Transmission and Risk Factors of COVID-19 among Health Care Workers

Majdi R.M. Alghader; Damaskini Valvi; Rafael E. de la Hoz

doi:10.1055/s-0043-1766118

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

Semin Respir Crit Care Med 2023; 44(03): 340-348
DOI: 10.1055/s-0043-1766118

Review Article

Transmission and Risk Factors of COVID-19 among Health Care Workers

Autor*innen

Majdi R.M. Alghader

¹Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
Damaskini Valvi

¹Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
Rafael E. de la Hoz

¹Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York

Abstract

Coronavirus disease 2019 (COVID-19) poses a significant occupational risk factor to health care workers (HCWs). As in previous events, this occupational risk amplifies and compounds the adverse impact of the pandemic. We conducted a narrative review summarizing risk factors associated with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) transmission in HCWs. We searched for original observational studies (including case-control, cross-sectional, prospective and retrospective cohorts) using PubMed, Scopus, and Google Scholar. A total of 22 articles were reviewed, including eligible English articles published between April 2020 and May 2022. Job category, work environment, personal protective equipment (PPE) noncompliance, lack of PPE awareness and training, unvaccinated status, and competing community and household exposures were identified as risk factors for SARS-CoV-2 transmission among HCWs. Effective measures to protect HCWs from SARS-CoV-2 need to account for the identified occupational risk factors. Identifying and understanding COVID-19 risk factors among HCWs must be considered a public health priority for policy makers to mitigate occupational and community transmission in current and future epidemics.

Keywords

COVID-19 - occupational health - occupational exposure - SARS-CoV-2 transmission - occupational risk factor - health care worker

Volltext

Referenzen

References
1 Zhou P, Yang X-L, Wang X-G. et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579 (7798): 270-273
2 World Health Organization (WHO). COVID-19 Weekly Epidemiological Update Edition 69. Geneva, Switzerland: World Health Organization (WHO); 2021
3 Occupational Safety and Health Administration. US Department of Labor. Accessed November 5, 2022 at: https://www.osha.gov/healthcare#:~:text=They%20include%20bloodborne%20pathogens%20and,material%20and%20x%2Dray%20hazards 2021
4 Chou R, Dana T, Buckley DI, Selph S, Fu R, Totten AM. Epidemiology of and risk factors for coronavirus infection in health care workers: a living rapid review. Ann Intern Med 2020; 173 (02) 120-136
5 Health and care worker deaths during COVID-19. World Health Organization. Accessed March 14, 2023 at: https://www.who.int/news/item/20-10-2021-health-and-care-worker-deaths-during-covid-19
6 Mutambudzi M, Niedwiedz C, Macdonald EB. et al. Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants. Occup Environ Med 2020; 78 (05) 307-314
7 Zhang M. Estimation of differential occupational risk of COVID-19 by comparing risk factors with case data by occupational group. Am J Ind Med 2021; 64 (01) 39-47
8 World Health Organization (WHO). COVID-19 Strategy Update. 2020. Accessed September 25, 2021 at: https://www.who.int/publications/m/item/covid-19-strategy-update
9 Szajek K, Fleisch F, Hutter S. et al; AMICO Study Group. Healthcare institutions' recommendation regarding the use of FFP-2 masks and SARS-CoV-2 seropositivity among healthcare workers: a multicenter longitudinal cohort study. Antimicrob Resist Infect Control 2022; 11 (01) 6
10 Pagheh AS, Asghari A, Abrari Romenjan K. et al. Seroprevalence of SARS-COV-2 antibodies among health-care workers exposed to COVID-19 patients in a large reference hospital, Iran. Iran J Microbiol 2022; 14 (02) 138-144
11 Alishaq M, Nafady-Hego H, Jeremijenko A. et al. Risk factors for breakthrough SARS-CoV-2 infection in vaccinated healthcare workers. PLoS One 2021; 16 (10) e0258820
12 Baker JM, Nelson KN, Overton E. et al. Quantification of occupational and community risk factors for SARS-CoV-2 seropositivity among healthcare workers in a large US healthcare system. Ann Intern Med 2021; 174 (05) 649-654
13 Lustig Y, Sapir E, Regev-Yochay G. et al. BNT162b2 COVID-19 vaccine and correlates of humoral immune responses and dynamics: a prospective, single-centre, longitudinal cohort study in health-care workers. Lancet Respir Med 2021; 9 (09) 999-1009
14 Venugopal U, Jilani N, Rabah S. et al. SARS-CoV-2 seroprevalence among health care workers in a New York City hospital: a cross-sectional analysis during the COVID-19 pandemic. Int J Infect Dis 2021; 102: 63-69
15 Scohy A, Gruson D, Simon A. et al. Seroprevalence of SARS-CoV-2 infection in health care workers of a teaching hospital in Belgium: self-reported occupational and household risk factors for seropositivity. Diagn Microbiol Infect Dis 2021; 100 (04) 115414
16 Akinbami LJ, Vuong N, Petersen LR. et al. SARS-CoV-2 seroprevalence among healthcare, first response, and public safety personnel, Detroit Metropolitan Area, Michigan, USA, May-June 2020. Emerg Infect Dis 2020; 26 (12) 2863-2871
17 Jungo S, Moreau N, Mazevet ME. et al. Prevalence and risk indicators of first-wave COVID-19 among oral health-care workers: a French epidemiological survey. PLoS One 2021; 16 (02) e0246586
18 Ashinyo ME, Dubik SD, Duti V. et al. Healthcare workers exposure risk assessment: a survey among frontline workers in designated COVID-19 treatment centers in Ghana. J Prim Care Community Health 2020; 11: 2150132720969483
19 Shah ASV, Gribben C, Bishop J. et al. Effect of vaccination on transmission of SARS-CoV-2. N Engl J Med 2021; 385 (18) 1718-1720
20 Pawloski KR, Kolod B, Khan RF. et al. Factors associated with SARS-CoV-2 infection in physician trainees in New York City during the First COVID-19 wave. Int J Environ Res Public Health 2021; 18 (10) 5274
21 Terminology. Centers for Disease Control and Prevention. Accessed November 27, 2022 at: . Published October 2, 2019 https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/appendix/terminology.html
22 Basso P, Negro C, Cegolon L, Larese Filon F. Risk of vaccine breakthrough SARS-CoV-2 infection and associated factors in healthcare workers of Trieste Teaching Hospitals (North-Eastern Italy). Viruses 2022; 14 (02) 336
23 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 (07) e2115699
24 El-Boghdadly K, Wong DJN, Owen R. et al. Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study. Anaesthesia 2020; 75 (11) 1437-1447
25 Dev N, Meena RC, Gupta DK, Gupta N, Sankar J. Risk factors and frequency of COVID-19 among healthcare workers at a tertiary care centre in India: a case-control study. Trans R Soc Trop Med Hyg 2021; 115 (05) 551-556
26 Malhotra S, Mani K, Lodha R. et al. COVID-19 infection, and reinfection, and vaccine effectiveness against symptomatic infection among health care workers in the setting of omicron variant transmission in New Delhi, India. Lancet Reg Health Southeast Asia 2022; 3: 100023
27 Bergwerk M, Gonen T, Lustig Y. et al. Covid-19 breakthrough infections in vaccinated health care workers. N Engl J Med 2021; 385 (16) 1474-1484
28 Haegdorens F, Franck E, Smith P, Bruyneel A, Monsieurs KG, Van Bogaert P. Sufficient personal protective equipment training can reduce COVID-19 related symptoms in healthcare workers: a prospective cohort study. Int J Nurs Stud 2022; 126: 104132
29 Garg K, Grewal A, Mahajan R, Kumari S, Mahajan A. A cross-sectional study on knowledge, attitude, and practices of donning and doffing of personal protective equipment: an institutional survey of health-care staff during the COVID-19 pandemic. Anesth Essays Res 2020; 14 (03) 370-375
30 Angel Y, Spitzer A, Henig O. et al. Association between vaccination with BNT162b2 and incidence of symptomatic and asymptomatic SARS-CoV-2 infections among health care workers. JAMA 2021; 325 (24) 2457-2465
31 Emecen AN, Keskin S, Boncukcu Eren E. et al. Impact of social contacts on SARS-CoV-2 exposure among healthcare workers. Occup Med (Lond) 2022; 72 (01) 10-16
32 Korona-Głowniak I, Mielnik M, Podgajna M. et al. SARS-CoV-2 seroprevalence in healthcare workers before the vaccination in Poland: evolution from the first to the second pandemic outbreak. Int J Environ Res Public Health 2022; 19 (04) 2319
33 Klompas M, Baker M, Rhee C. What Is an aerosol-generating procedure?. JAMA Surg 2021; 156 (02) 113-114
34 Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7 (04) e35797
35 Keehner J, Horton LE, Pfeffer MA. et al. SARS-CoV-2 infection after vaccination in health care workers in California. N Engl J Med 2021; 384 (18) 1774-1775
36 Wundavalli L, Singh S, Singh AR, Satpathy S. How to rapidly design and operationalise PPE donning and doffing areas for a COVID-19 care facility: quality improvement initiative. BMJ Open Qual 2020; 9 (03) e001022
37 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 (10) 1225-1230
38 Kayı İ, Madran B, Keske Ş. et al. The seroprevalence of SARS-CoV-2 antibodies among health care workers before the era of vaccination: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27 (09) 1242-1249
39 Butt AA, Khan T, Yan P, Shaikh OS, Omer SB, Mayr F. Rate and risk factors for breakthrough SARS-CoV-2 infection after vaccination. J Infect 2021; 83 (02) 237-279
40 Eyre DW, Lumley SF, O'Donnell D. et al; Oxford University Hospitals Staff Testing Group. Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study. eLife 2020; 9: e60675
41 Takahashi T, Wong P, Ellingson MK. et al; Yale IMPACT research team. Sex differences in immune responses to SARS-CoV-2 that underlie disease outcomes. medRxiv 2020; 588: 315-320
42 Butt AA, Yan P, Shaikh OS, Mayr FB, Omer SB. Rate and risk factors for severe/critical disease among fully vaccinated persons with breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a high-risk national population. Clin Infect Dis 2022; 75 (01) e849-e856
43 Shrotri M, Navaratnam AMD, Nguyen V. et al; Virus Watch Collaborative. Spike-antibody waning after second dose of BNT162b2 or ChAdOx1. Lancet 2021; 398 (10298): 385-387
44 Levin EG, Lustig Y, Cohen C. et al. Waning immune humoral response to BNT162b2 Covid-19 vaccine over 6 months. N Engl J Med 2021; 385 (24) e84
45 Watanabe M, Balena A, Tuccinardi D. et al. Central obesity, smoking habit, and hypertension are associated with lower antibody titres in response to COVID-19 mRNA vaccine. Diabetes Metab Res Rev 2022; 38 (01) e3465
46 Shah ASV, Wood R, Gribben C. et al. Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study. BMJ 2020; 371: m3582
47 Foo CC, Goon AT, Leow YH, Goh CL. Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome–a descriptive study in Singapore. Contact Dermat 2006; 55 (05) 291-294
48 Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014. Contact Dermat 2016; 75 (04) 213-222
49 Elhadi M, Msherghi A, Alkeelani M. et al. Assessment of healthcare workers' levels of preparedness and awareness regarding COVID-19 infection in low-resource settings. Am J Trop Med Hyg 2020; 103 (02) 828-833
50 Gruell H, Vanshylla K, Tober-Lau P. et al. mRNA booster immunization elicits potent neutralizing serum activity against the SARS-CoV-2 Omicron variant. Nat Med 2022; 28 (03) 477-480
51 Hetemäki I, Kääriäinen S, Alho P. et al. An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) in a secondary care hospital in Finland, May 2021. Euro Surveill 2021; 26 (30) 2100636
52 Levine-Tiefenbrun M, Yelin I, Katz R. et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med 2021; 27 (05) 790-792
53 Liu C, Lee J, Ta C. et al. A retrospective analysis of COVID-19 mRNA vaccine breakthrough infections - risk factors and vaccine effectiveness. Health Inform. medRxiv [Preprint] 2021;
54 Lumley SF, Rodger G, Constantinides B. et al; Oxford University Hospitals Staff Testing Group. An observational cohort study on the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and B.1.1.7 variant infection in healthcare workers by antibody and vaccination status. Clin Infect Dis 2022; 74 (07) 1208-1219

Zusatzmaterial

Supplementary Material (XLS) (opens in new window)