Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community

Shruti K Gohil; Kathleen A Quan; Keith M Madey; Suzanne King-Adelsohn; Tom Tjoa; Delia Tifrea; Bridgit O Crews; Edwin S Monuki; Saahir Khan; Sebastian D Schubl; Cassiana E Bittencourt; Neil Detweiler; Wayne Chang; Lynn Willis; Usme Khusbu; Antonella Saturno; Sherif A Rezk; Cesar Figueroa; Aarti Jain; Rafael Assis; Philip Felgner; Robert Edwards; Lanny Hsieh; Donald Forthal; William C Wilson; Michael J Stamos; Susan S Huang

doi:10.1186/s13756-021-01031-5

Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community

Antimicrob Resist Infect Control. 2021 Nov 22;10(1):163. doi: 10.1186/s13756-021-01031-5.

Authors

Shruti K Gohil^{1

2}, Kathleen A Quan³, Keith M Madey³, Suzanne King-Adelsohn⁴, Tom Tjoa⁵, Delia Tifrea⁴, Bridgit O Crews⁴, Edwin S Monuki⁴, Saahir Khan⁶, Sebastian D Schubl⁷, Cassiana E Bittencourt⁴, Neil Detweiler⁴, Wayne Chang⁸, Lynn Willis³, Usme Khusbu³, Antonella Saturno³, Sherif A Rezk⁴, Cesar Figueroa⁷, Aarti Jain⁹, Rafael Assis⁹, Philip Felgner⁹, Robert Edwards⁴, Lanny Hsieh⁵, Donald Forthal⁵, William C Wilson¹⁰, Michael J Stamos⁷, Susan S Huang^{3

5}

Affiliations

¹ Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA. skgohil@hs.uci.edu.
² Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA. skgohil@hs.uci.edu.
³ Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA.
⁴ Pathology and Laboratory Medicine, UCI Health, Newport Beach, USA.
⁵ Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA.
⁶ Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, USA.
⁷ Department of Surgery, Irvine School of Medicine, University of California, Irvine, USA.
⁸ Division of Occupational and Environmental Medicine, Irvine School of Medicine, University of California, Irvine, USA.
⁹ Department of Physiology and Biophysics, University of California, Irvine, USA.
¹⁰ Chief Medical Officer, UC Irvine Health, Orange, USA.

Abstract

Background: Early evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks.

Methods: Prior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology.

Results: Of 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05-3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28-3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00-2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12-3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30-0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01).

Conclusions: Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission. Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.

Keywords: COVID-19 outbreaks; COVID-19 seroprevalence; Healthcare professional COVID-19 exposure; Healthcare worker COVID-19 exposure; Severe acute respiratory syndrome coronavirus-2.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Academic Medical Centers
Adult
COVID-19 / prevention & control*
California / epidemiology
Community-Acquired Infections
Cross-Sectional Studies
Disease Outbreaks
Female
Health Personnel*
Humans
Infection Control*
Infectious Disease Transmission, Patient-to-Professional / prevention & control
Male
Middle Aged
Multivariate Analysis
Regression Analysis
Retrospective Studies
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding