Evaluation of healthcare personnel exposures to patients with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) associated with personal protective equipment

Effectiveness of face masks for reducing transmission of SARS-CoV-2: a rapid systematic review

This rapid systematic review of evidence asks whether (i) wearing a face mask, (ii) one type of mask over another and (iii) mandatory mask policies can reduce the transmission of SARS-CoV-2 infection, either in community-based or healthcare settings. A search of studies published 1 January 2020-27 January 2023 yielded 5185 unique records. Due to a paucity of randomized controlled trials (RCTs), observational studies were included in the analysis. We analysed 35 studies in community settings (three RCTs and 32 observational) and 40 in healthcare settings (one RCT and 39 observational). Ninety-five per cent of studies included were conducted before highly transmissible Omicron variants emerged. Ninety-one per cent of observational studies were at 'critical' risk of bias (ROB) in at least one domain, often failing to separate the effects of masks from concurrent interventions. More studies found that masks (n = 39/47; 83%) and mask mandates (n = 16/18; 89%) reduced infection than found no effect (n = 8/65; 12%) or favoured controls (n = 1/65; 2%). Seven observational studies found that respirators were more protective than surgical masks, while five found no statistically significant difference between the two mask types. Despite the ROB, and allowing for uncertain and variable efficacy, we conclude that wearing masks, wearing higher quality masks (respirators), and mask mandates generally reduced SARS-CoV-2 transmission in these study populations. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

Seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies among healthcare personnel in the Midwestern United States, September 2020-April 2021

Objective

To determine the prevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) IgG nucleocapsid (N) antibodies among healthcare personnel (HCP) with no prior history of COVID-19 and to identify factors associated with seropositivity.

Design

Prospective cohort study.

Setting

An academic, tertiary-care hospital in St. Louis, Missouri.

Participants

The study included 400 HCP aged ≥18 years who potentially worked with coronavirus disease 2019 (COVID-19) patients and had no known history of COVID-19; 309 of these HCP also completed a follow-up visit 70-160 days after enrollment. Enrollment visits took place between September and December 2020. Follow-up visits took place between December 2020 and April 2021.

Methods

At each study visit, participants underwent SARS-CoV-2 IgG N-antibody testing using the Abbott SARS-CoV-2 IgG assay and completed a survey providing information about demographics, job characteristics, comorbidities, symptoms, and potential SARS-CoV-2 exposures.

Results

Participants were predominately women (64%) and white (79%), with median age of 34.5 years (interquartile range [IQR], 30-45). Among the 400 HCP, 18 (4.5%) were seropositive for IgG N-antibodies at enrollment. Also, 34 (11.0%) of 309 were seropositive at follow-up. HCP who reported having a household contact with COVID-19 had greater likelihood of seropositivity at both enrollment and at follow-up.

Conclusions

In this cohort of HCP during the first wave of the COVID-19 pandemic, ∼1 in 20 had serological evidence of prior, undocumented SARS-CoV-2 infection at enrollment. Having a household contact with COVID-19 was associated with seropositivity.

Association of COVID-19 Infection With Wearing Glasses in a High-Prevalence Area in Denmark and Sweden

Importance

Observational studies have indicated that glasses might protect against contracting COVID-19 through reduced airborne and contact transmission.

Objective

To investigate the association between wearing one's own glasses with contracting COVID-19 when adjusting for relevant confounders.

Design, Setting, and Participants

This cohort study was conducted during the first wave of the COVID-19 pandemic (June to August 2020) in Denmark and Sweden, where personal protective equipment was not recommended for the general population at the time. Employees at Falck, an international rescue corps with different job functions (ambulance, health care, office, and field staff, firefighters, and roadside assistance) participated in the study.

Exposures

The main exposure was wearing glasses (also including contact lenses and reading glasses), which was assessed in a questionnaire. Persons wearing glasses were compared with those who did not wear glasses (ie, nonusers). To adjust for potential confounders, information on age, sex, job function, and number of workday contacts were included.

Main Outcomes and Measures

The outcome was COVID-19 infection before (positive polymerase chain reaction test) or during the study period (biweekly voluntary tests with a rapid test). The investigated hypothesis was formulated after collecting the data.

Results

A total of 1279 employees in Denmark and 841 in Sweden were included (839 [39.6%] female and 1281 [60.4%] male; 20.5% were aged <40 years; 57.0%, 40-60 years, and 22.5%, >60 years). Of these, 829 individuals (64.8%) in Denmark and 619 (73.6%) in Sweden wore glasses. Wearing glasses was inversely associated with COVID-19 infection in the Swedish cohort (odds ratio [OR], 0.61 [95% CI, 0.37-0.99]; P = .047; seroprevalence, 9.3%) but not in the Danish cohort (OR, 1.14 [95% CI, 0.53-2.45]; P = .73; seroprevalence, 2.4%). Adjusting for age, sex, job function, and number of workday contacts in Sweden, wearing glasses no longer was associated with COVID-19 infection (OR, 0.64 [95% CI, 0.37-1.11]; P = .11). When stratifying by job function, a large difference was observed among office staff (OR, 0.20 [95% CI, 0.06-0.70]; P = .01) but not ambulance staff (OR, 0.83 [95% CI, 0.41-1.67]; P = .60) nor health care staff (OR, 0.89 [95% CI, 0.35-2.30]; P = .81).

Conclusions and Relevance

While wearing one's glasses was inversely associated with COVID-19 in Sweden in an unadjusted analysis, an association no longer was identified when adjusting for confounders. These results provide inconclusive findings regarding whether wearing one's own glasses is associated with a decreased risk of COVID-19 infections.

Coworkers are more likely than patients to transmit SARS-CoV-2 infection to healthcare personnel

OBJECTIVES

To compare the impact of occupational exposures to SARS-CoV-2 positive patients and SARS-CoV-2 positive coworkers, by comparing the frequency of occupational exposure incidents and the rate of healthcare personnel (HCP) who developed a positive PCR test for SARS-COV-2 after occupational exposure to the two different types of infectious individuals.

METHODS

A retrospective analysis of all confirmed higher risk occupational exposure incidents that occurred in HCP from 20 March 2020 to 31 December 2020 at a large multisite US academic medical centre. Comparisons between groups for source type were performed using unpaired Student's t-test for continuous variables and the χ² test for categorical variables, regression analysis was conducted to assess the associations between source type and risk of positive COVID-19 test after occupational exposure.

RESULTS

In total, 2253 confirmed medium or high-risk occupational exposures occurred during the study period. 57% were exposures from coworker sources. Each source individual exposed a mean of 2.6 (95% CI 2.3 to 2.9) HCP; during postexposure surveillance, 4.5% of exposed HCP tested positive within 14 days. A coworker source on average exposed 2.2 (95% CI 2.01 to 2.4) other HCP and infected 0.14 (95% CI 0.1 to 0.17) HCP, while patient sources exposed a mean of 3.4 (95% CI 2.6 to 4.2) HCP but only infected 0.07 (95% CI 0.04 to 0.11) HCP. The multivariate analysis demonstrated that exposure to a coworker source carried a higher risk of testing positive compared with exposure to a patient source (OR 3.22; 95% CI 1.72 to 6.04).

CONCLUSION

Occupational exposures to coworker sources were not only more frequent but also associated with triple the risk of developing COVID-19 infection, compared with exposures to patient sources.

One Health response to SARS-CoV-2-associated risk from mink farming in British Columbia, Canada, October 2020 to October 2021

Background

Mink farms are susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks and carry an associated risk of novel SARS-CoV-2 variant emergence and non-human reservoir creation. In Denmark, control measures were insufficient to prevent onward transmission of a mink-associated variant, contributing to the nation-wide culling of farmed mink. To date, British Columbia (BC) is the only Canadian province to report mink farm SARS-CoV-2 outbreaks. The objective of this study is to describe BC's One Health response to SARS-CoV-2-associated risk from mink farming, its outcomes, and insights from implementation.

Methods

The detection of two mink farm outbreaks in December 2020 catalyzed BC's risk mitigation response for both infected and uninfected farms, including the following: farm inspections and quarantines; Public Health Orders mandating mink mortality surveillance, enhanced personal protective equipment, biosafety measures and worker coronavirus disease 2019 vaccination, at-a-minimum weekly worker viral testing, and wildlife surveillance.

Results

A One Health approach enabled a timely, evidence-informed and coordinated response as the situation evolved, including the use of various legislative powers, consistent messaging and combined human and mink phylogenetic analysis. Ongoing mink and worker surveillance detected asymptomatic/subclinical infections and facilitated rapid isolation/quarantine to minimize onward transmission. Voluntary testing and mandatory vaccination for workers were acceptable to industry; enhanced personal protective equipment requirements were challenging. Regular farm inspections helped to assess and improve compliance.

Conclusion

British Columbia's One Health response reduced the risk of additional outbreaks, viral evolution and reservoir development; however, a third outbreak was detected in May 2021 despite implemented measures, and long-term sustainability of interventions proved challenging for both industry and governmental agencies involved.

Infection Prevention and Control of Severe Acute Respiratory Syndrome Coronavirus 2 in Health Care Settings

The authors describe infection prevention and control approaches to severe acute respiratory syndrome coronavirus 2 in the health care setting, including a review of the chain of transmission and the hierarchy of controls, which are cornerstones of infection control and prevention. The authors also discuss lessons learned from nosocomial transmission events.

COVID-19 Severity among Healthcare Workers: Overweight Male Physicians at Risk

We performed a prospective longitudinal cohort study in two healthcare settings. In total, 909 HCWs out of 3982 (23.35%) were diagnosed with COVID-19 before the vaccination era. Eighty-five per cent of COVID-19 positive HCWs (n = 774) were asymptomatic or mild, and 15% were moderate or severe. The mean age of the infected HCWs in the moderate or severe group was higher than the mild or asymptomatic group (35.4 vs. 31.3 years, p < 0.001). Thirty-two per cent of HCWs were male and the rate of male gender was more frequent in the moderate/severe group (p = 0.009). The rate of those who have cardiovascular diseases (p = 0.003) and diabetes mellitus (p = 0.044) were significantly higher among the HCWs with moderate or severe COVID-19. In multivariate analysis, male gender (OR:1.65, CI:1.11−2.46, p = 0.013), BMI > 30 (OR: 1.9, CI: 1.09−3.51, p = 0.024), and being physician (OR: 2.56, CI:1.45−4.52, p = 0.001) were found to be associated with moderate or severe COVID-19.

Infection Prevention during the Coronavirus Disease 2019 Pandemic

COVID-19 is a nonspecific viral illness caused by a novel coronavirus, SARS-CoV-2, and led to an ongoing global pandemic. Transmission is primarily human-to-human via contact with respiratory particles containing infectious virus. The risk of transmission to health care personnel is low with proper use of personal protective equipment, including gowns, gloves, N95 or surgical mask, and eye protection. Additional measures affecting the risk of transmission include physical distancing, hand hygiene, routine cleaning and disinfection, appropriate air handling and ventilation, and public health interventions such as universal masking and stay-at-home orders.

Occupational risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel: A 6-month prospective analysis of the COVID-19 Prevention in Emory Healthcare Personnel (COPE) Study

Objectives:

To determine the incidence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel (HCP) and to assess occupational risks for SARS-CoV-2 infection.

Design:

Prospective cohort of healthcare personnel (HCP) followed for 6 months from May through December 2020.

Setting:

Large academic healthcare system including 4 hospitals and affiliated clinics in Atlanta, Georgia.

Participants:

HCP, including those with and without direct patient-care activities, working during the coronavirus disease 2019 (COVID-19) pandemic.

Methods:

Incident SARS-CoV-2 infections were determined through serologic testing for SARS-CoV-2 IgG at enrollment, at 3 months, and at 6 months. HCP completed monthly surveys regarding occupational activities. Multivariable logistic regression was used to identify occupational factors that increased the risk of SARS-CoV-2 infection.

Results:

Of the 304 evaluable HCP that were seronegative at enrollment, 26 (9%) seroconverted for SARS-CoV-2 IgG by 6 months. Overall, 219 participants (73%) self-identified as White race, 119 (40%) were nurses, and 121 (40%) worked on inpatient medical-surgical floors. In a multivariable analysis, HCP who identified as Black race were more likely to seroconvert than HCP who identified as White (odds ratio, 4.5; 95% confidence interval, 1.3–14.2). Increased risk for SARS-CoV-2 infection was not identified for any occupational activity, including spending >50% of a typical shift at a patient’s bedside, working in a COVID-19 unit, or performing or being present for aerosol-generating procedures (AGPs).

Conclusions:

In our study cohort of HCP working in an academic healthcare system, <10% had evidence of SARS-CoV-2 infection over 6 months. No specific occupational activities were identified as increasing risk for SARS-CoV-2 infection.

The effect of eye protection on SARS-CoV-2 transmission: a systematic review

BACKGROUND

The effect of eye protection to prevent SARS-CoV-2 infection in the real-world remains uncertain. We aimed to synthesize all available research on the potential impact of eye protection on transmission of SARS-CoV-2.

METHODS

We searched PROSPERO, PubMed, Embase, The Cochrane Library for clinical trials and comparative observational studies in CENTRAL, and Europe PMC for pre-prints. We included studies that reported sufficient data to estimate the effect of any form of eye protection including face shields and variants, goggles, and glasses, on subsequent confirmed infection with SARS-CoV-2.

RESULTS

We screened 898 articles and included 6 reports of 5 observational studies from 4 countries (USA, India, Columbia, and United Kingdom) that tested face shields, goggles, and wraparound eyewear on 7567 healthcare workers. The three before-and-after and one retrospective cohort studies showed statistically significant and substantial reductions in SARS-CoV-2 infections favouring eye protection with odds ratios ranging from 0.04 to 0.6, corresponding to relative risk reductions of 96% to 40%. These reductions were not explained by changes in the community rates. However, the one case-control study reported odds ratio favouring no eye protection (OR 1.7, 95% CI 0.99, 3.0). The high heterogeneity between studies precluded any meaningful meta-analysis. None of the studies adjusted for potential confounders such as other protective behaviours, thus increasing the risk of bias, and decreasing the certainty of evidence to very low.

CONCLUSIONS

Current studies suggest that eye protection may play a role in prevention of SARS-CoV-2 infection in healthcare workers. However, robust comparative trials are needed to clearly determine effectiveness of eye protections and wearability issues in both healthcare and general populations.

Lessons from COVID-19: A reflection on the strengths and weakness of early consensus recommendations for pediatric difficult airway management during a respiratory viral pandemic using a modified Delphi method

BACKGROUND

The authors recognized a gap in existing guidelines and convened a modified Delphi process to address novel issues in pediatric difficult airway management raised by the COVID-19 pandemic.

METHODS

The Pediatric Difficult Intubation Collaborative, a working group of the Society for Pediatric Anesthesia, assembled an international panel to reach consensus recommendations on pediatric difficult airway management during the COVID-19 pandemic using a modified Delphi method. We reflect on the strengths and weaknesses of this process and ways care has changed as knowledge and experience have grown over the course of the pandemic.

RECOMMENDATIONS

In the setting of the COVID-19 pandemic, the Delphi panel recommends against moving away from the operating room solely for the purpose of having a negative pressure environment. The Delphi panel recommends supplying supplemental oxygen and using videolaryngoscopy during anticipated difficult airway management. Direct laryngoscopy is not recommended. If the patient meets extubation criteria, extubate in the OR, awake, at the end of the procedure.

REFLECTION

These recommendations remain valuable guidance in caring for children with anticipated difficult airways and infectious respiratory pathology when reviewed in light of our growing knowledge and experience with COVID-19. The panel initially recommended minimizing involvement of additional people and trainees and minimizing techniques associated with aerosolization of viral particles. The demonstrated effectiveness of PPE and vaccination at reducing the risk of exposure and infection to clinicians managing the airway makes these recommendations less relevant for COVID-19. They would likely be important initial steps in the face of novel respiratory viral pathogens.

CONCLUSIONS

The consensus process cannot and should not replace evidence-based guidelines; however, it is encouraging to see that the panel's recommendations have held up well as scientific knowledge and clinical experience have grown.