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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 29-32

Epidemiological characteristics of COVID-19-positive health-care personnel and their workplace contacts at a tertiary care hospital


Department of Community Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Date of Submission24-Nov-2020
Date of Decision09-Jan-2021
Date of Acceptance02-Feb-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Uroosa Farooq Allaqband
Department of Community Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_82_20

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  Abstract 


Background: Health care personnel (HCP) are at risk for nosocomial acquisition of severe acute respiratory syndrome-COV 2 from the exposure to infected patients and co-workers.
Aim and Objective: This study was done to assess the epidemiological characteristics of HCP with COVID-19 and their workplace contacts.
Methodology: This is a cross-sectional study done from April to July 2020. Data were collected telephonically from the cases, whereas the data from contacts were collected by both face-to-face interview and telephonically. A total of 125 cases and their 552 workplace contacts were included in the study.
Results: Majority of study participants were symptomatic, young males with majority reporting exposure within the health facility.
Conclusion: Ensuring workplace safety and adequate availability of personal protective equipment and sanitizers are the responsibility which every HC facility has to take care of COVID-19, health-care.

Keywords: Contact tracing, COVID-19, health-care personnel, workplace contacts


How to cite this article:
Fazili AB, Qadri SH, Allaqband UF, Shah Rj, Shah SM, Parray JA. Epidemiological characteristics of COVID-19-positive health-care personnel and their workplace contacts at a tertiary care hospital. J Curr Res Sci Med 2021;7:29-32

How to cite this URL:
Fazili AB, Qadri SH, Allaqband UF, Shah Rj, Shah SM, Parray JA. Epidemiological characteristics of COVID-19-positive health-care personnel and their workplace contacts at a tertiary care hospital. J Curr Res Sci Med [serial online] 2021 [cited 2021 Dec 5];7:29-32. Available from: https://www.jcrsmed.org/text.asp?2021/7/1/29/320510




  Introduction Top


Contact tracing, a key public health response to infectious disease outbreak, when used in combination with the quarantine and potential testing of contacts is considered as a highly effective and robust strategy for successfully controlling the transmission. Contact tracing deals with finding unreported infected people by tracing back who could have possibly caught the disease from a verified case. To be more precise, we can say contact tracing is an intervention where an index case with confirmed infection is asked to provide information about persons with whom he was in contact and were at risk of acquiring infection from the index case within a given time period before the positive test result. These contacts are then traced, informed about their risk, quarantined and tested, if needed as per the protocol. The main advantage of contact tracing is that it can identify potentially infected individuals before severe symptoms emerge, and if conducted properly, in a time-based manner can prevent onward transmission from the secondary cases.[1] Health-care personnel (HCP) face high risks of contracting infection because of factors such as inadequate personal protective equipment (PPE), work overload, and insufficient diagnostic testing. Besides, HCP are at risk for nosocomial acquisition of severe acute respiratory syndrome (SARS)-Cov 2 from the exposure to infected patients and co-workers. This is due to large amounts of time they spend interacting with patients and their co-workers.[2],[3] A study has shown that HCP experience contact with 14–18 persons in a typical work shift in a general ward, with nurses having the longest duration of physical contact with patients.[4] Similarly, in a recent study, nearly half of HCP were exposed to another HCP with COVID-19.[5] As contacts in health-care settings tend to be close, any exposure to an infectious patient requires immediate contact tracing. Failure to identify potentially exposed contacts puts other patients and co-workers at greater risk of infection.[6] More research is needed to understand the factors that contribute to infection in HCP. With this background, this study was done to assess and evaluate the epidemiological factors of HCP with COVID-19 and their contacts at a tertiary care hospital.


  Methodology Top


This study is a cross-sectional study carried from April 2020 to July 2020. Sheri-Kashmir Institute of Medical Sciences is a Premier Tertiary Care Institute of Kashmir and was actively involved in the management of COVID-19 cases. A total of 125 HCP of the institute contracted the infection during the study period. The responsibility of contact tracing of these HCP was given to the department of community medicine. As soon as a HCP came positive, case was reported to our department and a team from the department then would go for meticulous contact tracing. Since case was immediately sent for isolation either in home or hospital itself, team used to approach the case telephonically and elicit all relevant information. Information from the contacts was elicited mainly by interviewing in person and telephonically where face-to-face interview was not feasible. Preformed structured questionnaire was used to collect the information regarding sociodemographic characteristics, and risk assessment was done as per the guidelines to categorize contacts as high- and low-risk contacts. All COVID-19 positive HCP and their contacts were included in the study. Data so collected were compiled and analyzed using the SPSS software version 20.


  Results Top


[Table 1] shows the complete contact tracing details; during the study period, computed tomography of 513 COVID-19-positive cases was done which included 125 hospital staff. HCP were in total having 928 number of contacts among which 552 were their workplace contacts and rest were household contacts.
Table 1: Contact tracing details

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[Table 2] depicts sociodemographic characteristics of cases in which 60% of cases were in the age group of 20–39 years, 73.6% were males, 56.8% were from urban area, 37.6% were from medicine and allied departments, and 46.4% were doctors. Majority was infected in hospital and was symptomatic (76% and 84.8%, respectively).
Table 2: Sociodemographic characteristics of Covid-positive health-care personnel cases (n=125)

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[Table 3] depicts sociodemographic characteristics of workplace contacts in which majority of contacts were in the age group of 30–59 years (89.7%), almost half (51%) of contacts were male, 60% of contacts belong to medical and allied department, 42% were paramedics followed by doctors 36.2%, 48% of contacts were exposed to infection due to sharing of workplace followed by 26.3% had given I/V medication, 12.5% had examined the patients, and 10.4% had shared lunch. Only 10% of contacts were symptomatic. Majority (66%) used appropriate PPE. 54.7% were high-risk contacts .Only 38.7% have gone for testing against COVID-19 and 24.4% came out positive.
Table 3: Sociodemographic characteristics of workplace contacts (n=552) of Covid-positive health-care personnel

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Among COVID-19 positive work place contacts only 63.5% were high risk contacts and only 11.5% were symptomatic positive contacts [Table 4].
Table 4: Details of Covid-positive workplace contacts

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  Discussion Top


HCP are crucial to any health-care system. In the current COVID-19 scenario, HCP are at an increased risk of contracting SARS-COV 2 infection which can create a vicious cycle with patients infecting HCP and vice versa, which in turn can prove catastrophic to overall patient care. Early detection of COVID-19 in HCP is therefore crucial for community health and same can be achieved by a meticulously done contact tracing. This study is an attempt to provide an insight into COVID-19 epidemiology of HCP and their workplace contacts during the acute phase of pandemic at a tertiary care hospital.

Among HCP COVID-positive cases, 102 (81.6%) were below 50 years of age. Similar finding was seen in a study[7] by Michelle Hughes. Majority (73.6) were males which are in contrast to few other studies where majority were females.[7],[8] Since the work force predominantly at this tertiary care institute is of male gender so majority of infected personnel were also males. More than half (53.6%) of HCP comprised of paramedics and supportive staff which is consistent with a study by Magnavita et al.[8] where 66% cases belonged to paramedical and other staff. Majority (76%) reported hospital as place of exposure; similar finding was seen in Michelle Hughes study.[7] Although most of HCPs in this study had acquired infection through work place exposure, household (19.2%) and community (4.8%) transmission is also a concern. 84.8% of cases were symptomatic which is consistent with studies by Nicola and Michelle.[7],[8] The presence of 15.2% of asymptomatic infected HCPs signifies screening of all workers who have had contact even if they are asymptomatic. Otherwise these asymptomatic if not detected can lead to prolongation of transmission chain with more and more HCPs and patients in health care facility getting infected.

Workplace contact was defined as the exposure to a COVID-19 HCW within the health care facility. High-risk contact was defined as a contact of more than 15 min within a distance of <2 m with a HCW with COVID-19 without wearing the complete PPE. Total work place contacts of the COVID-19 positive HCWs were 552 and almost 80% were below the age of 50 a finding similar to study by Helena C Maltezou.[5] Majority were males (51.1%). Involvement of young males mainly can be attributed to the fact that since the cases were also young males they would have more compatibility and contact with the same age groups and gender. 60.2% of workplace contacts were from the medicine and allied branches a finding consistent with a study by Helena.[5] In terms of HCP designation, paramedics accounted for most exposures (42%) a finding again consistent with the findings in a study by Helena[5] and can be attributed to their comparatively longer stay in wards. Majority of HCP were exposed either to a another HCP with COVID-19 (59.8%) or to a patient with COVID-19 (40.2%) almost similar to findings in yet another study (Helena).[5] Only 10% of workplace contacts were symptomatic, while in Helena et al.'s study, 22.2% were found asymptomatic. 54.7% were assessed as high risk contacts, but testing was done only in 38.6% of contacts among which almost 25% came positive. This is a high percentage compared to other study where only 4.8% tested positive.[5] This may be due to the fact that in that study, they have categorized contacts as per high, moderate, or low exposure while we only categorized them as high-risk and low-risk contacts which gave us a higher no. of positive cases in contacts that were tested for COVID-19. It is possible that inappropriate wearing of PPE (34%) accounted for the COVID-19 cases among the workplace contacts.

Out of 52 workplace contacts that turned positive, 88.5% were asymptomatic again highlighting the importance of contact tracing and aggressive testing of all contacts irrespective of presence or absence of symptoms. Again 36.5 positive workplace contacts were in low-risk category, thereby depicting that low-risk contacts do not mean no risk contacts and therefore equal emphasis must be given for low-risk contacts as they are potential source for transmitting the disease.

In conclusion, this study provides an insight on dynamics of COVID-19 in HCP and their work place contacts. Clear strategies to support and manage infected and exposed HCP are integral to repose trust in staff and to ensure effective staff management. These strategies should focus on risk assessment and risk reduction of HCP and monitoring and surveillance at health care facilities. Infection prevention and control measures (IPC) include rigorous cleaning and disinfection to reduce environmental contamination, isolating the infected personnel, and diligent contact tracing of exposed ones. Improving surveillance through regular reporting is essential for monitoring the impact of IPC measures. At the same time, training of HCP on preventive measures including hand hygiene and appropriate donning and doffing of PPE is a reassuring strategy to reduce the transmission in the HC setting. Ensuring adequate availability of PPE, sanitizers and workplace safety is the responsibility which every HC facility has to take care of religiously.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Keeling MJ, Hollingsworth TD, Read JM. The efficacy of contact tracing for the containment of the 2019 novel corona virus (COVID-19). J Epidemeiol Community Health 2020;74:861-6.  Back to cited text no. 1
    
2.
Kuster SP, Shah PS, Coleman BL, Lam PP, Tong A, Wormsbecker A, et al. Incidence of influenza in healthy adults and healthcare workers: A systematic review and meta-analysis. PLoS One 2011;6:e26239.  Back to cited text no. 2
    
3.
Lowery-North DW, Hertzberg VS, Elon L, Cotsonis G, Hilton SA, Vaughns CF 2nd, et al. Measuring social contacts in the emergency department. PLoS One 2013;8:e70854.  Back to cited text no. 3
    
4.
Jiang L, Ng HL, Ho HJ, Leo YS, Prem K, Cook AR, et al. Contacts of healthcare workers, patients and visitors in general wards in Singapore. Epidemiol Infect 2017;145:3085-95.  Back to cited text no. 4
    
5.
Maltezou HC, Dedoukou X, Tseroni M, Tsonou E, Raftopoulos V, Papadima K, et al. SARS-CoV-2 infection in healthcare personnel with high-risk occupational exposure: evaluation of seven-day exclusion from work policy. Clin Infect Dis 2020;71:3182-7.  Back to cited text no. 5
    
6.
Drumright LN, Holmes AH. Monitoring major illness in health care workers and hospital staff. Clin Infect Dis 2011;53:284-6.  Back to cited text no. 6
    
7.
Hughes MM, Luckhaupt SE. Characteristics of health care personnel with Covid-19 – United States, 2020;69:477-481.  Back to cited text no. 7
    
8.
Magnavita N, Tripepi G, Di Prinzio RR. Symptoms in Health Care Workers during the COVID-19 Epidemic. A Cross-Sectional Survey. Int J Environ Res Public Health 2020;17:5218.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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