Robert J Lentz1,2,3, Henri Colt4, Heidi Chen5, Rosa Cordovilla6, Spasoje Popevic7, Sarabon Tahura8, Piero Candoli9, Sara Tomassetti10, Gerard J Meachery11,12, Brandon P Cohen13, Bryan D Harris3,14, Thomas R Talbot14, Fabien Maldonado1,2. 1. Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, United States. 2. Departments of Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States. 3. Department of Veterans' Affairs Medical Center, Nashville, Tennessee, United States. 4. Division of Pulmonary Diseases and Critical Care Medicine (Emeritus), University of California, Irvine, California, United States. 5. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States. 6. Department of Pulmonology, Interventional Pulmonary Unit, Salamanca University Hospital, Salamanca, Spain. 7. Department of Pulmonology, Interventional Pulmonology Unit, Clinical Center of Serbia, Belgrade, Serbia. 8. Department of Pediatric Respiratory Medicine, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh. 9. Pulmonology Unit, Azienda Ospedali Riuniti Marche Nord, Pesaro, Italy. 10. Department of Experimental and Clinical Medicine, Interventional Pulmonary Unit, Careggi University Hospital, Florence, Italy. 11. Department of Respiratory Medicine and Cardiothoracic Transplantation, Institute of Transplantation, Freeman Hospital and Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, United Kingdom. 12. Newcastle University, Newcastle Upon Tyne, United Kingdom. 13. HCA Healthcare, Ocala Health System, Ocala, Florida, United States. 14. Division of Infectious Diseases and Department of Infection Prevention, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Abstract
OBJECTIVE: To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection. DESIGN: Case-control study. SETTING: We collected data from international participants via an online survey. PARTICIPANTS: In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study. METHODS: Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases. RESULTS: HCP infection was associated with non-aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04-1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1-16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2-0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4-0.7). CONCLUSIONS: COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.
OBJECTIVE: To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection. DESIGN: Case-control study. SETTING: We collected data from international participants via an online survey. PARTICIPANTS: In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study. METHODS: Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases. RESULTS:HCP infection was associated with non-aerosol-generating contact with COVID-19patients (adjusted OR, 1.4; 95% CI, 1.04-1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1-16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2-0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4-0.7). CONCLUSIONS:COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.
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