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Carazo S, Villeneuve J, Laliberté D, Longtin Y, Talbot D, Martin R, Denis G, Ducharme F, Paquet-Bolduc B, Anctil G, Hegg-Deloye S, De Serres G. Risk and protective factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare workers: A test-negative case-control study in Québec, Canada. Infect Control Hosp Epidemiol 2023; 44:1121-1130. [PMID: 36082690 PMCID: PMC9530374 DOI: 10.1017/ice.2022.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In Québec, Canada, we evaluated the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection associated with (1) the demographic and employment characteristics among healthcare workers (HCWs) and (2) the workplace and household exposures and the infection prevention and control (IPC) measures among patient-facing HCWs. DESIGN Test-negative case-control study. SETTING Provincial health system. PARTICIPANTS HCWs with PCR-confirmed coronavirus disease 2019 (COVID-19) diagnosed between November 15, 2020, and May 29, 2021 (ie, cases), were compared to HCWs with compatible symptoms who tested negative during the same period (ie, controls). METHODS Adjusted odds ratios (aORs) of infection were estimated using regression logistic models evaluating demographic and employment characteristics (all 4,919 cases and 4,803 controls) or household and workplace exposures and IPC measures (2,046 patient-facing cases and 1,362 controls). RESULTS COVID-19 risk was associated with working as housekeeping staff (aOR, 3.6), as a patient-support assistant (aOR, 1.9), and as nursing staff (aOR, 1.4), compared to administrative staff. Other risk factors included being unexperienced (aOR, 1.5) and working in private seniors' homes (aOR, 2.1) or long-term care facilities (aOR, 1.5), compared to acute-care hospitals. Among patient-facing HCWs, exposure to a household contact was reported by 9% of cases and was associated with the highest risk of infection (aOR, 7.8). Most infections were likely attributable to more frequent exposure to infected patients (aOR, 2.7) and coworkers (aOR, 2.2). Wearing an N95 respirator during contacts with COVID-19 patients (aOR, 0.7) and vaccination (aOR, 0.2) were the measures associated with risk reduction. CONCLUSION In the context of the everchanging SARS-CoV-2 virus with increasing transmissibility, measures to ensure HCW protection, including vaccination and respiratory protection, and patient safety will require ongoing evaluation.
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Affiliation(s)
- Sara Carazo
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Jasmin Villeneuve
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Denis Laliberté
- Direction de la santé publique de la Capitale-Nationale, CIUSSS de la Capitale-Nationale, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Yves Longtin
- Infection Prevention and Control Unit, Jewish General Hospital, Montreal, Québec, Canada
- McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Denis Talbot
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- Centre de recherche du CHU de Québec—Université Laval, Québec, Québec, Canada
| | - Richard Martin
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Geoffroy Denis
- McGill University Faculty of Medicine, Montreal, Québec, Canada
- CIUSSS Centre Sud de Montréal, Montreal, Québec, Canada
| | - Francine Ducharme
- Faculté des sciences infirmières, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche de l’Institut de gériatrie de Montréal, Montreal, Québec, Canada
| | - Bianka Paquet-Bolduc
- Infection Prevention and Control Unit, Institut Universitaire en cardiologie et pneumologie de Québec, Québec, Québec, Canada
| | - Geneviève Anctil
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | | | - Gaston De Serres
- Institut national de santé Publique du Québec, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- Centre de recherche du CHU de Québec—Université Laval, Québec, Québec, Canada
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Loibner M, Barach P, Wolfgruber S, Langner C, Stangl V, Rieger J, Föderl-Höbenreich E, Hardt M, Kicker E, Groiss S, Zacharias M, Wurm P, Gorkiewicz G, Regitnig P, Zatloukal K. Resilience and Protection of Health Care and Research Laboratory Workers During the SARS-CoV-2 Pandemic: Analysis and Case Study From an Austrian High Security Laboratory. Front Psychol 2022; 13:901244. [PMID: 35936273 PMCID: PMC9353000 DOI: 10.3389/fpsyg.2022.901244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
The SARS-CoV-2 pandemic has highlighted the interdependency of healthcare systems and research organizations on manufacturers and suppliers of personnel protective equipment (PPE) and the need for well-trained personnel who can react quickly to changing working conditions. Reports on challenges faced by research laboratory workers (RLWs) are rare in contrast to the lived experience of hospital health care workers. We report on experiences gained by RLWs (e.g., molecular scientists, pathologists, autopsy assistants) who significantly contributed to combating the pandemic under particularly challenging conditions due to increased workload, sickness and interrupted PPE supply chains. RLWs perform a broad spectrum of work with SARS-CoV-2 such as autopsies, establishment of virus cultures and infection models, development and verification of diagnostics, performance of virus inactivation assays to investigate various antiviral agents including vaccines and evaluation of decontamination technologies in high containment biological laboratories (HCBL). Performance of autopsies and laboratory work increased substantially during the pandemic and thus led to highly demanding working conditions with working shifts of more than eight hours working in PPE that stressed individual limits and also the ergonomic and safety limits of PPE. We provide detailed insights into the challenges of the stressful daily laboratory routine since the pandemic began, lessons learned, and suggest solutions for better safety based on a case study of a newly established HCBL (i.e., BSL-3 laboratory) designed for autopsies and research laboratory work. Reduced personal risk, increased resilience, and stress resistance can be achieved by improved PPE components, better training, redundant safety measures, inculcating a culture of safety, and excellent teamwork.
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Affiliation(s)
- Martina Loibner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Paul Barach
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stella Wolfgruber
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Christine Langner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Julia Rieger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Melina Hardt
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Eva Kicker
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Silvia Groiss
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Philipp Wurm
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Kurt Zatloukal
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
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8
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Kanji JN, Chan YLE, Boychuk LR, Boyington C, Turay S, Kobelsky M, Doroshuk C, Choo P, Jacka S, Roberts E, Leighton K, Smith SW, Sikora C, Black R. SARS-CoV-2 outbreak in a Canadian suburban tertiary hospital necessitating full facility closure: a descriptive observational study. CMAJ Open 2022; 10:E137-E145. [PMID: 35193878 PMCID: PMC9259436 DOI: 10.9778/cmajo.20210064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND SARS-CoV-2 can cause outbreaks in community- and hospital-based settings. The aim of this study was to provide a detailed epidemiologic account of a hospital-wide SARS-CoV-2 outbreak and provide a description of case evaluations, transmission networks and the interventions implemented to stem the outbreak. METHODS We conducted a retrospective descriptive study of a hospital-wide SARS-CoV-2 outbreak at the Misericordia Community Hospital (Edmonton) from June 21 to Aug. 14, 2020. We reviewed hospital chart, public health and occupational health records to determine demographics, case type (community- or hospital-acquired), need for critical care and outcome for each case linked to the outbreak (patients, hospital staff, and community and patient visitors). We developed detailed transmission networks using epidemiologic data to determine what variables may have contributed to transmission. RESULTS Fifty-eight cases of SARS-CoV-2 infection were linked to this hospital outbreak (31 patients, 25 staff members and 2 visitors; 66% female, age range 19-97 years). One patient required critical care, and 11 deaths were recorded (all among inpatients). Most cases were hospital-acquired (91%), and 28% were asymptomatic at the time of diagnosis. The outbreak was composed of 2 clusters driven by protective equipment breaches, premature removal of precautions, transmission in small staff quarters and infection of a staff member after exposure to a wandering patient with dementia and asymptomatic, undetected SARS-CoV-2 infection. INTERPRETATION A detailed epidemiologic review of this hospital-wide outbreak shows that a SARS-CoV-2 outbreak can involve complex transmission chains and clusters. Multipronged bundled approaches, aggressive contact tracing, and patient and staff prevalence screening are important to help bring such outbreaks under control, along with ongoing vigilance in detecting delayed cases.
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Affiliation(s)
- Jamil N Kanji
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta.
| | - Y L Elaine Chan
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Lesia R Boychuk
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Curtiss Boyington
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Sebora Turay
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Melissa Kobelsky
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Carolyn Doroshuk
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Philana Choo
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Susan Jacka
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Erin Roberts
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Karen Leighton
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Christopher Sikora
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Robert Black
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
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