Risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) seropositivity among nursing home staff

Avnika B Amin; Joseph T Kellogg; Carly Adams; William C Dube; Matthew H Collins; Benjamin A Lopman; Theodore M Johnson 2nd; Joshua Weitz; Scott K Fridkin

doi:10.1017/ash.2021.193

Risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) seropositivity among nursing home staff

Antimicrob Steward Healthc Epidemiol. 2021 Oct 28;1(1):e35. doi: 10.1017/ash.2021.193. eCollection 2021.

Authors

Avnika B Amin¹, Joseph T Kellogg², Carly Adams¹, William C Dube², Matthew H Collins³, Benjamin A Lopman^{1

4}, Theodore M Johnson 2nd^{1

5

6}, Joshua Weitz^{7

8}, Scott K Fridkin^{1

2}

Affiliations

¹ Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
² Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
³ The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.
⁴ Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, Georgia.
⁵ Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
⁶ Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia.
⁷ School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia.
⁸ School of Physics, Georgia Institute of Technology, Atlanta, Georgia.

Abstract

Objectives: To estimate prior severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among skilled nursing facility (SNF) staff in the state of Georgia and to identify risk factors for seropositivity as of fall 2020.

Design: Baseline survey and seroprevalence of the ongoing longitudinal Coronavirus 2019 (COVID-19) Prevention in Nursing Homes study.

Setting: The study included 14 SNFs in the state of Georgia.

Participants: In total, 792 SNF staff employed or contracted with participating SNFs were included in this study. The analysis included 749 participants with SARS-CoV-2 serostatus results who provided age, sex, and complete survey information.

Methods: We estimated unadjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for potential risk factors and SARS-CoV-2 serostatus. We estimated adjusted ORs using a logistic regression model including age, sex, community case rate, SNF resident infection rate, working at other facilities, and job role.

Results: Staff working in high-infection SNFs were twice as likely (unadjusted OR, 2.08; 95% CI, 1.45-3.00) to be seropositive as those in low-infection SNFs. Certified nursing assistants and nurses were 3 times more likely to be seropositive than administrative, pharmacy, or nonresident care staff: unadjusted OR, 2.93 (95% CI, 1.58-5.78) and unadjusted OR, 3.08 (95% CI, 1.66-6.07). Logistic regression yielded similar adjusted ORs.

Conclusions: Working at high-infection SNFs was a risk factor for SARS-CoV-2 seropositivity. Even after accounting for resident infections, certified nursing assistants and nurses had a 3-fold higher risk of SARS-CoV-2 seropositivity than nonclinical staff. This knowledge can guide prioritized implementation of safer ways for caregivers to provide necessary care to SNF residents.