A mixed-methods study of risk factors and experiences of healthcare workers tested for the novel coronavirus in Canada

ObjectivesWe aimed to investigate the contribution of occupational and non-work-related factors to the risk of novel coronavirus (SARS-CoV-2) infection among healthcare workers (HCWs) in Vancouver Coastal Health, British Columbia, Canada. We also aimed to examine how HCWs described their experiences. MethodsWe conducted a matched case-control study using data from online and phone questionnaires with optional open-ended questions completed by HCWs who sought SARS-CoV-2 testing between March 2020 and March 2021. Conditional logistic regression and thematic analysis were utilized. ResultsData from 1340 HCWs were included. Free-text responses were provided by 257 respondents. Adjusting for age, gender, race, occupation, and number of weeks since pandemic was declared, community exposure to a known COVID-19 case (adjusted odds ratio -aOR: 2.45; 95% CI 1.67-3.59), and difficulty accessing personal protective equipment -PPE- (aOR: 1.84; 95% CI 1.07-3.17) were associated with higher infection odds. Care-aides/licensed practical nurses had substantially higher risk (aOR: 2.92; 95% CI 1.49-5.70) than medical staff who had the lowest risk. Direct COVID-19 patient care was not associated with elevated risk. HCWs experiences reflected the phase of the pandemic when they were tested. Suboptimal communication, mental stress, and situations perceived as unsafe were common sources of dissatisfaction. ConclusionsCommunity exposures and occupation were important determinants of infection among HCWs in our study. The availability of PPE and clear communication enhanced a sense of safety. Varying levels of risk between occupational groups call for wider targeting of infection prevention measures. Strategies for mitigating community exposure and supporting HCW resilience are required.

Repeat Auditing of Primary Health-care Facilities Against Standards for Occupational Health and Infection Control: A Study of Compliance and Reliability

Background@#The elevated risk of occupational infection such as tuberculosis among health workers in many countries raises the question of whether the quality of occupational health and safety (OHS) and infection prevention and control (IPC) can be improved by auditing. The objectives of this study were to measure (1) audited compliance of primary health-care facilities in South Africa with national standards for OHS and IPC, (2) change in compliance at reaudit three years after baseline, and (3) the inter-rater reliability of the audit. @*Methods@#The study analyzed audits of 60 primary health-care facilities in the Western Cape Province of South Africa. Baseline external audits in the time period 2011–2012 were compared with follow-up internal audits in 2014–2015. Audits at 25 facilities that had both internal and external audits conducted in 2014/2015 were used to measure reliability. @*Results@#At baseline, 25% of 60 facilities were “noncompliant” (audit score50 80%). Overall, there was no significant improvement in compliance three years after baseline. Percentage agreement on specific items between internal and external audits ranged from 28% to 92% and kappa from -0.8 to 0.41 (poor to moderate). @*Conclusion@#Low baseline compliance with OHS–IPC measures and lack of improvement over three years reflect the difficulties of quality improvement in these domains. Low inter-rater reliability of the audit instrument undermines the audit process. Evidence-based investment of effort is required if repeat auditing is to contribute to occupational risk reduction for health workers.