Risk Factors Associated with SARS-CoV-2 Infection among Healthcare Workers in a NonCOVID Hospital in Malaysia

IntroductionIntroduction This study aimed to evaluate risk factors associated with SARS-CoV-2 infection among HCWs who had exposure from infected patients and HCWs in a recent outbreak in Sarawak General Hospital (SGH). Materials and Methods We included HCWs who were investigated during contact tracing of SARS-CoV-2 confirmed patients and HCWs in SGH. We analysed the risk factors including personal protective equipment (PPE) use, social distancing, contact duration, hand hygiene practice, and involvement in aerosol producing activities associated with HCW’s SARSCoV-2 infection risk, which was confirmed by using real-time polymerase chain reaction assay. Results We included 2104 HCWs: 62.2% were female with median age of 32 years old. Majority were nurses (45.3%) and doctors (29.8%). Fifty (2.4%) HCWs were later confirmed with SARS-CoV-2 infection. Among them, 12 had exposure from infected patient(s); 34 from infected HCW(s); and four had contacted both infected patient(s) and HCW(s). Discussion & Conclusion Aerosol-producing activities and hand hygiene were the significant risk factors associated with SARSCoV-2 infection risk in HCWs. The findings indicate indirect contact of contaminated surfaces or formite transmission as the possible transmission mode of SARS-CoV-2. Actions are needed to reinforce hand hygiene habits and practice while use of mask and PPEs should not be undermined in the effort of preventing nosocomial transmission of SARS-CoV-2. In univariable and multivariable analyses, in patient-HCW exposure, aerosol-producing activities was the only risk factor significantly associated with SARS-CoV-2 infection [OR=4.55, 95%CI=1.14-18.12], while in HCW-HCW exposure, hand hygiene was the sole significant risk factor (OR=2.21, 95%CI=1.13-4.31). Not wearing mask in HCW-HCW contact showed marginal significance level in univariable analysis (p=0.06, OR=6.98, 95%CI=0.93-50.03). Other risk factors were not found to significantly associated with SARS-CoV-2 infection risk in HCWs