariate analysis revealed that ZIP-regions having comparably higher incidences were significantly associated with increased risk of infection. Furthermore, clinical setting and the GIE specialty have more than double the risk of infection (OR 2.63; 95% CI 2.501-2.817, p<0.01 and OR 2.35; 95% CI 2.245-2.498, p<0.01). The number of procedures performed per day was also significantly associated with an increased risk of infection (OR 1.01; 95% CI 1.007-1.014), p<0.01). No treatment of confirmed SARS-CoV-2 cases was tending to lower the risk of infection (OR 0.72; 95% CI 0.507-1.025, p=0.068). ConclusionHCW in GIE seem to be at higher risk of infection than those in other AGP, especially in the clinical setting. Regions having comparably higher incidences as well as the number of procedures performed per day were also significantly associated with increased risk of infection. Significance of this studyO_ST_ABSWhat is already known on this subject?C_ST_ABSHealth care workers, especially those exposed to aerosol generating procedures, are assumed to have an increased risk of SARS-CoV-2 infection. However, data confirming this are lacking, especially for the outpatient care setting. What are the new findings?Health care workers in gastrointestinal endoscopy have a higher risk of SARS-CoV-2-infection than in other AGPs. This risk is particularly higher - in clinical settings compared to private practices - in regions having comparably higher incidences - the more procedures are performed per day How might it impact on clinical practice in the foreseeable future?Our study suggests making additional efforts to protect HCW in the gastrointestinal work field.
ABSTRACT
ObjectiveThe COVID-19 pandemic challenges health care systems worldwide. In this situation, guidelines for health care professionals in endoscopy units with increased risk of infection from inhalation of airborne droplets, conjunctival contact and faeces are urgently needed. Recently, the European Society of Gastrointestinal Endoscopy (ESGE) and the German Society for Pneumology (DGP) issued recommendations. However, real-world data on the conditions and requirements of endoscopy units to adhere to this guidance are missing. DesignWe conducted an internet-based survey among German endoscopy units from all levels of care from April 1st to 7th, 2020. The survey comprised 33 questions and was distributed electronically by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the DGP. ResultsIn total, 656 endoscopy units completed the survey. Overall, 253 units (39%) cancelled fewer than 40% of their procedures. Of note, private practices cancelled less procedures than hospital-based units. Complete separation of high-risk and COVID-19 positive patients was achieved in only 20% of the units. Procedural measures were well adopted, with 91% of the units systematically identifying patients at risk and 85% using risk-adapted personal protective equipment (PPE). For the future, shortages in PPE (81%), staff (69%) and relevant financial losses (77%) were expected. ConclusionConcise definitions of non-urgent, elective interventions and endoscopic surveillance strategies are needed to better guide endoscopic activity and intervention cancellations. In the short term, a lack of PPE can constitute considerable impairment of endoscopy units operability and patient outcomes. SUMMARY BOXO_LIWhat is already known about this subject? - Recent data indicate a potentially important role of the gastrointestinal tract in the spreading of COVID-19. - Endoscopy units and their personnel are at high risk to be exposed to and to distribute COVID-19 infections. - Several societies have formulated guidance for endoscopy units in the current situation, but their feasibility is unclear. C_LIO_LIWhat are the new findings? - Endoscopic activity seems not to be limited to urgent interventions across all units as 39% of all endoscopy units cancelled less than 40% of procedures. - For most endoscopy units, structural conditions are insufficient to realize a complete separation of high-risk patients, which can be guaranteed by only 20% of the units. - The willingness to adhere to the recommendations is very high, as most endoscopy units adopted their procedures accordingly. Shortage of personal protective equipment is a critical concern in many units. C_LIO_LIHow might it impact on clinical practice in the foreseeable future? - An update of the current recommendations to refine practicable measures for the majority of endoscopic units is warranted. - A concise definition of non-urgent or elective procedures as well as postponement strategies and intervals are of utmost importance, since current data implicate that transmission of SARS-CoV-2 via the respiratory and gastrointestinal tract may be critical for public health. C_LI
