Factors associated with an increased risk of SARS-CoV-2 infection in healthcare workers in aerosol-generating disciplines

Abstract

Background Healthcare workers (HCWs) are at a high risk of SARS-CoV-2 infection due to exposure to potentially infectious material, especially during aerosol-generating procedures (AGP). We aimed to investigate risk factors for SARS-CoV-2 infection among HCWs in medical disciplines with AGP.

Methods A nationwide questionnaire-based study in private practices and hospital settings was conducted between 12/16/2020 and 01/24/2021. Data on SARS-CoV-2 infections among HCWs and potential risk factors of infection were investigated.

Results 2070 healthcare facilities with 25113 employees were included in the study. The overall infection rate among HCWs was 4.7%. Multivariate analysis showed that regions with higher incidence rates had a significantly increased risk of infection. Furthermore, hospital setting and HCWs in gastrointestinal endoscopy (GIE) had more than double the risk of infection (OR 2.63; 95% CI 2.50–2.82, p<0.01 and OR 2.35; 95% CI 2.25–2.50, p<0.01). For medical facilities who treated confirmed SARS-CoV-2 cases, there was a tendency towards higher risk of infection (OR 1.39; 95% CI 1.11–1.63, p=0.068).

Conclusion Both factors within and outside medical facilities appear to be associated with an increased risk of infection among HCWs. Therefore, GIE and healthcare delivery setting were related to increased infection rates. Regions with higher SARS-CoV-2 incidence rates were also significantly associated with increased risk of infection.

Zusammenfassung

Hintergrund Medizinisches Personal ist durch die Exposition gegenüber potenziell infektiösem Material einem erhöhten Infektionsrisiko ausgesetzt. Dies gilt insbesondere für Fachdisziplinen mit aerosolgenerierenden Prozeduren (AGP). Hierfür gibt es jedoch kaum Daten, insbesondere für den ambulanten Versorgungssektor. Ziel dieser Studie war es, die Häufigkeit sowie potenzielle Risikofaktoren für SARS-CoV-2-Infektionen bei medizinischem Personal von aerosolgenerierenden Disziplinen zu erheben und zu identifizieren.

Methoden Zwischen dem 16.12.2020 und 24.01.2021 wurde eine bundesweite Umfrage in den Disziplinen der gastrointestinalen Endoskopie (GIE); Hals-, Nasen-, Ohrenheilkunde (HNO); Mund-, Kiefer-, Gesichtschirurgie (MKG) und der Zahn-, Mund-, Kieferheilkunde (ZMK) durchgeführt. Hierbei wurden Daten zu SARS-CoV-2-Infektionen beim medizinischen Personal sowie potenzielle Risikofaktoren erfasst.

Ergebnisse 25113 Beschäftigte in 2070 Einrichtungen wurden in die Studie eingeschlossen. Die Gesamtinfektionsrate unter dem medizinischen Personal betrug 4,7 %. Die multivariate Analyse zeigte, dass Regionen mit höheren Inzidenzraten ein deutlich erhöhtes Infektionsrisiko aufwiesen. Außerdem war das Infektionsrisiko in Krankenhäusern und bei Beschäftigten der GIE um mehr als das Zweifache erhöht (OR 2,63; p<0,01 und OR 2,35; p<0,01). Ein tendenziell erhöhtes Infektionsrisiko bestand in Einrichtungen, die bestätigte SARS-CoV-2-Fälle behandelt haben (OR 1,39; p=0,068).

Fazit Das SARS-CoV-2-Infektionsrisiko für medizinisches Personal wird sowohl von Faktoren innerhalb als auch Faktoren außerhalb von medizinischen Einrichtungen bestimmt. Die Fachrichtung der GIE sowie die Tätigkeit in einem Krankenhaus beeinflussen signifikant die Infektionsraten. Eine höhere SARS-CoV-2-Inzidenzrate in der Region geht ebenfalls mit einem signifikant erhöhten Infektionsrisiko einher.

Schlüsselwörter

Aerosol-generating procedures - SARS-CoV-2 - Prevalence - endoscopy - risk factors - COVID-19

Keywords

aerosol-generating procedures - SARS-CoV-2 infection prevalence - pre-interventional testing - gastro-enterological endoscopy - COVID-19 incidence

• References

• 1 Center JHCR. COVID-19 Map. 2020 https://coronavirus.jhu.edu/map.html
• 2 Kambhampati AK, OʼHalloran AC, Whitaker M. et al. COVID-19-Associated Hospitalizations Among Health Care Personnel – COVID-NET, 13 States, March 1-May 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1576-1583
• 3 Çelebi G, Pişkin N, Çelik Bekleviç A. et al. Specific risk factors for SARS-CoV-2 transmission among health care workers in a university hospital. Am J Infect Control 2020; 48: 1225-1230
• 4 Jespersen S, Mikkelsen S, Greve T. et al. SARS-CoV-2 seroprevalence survey among 17971 healthcare and administrative personnel at hospitals, pre-hospital services, and specialist practitioners in the Central Denmark Region. Clin Infect Dis 2020;
• 5 Wachtler BN, Neuhauser H, Haller S. et al. The risk of infection with SARS-CoV-2 among healthcare workers during the pandemic. Findings of a nationwide seroepidemiological Study in Germany. Dtsch Arztebl Int 2021;
• 6 Bahl P, Doolan C, de Silva C. et al. Airborne or droplet precautions for health workers treating COVID-19?. J Infect Dis 2020; 225: 1561-1568
• 7 Robert Koch-Institut: SurvStat@RKI 2.0. https://survstat.rki.de
• 8 (Destatis) SB. 2021 https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Bevoelkerungsstand/Tabellen/bevoelkerung-nichtdeutsch-laender.html
• 9 Garcia-Basteiro AL, Moncunill G, Tortajada M. et al. Seroprevalence of antibodies against SARS-CoV-2 among health care workers in a large Spanish reference hospital. Nature Communications 2020; 11
• 10 Rudberg AS, Havervall S, Månberg A. et al. SARS-CoV-2 exposure, symptoms and seroprevalence in healthcare workers in Sweden. Nat Commun 2020; 11: 5064
• 11 Brehm TT, Schwinge D, Lampalzer S. et al. Seroprevalence of SARS-CoV-2 antibodies among hospital workers in a German tertiary care center: A sequential follow-up study. Int J Hyg Environ Health 2021; 232: 113671
• 12 Korth J, Wilde B, Dolff S. et al. SARS-CoV-2-specific antibody detection in healthcare workers in Germany with direct contact to COVID-19 patients. J Clin Virol 2020; 128: 104437
• 13 Gomez-Ochoa SA, Franco OH, Rojas LZ. et al. COVID-19 in Health-Care Workers: A Living Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes. Am J Epidemiol 2021; 190: 161-175
• 14 Poletti P, Tirani M, Cereda D. et al. Seroprevalence of and Risk Factors Associated With SARS-CoV-2 Infection in Health Care Workers During the Early COVID-19 Pandemic in Italy. JAMA Netw Open 2021; 4: e2115699
• 15 Kumar Goenka M, Bharat Shah B, Goenka U. et al. COVID-19 prevalence among healthcare workers of Gastroenterology department: An audit from a tertiary-care hospital in India. JGH Open 2021; 5: 56-63
• 16 Jungo S, Moreau N, Mazevet ME. et al. Prevalence and risk indicators of first-wave COVID-19 among oral healthcare workers: A French epidemiological survey. PLOS ONE 2021; 16: e0246586
• 17 COVID-19 Datenhub: RKI Corona Bundesländer. https://npgeo-corona-npgeo-de.hub.arcgis.com/datasets/ef4b445a53c1406892257fe63129a8ea_0/explore?location=51.164254%2C8.127781%2C6.78&showTable=true
• 18 Gao Z, Xu Y, Sun C. et al. A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect 2021; 54: 12-16
• 19 Zhao H, Lu X, Deng Y. et al. COVID-19: Asymptomatic carrier transmission is an underestimated problem. Epidemiology and Infection 2020; 148: E116
• 20 e.V. D. COVID-19 Dunkelzifferradar. 2021 https://covid19.dunkelzifferradar.de/
• 21 Liu Z, Magal P, Webb G. Predicting the number of reported and unreported cases for the COVID-19 epidemics in China, South Korea, Italy, France, Germany and United Kingdom. J Theor Biol 2021; 509: 110501
• 22 Dashboard Gutenberg COVID-19 Studie. https://www.unimedizin-mainz.de/GCS/dashboard/#/app/pages/AktuelleErgebnisse/ergebnisse
• 23 Repici A, Pace F, Gabbiadini R. et al. Endoscopy Units and the Coronavirus Disease 2019 Outbreak: A Multicenter Experience From Italy. Gastroenterology 2020; 159: 363-366.e3
• 24 Repici A, Maselli R, Colombo M. et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointestinal Endoscopy 2020; 92: 192-197
• 25 Tang JW, Li Y, Eames I. et al. Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises. J Hosp Infect 2006; 64: 100-114
• 26 D’Amico F, Baumgart DC, Danese S. et al. Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management. Clin Gastroenterol Hepatol 2020; 18: 1663-1672
• 27 Holtermüller KH, Ebener B, Kühl HJ. et al. Stress ulcerations: pathogenesis and prevention. Z Gastroenterol 1983; 21: 88-100
• 28 Finkenzeller T, Faltlhauser A, Dietl KH. et al. SARS-CoV-2 antibodies in ICU and clinic staff : From Germany's region with the highest infection rate. Med Klin Intensivmed Notfmed 2020; 115: 139-145
• 29 Bahrs C, Kimmig A, Weis S. et al. Seroprevalence of SARS CoV-2 antibodies in healthcare workers and administration employees: a prospective surveillance study at a 1400-bed university hospital in Germany. medRxiv 2020;
• 30 Weinberger T, Steffen J, Osterman A. et al. Prospective Longitudinal Serosurvey of Health Care Workers in the First Wave of the SARS-CoV-2 Pandemic in a Quaternary Care Hospital in Munich, Germany. Clin Infect Dis 2021;
• 31 Sultan S, Siddique SM, Altayar O. et al. AGA Institute Rapid Review and Recommendations on the Role of Pre-Procedure SARS-CoV-2 Testing and Endoscopy. Gastroenterology 2020; 159: 1935-1948.e5
• 32 Ebigbo A, Rommele C, Bartenschlager C. et al. Cost-effectiveness analysis of SARS-CoV-2 infection prevention strategies including pre-endoscopic virus testing and use of high risk personal protective equipment. Endoscopy 2021; 53: 156-161
• 33 Kahn MZS, Ebigbo A, Muzalyova A. et al. Ein Jahr COVID-19: Testung, Verwendung von Schutzausrüstung und Auswirkungen auf die Gastrointestinale Endoskopie in Deutschland. Zeitschrift für Gastroenterologie 2021;
• 34 Kahn M, Schuierer L, Bartenschlager C. et al. Performance of antigen testing for diagnosis of COVID-19: a direct comparison of a lateral flow device to nucleic acid amplification based tests. BMC Infect Dis 2021; 21: 798