1. Assessing coronavirus disease 2019 (COVID-19) transmission to healthcare personnel: The global ACT-HCP case-control study
- Author
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Lentz, Robert J, Colt, Henri, Chen, Heidi, Cordovilla, Rosa, Popevic, Spasoje, Tahura, Sarabon, Candoli, Piero, Tomassetti, Sara, Meachery, Gerard J, Cohen, Brandon P, Harris, Bryan D, Talbot, Thomas R, and Maldonado, Fabien
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Clinical Research ,Lung ,Emerging Infectious Diseases ,Prevention ,Infectious Diseases ,Infection ,Good Health and Well Being ,Adult ,Aged ,COVID-19 ,Case-Control Studies ,Female ,Global Health ,Humans ,Infectious Disease Transmission ,Patient-to-Professional ,Logistic Models ,Male ,Middle Aged ,Occupational Exposure ,Personal Protective Equipment ,Respiratory Protective Devices ,Young Adult ,Medical and Health Sciences ,Epidemiology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveTo 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.DesignCase-control study.SettingWe collected data from international participants via an online survey.ParticipantsIn 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.MethodsRespondents 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.ResultsHCP 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).ConclusionsCOVID-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.
- Published
- 2021