Healthcare personnel exposure to COVID - 19: an observational study on quarantined positive workers

Main Article Content

Ivan Rubbi
Gianandrea Pasquinelli
Aura Brighenti
Marcella Fanelli
Patrizia Gualandi
Eleonora Nanni
Viviana D'Antoni
Cristina Fabbri

Keywords

COVID-19 infection, healthcare professionals, risk factors, infection prevention and control measures, Coronavirus 19 disease

Abstract

Background and aim of the study. COVID-19 is characterized by super spread events occurring in communities, e.g., hospitals. To limit virus diffusion among healthcare workers the use of personal protective equipment and screening tests are highly advised; also, isolation of virus positive professionals while monitoring their health condition is recommended. This study aims to assess, in a cohort of COVID-19 positive quarantined healthcare workers, the perceived source of infection and exposure risk as well as the clinical evolution of the disease through a surveillance interview. Methods. A retrospective observational study accounting 896 observations on 93 healthcare professionals tested positive for COVID-19. Data were collected from the Nursing and Technical Directorate of Romagna, Ravenna, Local Health Company, Italy. Results. 99.5% of the positive workers accepted phone interviews with management staff. 2.6% of workers were positive with increasing records in the specialist medical area. Nurses and social health professionals were mostly affected.  Patient exposure at a distance <1 m and a contact time > 2 hours was the first cause of positivity. In COVID-19 and territorial emergency departments, the first cause was the contact with colleagues. At the time of the infection, most of the staff wore a surgical mask. Cough, asthenia, fever, anosmia, dysgeusia, and rhinitis were common symptoms. Asymptomatic percentage was about 10%. The self-perceived physical condition was high (>7) and improved during the observation period. Conclusions. The diffusion rate of COVID-19 among healthcare workers is relatively low, probably due to the use of personal protective equipment. The distancing, also among colleagues, is a fundamental measure to reduce the possibility of infection. Symptoms are mild and can be controlled by surveillance measures. Constant contact with the organization is an essential strategy for promoting recovering of workers and reducing the spread of the virus within the healthcare organization.

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References

1. Callaway E. Time to use the p-word? Coronavirus enter dangerous new phase. Nature 2020; 579: 12.
2. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet 2020; 395: 1225 – 1228.
3. Worldometer COVID-19 Coronavirus Pandemic. 2020. https://www.worldometers.info/coronavirus/. Date last updated: 02 July 2020.
4. Civil protection. 2020. COVID-19 Situation Italy.
http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1. (Accessed on september 23, 2020)
5. Ferioli M, Cisternino C, Leo V, et al. Protecting healthcare workers from SARS-CoV-2 infection: practical indications. Eur Respir Rev 2020; 29: 200068.
6. Yu IT, Xie ZH, Tsoi KK, et al. Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others? Clin Infect Dis 2007; 44:
1017–1025.
7. Disposition of the Italian Minister of Health n. 5443. New indications and clarifications. http://www.trovanorme.salute.gov.it/norme/home. Date last
updated: 22 February 2020; date last accessed: 20 April 2020.
8. World Health Organization. 2020. Rational use of personnel protective equipment for coronavirus disease 2019 (COVID-19) Interim guidance.
https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf. Date last updated: 27 February; date last accessed:
20 April 2020.
9. World Health Organization. 2020. Advice on the use of masks in the community, during home care and in health care settings in the context of the novel
coronavirus (2019-nCoV) outbreak. Interim guidance. Date last updated: 19 March; date last accessed: 20 April 2020.
10. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020; 109: 102433.
11. Hui DS, Ip M, Tang JW, et al. Airflows around oxygen masks: a potential source of infection? Chest 2006; 130: 822–826.
12. Hui DS, Chow BK, Chu L. Exhaled air dispersion and removal is influenced by isolation room size and ventilation settings during oxygen delivery via nasal
cannula. Respirology 2011; 16: 1005–1013.
13. Hui DS, Chow BK, Chu L, et al. Exhaled air dispersion during coughing with and without wearing a surgical or N95 mask. PloS One 2012; 7: e50845.
14. Hui DS, Chan MT, Chow B. Aerosol dispersion during various respiratory therapies: a risk assessment model of nosocomial infection to health care workers.
Hong Kong Med J 2014; 20 Suppl. 4: 9–13.
15. Hui DS, Chow BK, Lo T, et al. Exhaled air dispersion during noninvasive ventilation via helmets and a total facemask. Chest 2015; 147: 1336–1343.
16. Tran K, Cimon K, Severn M, et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic
review. PloS 2012; 7: e35797.
17. World Health Organization. Infection prevention and control of epidemic and pandemic-prone acute respiratory infections in health care. Geneva: WHO
2014.
18. European Centre for Disease Prevention and Control. Personnel protective equipment (PPE) needs in healthcare settings for the care of patients with
suspected or confirmed 2019-nCoV. Stockholm: ECDC 2020.
19. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J
Anaesth 2020; 67: 568 – 576.
20. World Health Organization. 2020. Clinical management of severe acute respiratory infection (SARI) when Covid-19 disease is suspected. Interim guidance.
https://apps.who.int/iris/handle/10665/331446?show=full Date last updated: 13 March; date last accessed: 20 April 2020.
21. Seto WH, Tsang D, Yung RW, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute
respiratory syndrome (SARS). Lancet 2003; 361: 1519 – 1520.
22. Schwartz J, King CC, Yen MY. Protecting Health Care Workers during the COVID-19 Coronavirus Outbreak-Lessons from Taiwan’s SARS response. Clin Infect
Dis 2020; 71: 858 – 860.
23. Black JRM, Bailey C, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lanced 2020; 395: 1418 – 1420.
24. Liu M, He P, Liu HG, et al. Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43:
209-214.
25. Wilson NM, Norton A, Young FP, Collins DW. Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative
review. Anaesthesia 2020; 75:1086-1095.
26. Rowan NJ, Laffey JG. Challenges and solutions for addressing critical shortage of supply chain for personnel and protective equipment (PPE) arising from
Coronavirus disease (COVID19) pandemic - Case study from the Republic of Ireland. Sci Total Environ 2020; 725: 138532.
27. Yen MY, Lin YE, Lee CH, et al. Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among health care
workers. J Hosp Infect 2011; 77: 332-337.
28. Yen MY, Schwartz J, Wu JSJ, Hsueh PR. Controlling MERS: Lesson Learned from SARS. Clin Infect Dis 2015; 61: 1761-1762.
29. Su TP, Lien TC, Yang CY, et al. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during
outbreak: A prospective and periodic assessment study in Taiwan. J Psychiatr Res, 2007; 41: 119-130.
30. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCOV infection from an asymptomatic contact in Germany. N Engl J Med 2020; 382: 970-971.
31. Baetting SJ, Parini A, Cardona I, Morand GB. Case series of coronavirus (SARS-CoV-2) in a military recruit school: clinical, sanitary and logistical implications.
BMJ Mil Health 2020; april 16.
32. Vandenbrouckel JP, von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and
elaboration. PLoS Med 2007; 4: 1628-1655.
33. 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
Revew. Ann Intern Med 2020; 173; 120-136.
34. World Health Organization. 2020d. Protocol for assessment of potential risk factors for 2019-novel coronavirus (2019-nCoV) infection among health care
workers in a health care setting. https://www.who.int/publications-detail/protocol-for-assessment-of-potential-risk-factors-for-2019-novel-coronavirus-
(2019-ncov)-infection-among-health-care-workers-in-a-health-care-setting Date last updated: 25 January; date last accessed: 24 April 2020.
35. Kim AY, Hirsch MS, Bloom A 2020. Coronavirus disease 2019 (COVID-19): Management in adults. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.
(Accessed on April 21, 2020.)
36. Tara N, Sexton DJ, Bloom A, Mitty J 2020. Coronavirus disease 2019 (COVID-19): Infection control in health care and home settings. In: UpToDate, Post TW
(Ed), UpToDate, Waltham, MA. (Accessed on April 21, 2020).
37. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive
study. Lancet 2020; 395: 507-513.
38. Guo YR, Cao QD, Hong ZS. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil
Med Res 2020; 7: 11.
39. Hormati A, Shahhamzeh A, Afifian M, et al. Can COVID-19 present unusual GI symptoms? Journal of Microbiology, Immunology and Infection 2020; 53: 384-
385.
40. Mclntosh K, Hirsch S, Bloom A 2020. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical features, diagnosis, and prevention. In:
UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on April 21, 2020).
41. Scarpa N, Sghedoni D, Rosa V. COVID-19, la malattia da nuovo coronavirus (SARS-CoV-2). Quesiti clinici 2020; 11: 1-50.
42. Horowitz RI, Freeman PR. Three novel prevention, diagnostic, and treatment options for COVID-19 urgently necessitating controlled randomized trials. Med
Hypotheses 2020; 143: 109851.
43. Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect 2020; 205:
100-101.
44. Chew NWS, Lee GKH, Benjamin YQT, Jing M, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms
amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun 2020; 88: 559-565.
45. World Health Organization. 2020. Clinical management of severe acute respiratory infection (SARI) when Covid-19 disease is suspected. Interim guidance.
https://apps.who.int/iris/handle/10665/331446?show=full Date last accessed: 30 March 2020; date last accessed: 24 april 2020.
46. Lai X, Wang M, Qin C, Tan L, Ran L, Chen D, Zhang H, Shang K, Xia C, Wang S, Xu S, Wang W. Coronavirus disease 2019 (COVID-2019) infection among health
care workers and implications for prevention measures in a tertiary hospital in Wuhan, China. JAMA Netw Open 2020; 3: e209666.
47. Jin YH, Huang Q, Wang YY, Zeng XT, Luo LS, et al. Perceived infection transmission routes, infection control practices, psychosocial changes, and
management of COVID-19 infected healthcare workers in a tertiary acute care hospital in Wuhan: a crosssectional survey. Mil Med Res 2020; 7: 24.
48. Huang J, Nie S, Wei S. Reflections on the present response to the pneumonia associated with a novel coronavirus (2019-nCov). New Med 2020; 30: 10-3.
49. Röhr S, Müller F, Jung F, Apfelbacher C, Seidler A, Riedel-Heller SG. Psychosoziale Folgen von Quarantänemaßnahmen bei schwerwiegenden Coronavirus-
Ausbrüchen: ein Rapid Review. Psychiatr Prax 2020; 47: 179-189.
50. Shahid Z, Kalayanamitra R, McClafferty B, Kepko D, Ramgobin D, Patel R, Aggarwal CS, Vunnam R, Sahu N, Bhatt D, Jones K, Golamari R, Jain R. COVID-19 and
Older Adults: What we know. J Am Geriatr Soc 2020; 68: 926-929.
51. Nanshan C, Zhou M, Dong X, Qu J, Gong F, et al. Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Coronavirus Pneumonia in Wuhan,
China: A Descriptive Study. Lancet 2020; 395: 507–513.
52. Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, Zhang HY, Sun W, Wang, Y. COVID-19 Patients' Clinical Characteristics, Discharge Rate, and Fatality
Rate of Meta-Analysis. J Med Virol 2020; 92: 577-583.
53. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-
to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol 2020; 277: 2251-2261.
54. Klopfenstein T, Kadiane-Oussou NJ, Toko L, Royer PY, Lepiller Q, Gendrin V, et al. Features of anosmia in COVID-19. Med Mal Infect 2020; 50: 436-439.
55. Zayet S, N’dri Juliette KO, Royer PY, Toko L, Gendrin V, Klopfenstein T. Coronavirus disease 2019: new things to know! J Med Virol 2020; april 13.
56. Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, Ma H, Chen W, Lin Y, Zheng Y, Wang J, Hu Z, Yi Y, Shen H. Clinical Characteristics of 24 Asymptomatic Infections With
COVID-19 Screened Among Close Contacts in Nanjing, China. Sci China Life Sci 2020; 63: 706-711.
57. Cheng X, Liu J, Li N, Nisenbaum E, Sun Q, Chen B, Casiano R, Weed D, Telischi F, Denneny JC, Liu X, Shu Y. Otolaryngology Providers Must Be Alert for
Patients With Mild and Asymptomatic COVID-19. Otolaryngol Head Neck Surg 2020; 162: 809-810.

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