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Talbot, Thomas R., Suzanne F. Bradley, Sara E. Cosgrove, Christian Ruef, Jane D. Siegel, and David J. Weber. "Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages." Infection Control & Hospital Epidemiology 26, no. 11 (November 2005): 882–90. http://dx.doi.org/10.1086/502512.
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AbstractInfluenza causes substantial morbidity and mortality annually, particularly in high-risk groups such as the elderly, young children, immunosuppressed individuals, and individuals with chronic illnesses. Healthcare-associated transmission of influenza contributes to this burden but is often under-recognized except in the setting of large outbreaks. The Centers for Disease Control and Prevention has recommended annual influenza vaccination for healthcare workers (HCWs) with direct patient contact since 1984 and for all HCWs since 1993. The rationale for these recommendations is to reduce the chance that HCWs serve as vectors for healthcare-associated influenza due to their close contact with high-risk patients and to enhance both HCW and patient safety. Despite these recommendations as well as the effectiveness of interventions designed to increase HCW vaccination rates, the percentage of HCWs vaccinated annually remains unacceptably low. Ironically, at the same time that campaigns have sought to increase HCW vaccination rates, vaccine shortages, such as the shortage during the 2004-2005 influenza season, present challenges regarding allocation of available vaccine supplies to both patients and HCWs. This two-part document outlines the position of the Society for Healthcare Epidemiology of America on influenza vaccination for HCWs and provides guidance for the allocation of influenza vaccine to HCWs during a vaccine shortage based on influenza transmission routes and the essential need for a practical and adaptive strategy for allocation. These recommendations apply to all types of healthcare facilities, including acute care hospitals, long-term-care facilities, and ambulatory care settings.
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Kim, Rachel, Sharon Nachman, Rafael Fernandes, Kristen Meyers, Maria Taylor, Debra LeBlanc, and Adam J. Singer. "Comparison of COVID-19 infections among healthcare workers and non-healthcare workers." PLOS ONE 15, no. 12 (December 9, 2020): e0241956. http://dx.doi.org/10.1371/journal.pone.0241956.
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Objectives Healthcare workers face distinct occupational challenges that affect their personal health, especially during a pandemic. In this study we compare the characteristics and outcomes of Covid-19 patients who are and who are not healthcare workers (HCW). Methods We retrospectively analyzed a cohort of 2,842 adult patients with known HCW status and a positive SARS-CoV-2 RT-PCR test presenting to a large academic medical center emergency department (ED) in New York State from March 21 2020 through June 2020. Early in the pandemic we instituted a policy to collect data on patient occupation and exposures to suspected Covid-19. The primary outcome was hospital admission. Secondary outcomes were ICU admission, need for invasive mechanical ventilation (IMV), and mortality. We compared baseline characteristics and outcomes of Covid-19 adult patients based on whether they were or were not HCW using univariable and multivariable analyses. Results Of 2,842 adult patients (mean age 53+/-19 years, 53% male) 193 (6.8%) were HCWs and 2,649 (93.2%) were not HCWs. Compared with non-HCW, HCWs were younger (43 vs 53 years, P<0.001), more likely female (118/193 [61%] vs 1211/2649 [46%], P<0.001), and more likely to have a known Covid-19 exposure (161/193 [83%] vs 946/2649 [36%], P<0.001), but had fewer comorbidities. On presentation to the ED, HCW also had lower frequencies of tachypnea (12/193 [6%] vs 426/2649 [16%], P<0.01), hypoxemia (15/193 [8%] vs 564/2649 [21%], P<0.01), bilateral opacities on imaging (38/193 [20%] vs 1189/2649 [45%], P<0.001), and lymphocytopenia (6/193 [3%] vs 532/2649 [20%], P<0.01) compared to non-HCWs. Direct discharges home from the ED were more frequent in HCW 154/193 (80%) vs 1275/2649 (48%) p<0.001). Hospital admissions (38/193 [20%] vs 1264/2694 [47%], P<0.001), ICU admissions (7/193 [3%] vs 321/2694 [12%], P<0.001), need for IMV (6/193 [3%] vs 321/2694 [12%], P<0.001) and mortality (2/193 [1%] vs 219/2694 [8%], P<0.01) were lower than among non-HCW. After controlling for age, sex, comorbidities, presenting vital signs and radiographic imaging, HCW were less likely to be admitted (OR 0.6, 95%CI 0.3–0.9) than non HCW. Conclusions Compared with non HCW, HCW with Covid-19 were younger, had less severe illness, and were less likely to be admitted.
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Ogunremi, Toju, Katherine Defalco, B. Lynn Johnston, Isabelle Boucoiran, Maureen Cividino, Blaine Cleghorn, Melody Ann Isinger, et al. "1208. Preventing Transmission of Bloodborne Viruses from-Infected Healthcare Workers to Patients in Canadian Healthcare Settings: A National Guideline." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S434. http://dx.doi.org/10.1093/ofid/ofz360.1071.
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Abstract Background Infectious agents, such as bloodborne viruses (BBVs), can potentially be transmitted from healthcare workers (HCWs) to patients. In an effort to reduce this risk to patients, this guideline, which provides a framework for policies on the management of HCWs infected with BBVs in Canada, was developed. Methods A total of six systematic reviews (1995–2016) were conducted to inform the risk of transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) from infected HCWs to patients and the infectivity of each virus related to source serum viral load. Three environmental scans were conducted to inform sections on disclosure of HCW’s serologic status, Expert Review Panels, and lookback investigations. Government partners and key stakeholder organizations were consulted and a Task Group provided technical expertise. Results The risk of HCW-to-patient BBV transmission is negligible, except during exposure-prone procedures where there is a risk of HCW injury and possible exposure of a patient’s open tissues to the HCW’s blood. Transmission rates were lowest with HIV and highest with HBV (Table 1). Rates varied with several factors including source viral load, nature of potential exposure, infection prevention and control breaches, susceptibility of exposed patient, and use of post-exposure prophylaxis where relevant. The extent of reporting bias for exposure incidents where transmission did not occur is unknown. Current antiviral therapy informed guideline recommendations, with viral load thresholds provided to assist treating physician, Expert Review Panels and regulatory authorities in determining a HCW’s fitness for practice. Conclusion Routine Practices (or Standard Precautions) are critical to prevent HCW-to-patient transmission of infections; including BBVs. Recommendations provided in this guideline aim to further reduce the already minimal risk of HCW-to-patient transmission. The guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations directly impacting clinical practice related to preventing and controlling healthcare-associated infections. Disclosures All authors: No reported disclosures.
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Apisarnthanarak, Anucha, Rungrueng Kitphati, Pranee Tawatsupha, Kanokporn Thongphubeth, Piyaporn Apisarnthanarak, and Linda M. Mundy. "Outbreak of Varicella-Zoster Virus Infection Among Thai Healthcare Workers." Infection Control & Hospital Epidemiology 28, no. 4 (April 2007): 430–34. http://dx.doi.org/10.1086/512639.
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Objective.To evaluate the correlation between self-report of a prior history of chickenpox and results of varicella-zoster virus (VZV) immunoglobulin (Ig) G serologic test results in an outbreak of VZV infection among Thai healthcare workers (HCWs) and to conduct a cost-benefit analysis of establishing routine VZV immunization as part of an occupational health program on the basis of the outbreak data.Methods.All exposed patients received prophylaxis and the HCWs in our 3 intensive care units (ICUs) were prospectively evaluated. HCWs were assessed for disease history and serologic evidence of VZV IgG. A cost-benefit analysis was performed.Results.After 140 HCWs and 18 ICU patients were exposed to VZV, 10 HCWs (7%) with active VZV infection were relieved from work until skin lesions were crusted. Acyclovir (ACV) was prescribed to all 10 HCWs with active disease, and all 18 exposed patients received prophylaxis with ACV. Of 140 HCWs, 100 consented to longitudinal follow-up. Twenty-three (100%) of the HCWs who reported a history of chickenpox also had serologic test results that were postive for VZV IgG, compared with 30 (39%) of 77 HCWs who reported no prior history of chickenpox, yet had test results that were positive for VZV IgG. Reported history of chickenpox had a sensitivity of 43%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 61% with respect to VZV infection immunity. The total cost estimate for this outbreak investigation was $23,087.Conclusions.An HCWs reported history of chickenpox was a reliable predictor of immunity; a report of no prior history of chickenpox was unreliable. Our cost-benefit analysis suggests that the costs of an occupational health program that included VZV surveillance and immunization for the next 323 HCWs would be approximately equal to the excess costs of $17,227 for the ACV therapy, HCW furloughs, and staff overtime associated with this outbreak.
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Shweta Dadarao Parwe, Avinash Sukhdeorao Ingle, Milind Abhimanyu Nisargandha, and Bharat Rathi. "Healthcare workers novel coronavirus (nCOVID 19) life-threatening situation during the pandemic." International Journal of Research in Pharmaceutical Sciences 11, SPL1 (November 17, 2020): 1222–25. http://dx.doi.org/10.26452/ijrps.v11ispl1.3600.
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Healthcare workers (HCWs) are the professional workers directly acquired infection during this coronavirus outbreak. Coronavirus potentially severe acute respiratory infection caused by nCOVID-19 has been declared by pandemic on 11th March 2020 by Word health organisation (WHO). The previous study has reported high susceptibility of respiratory infection in the HCWs. The HCWs are at increased risk for severe respiratory syndrome coronavirus infection. The spread of coronavirus became global public health event, threatening physical and Mental Health of HCWs. This study reviews the possible risk factors for being infected HCWs and avoid transmission of infection at the workplace. Spreading the coronavirus day by day is the life-threatening condition for Health care workers during a pandemic. The community should understand the HCW’s increased responsibility during this public health emergency and must provide the necessary social support as well. There should be enough protective and preventive measures for avoiding transmission in HCWs. Apart from heavy duties HCWs while using PPEs they also have physical and mental exhaustion along with the fear produced out of risk-specific exposures.
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Umegbolu, Emmanuel I., and Innocentia N. Ozoejike. "Management of solid healthcare wastes in some government healthcare facilities in Enugu state, Southeast Nigeria: a cross-sectional study." International Journal Of Community Medicine And Public Health 4, no. 11 (October 25, 2017): 4031. http://dx.doi.org/10.18203/2394-6040.ijcmph20174813.
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Background: The significance of healthcare wastes (HCWs) consists in their hazardous component, which constitutes real danger to public health. In Nigeria, healthcare waste management (HCWM) has remained a problem yet to be properly recognized and so addressed. The study aimed to sensitise health workers and the public on the need for proper management of HCWs, considering the public health implications of not doing so.Methods: The waste management systems of ten healthcare facilities (HCFs) were assessed, using a modification of the WHO rapid assessment tool. In each HCF, segregated wastes were collected daily for ten days and quantified by weighing, using a spring balance.Results: Administratively, the HCWM system was poor in the ten HCFs (40.6%). 70% of them had satisfactory waste segregation, 81%, good waste treatment, and 26.7% adequate transportation methods for waste. None of the HCFs had budget allocation for HCWM, and 90% had inadequate storage facilities. Mean waste generation was 1.81 kg/day, 0.23 kg/patient/day, 0.16 kg/bed/day, and proportion of infectious wastes 16.8%. Correlation between the number of patients and proportion of infectious waste, was positive, strong and significant (r=0.80, p=0.01), and between bed occupancy rate and proportion of infectious waste, was positive too, but weak, and insignificant (r=0.34, p=0.34).Conclusions: In view of the identified weaknesses of the ten HCFs in HCWM, budget allocations for HCWM, improving waste storage facilities and transportation, with strengthening of waste segregation, collection, and treatment, would help to ensure adequate HCWM in the HCFs.
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Corpora, LMSW, Miranda, Andres F. Leone, MD, and Elena Liggett, LISW-CP. "Burnout prevention pilot intervention for healthcare workers during COVID-19." Journal of Emergency Management 19, no. 9 (July 1, 2021): 117–20. http://dx.doi.org/10.5055/jem.0600.
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Background: Burnout is often prevalent among healthcare workers (HCWs) given the stressful nature of their work. COVID-19 has intensified HCW burnout, and little is known about burnout prevention interventions that may help alleviate HCW burnout during COVID-19.Methods: This study adopted a pre-experimental post-test only design. The sample (n = 53) was adult HCWs at a large metropolitan-area hospital. The intervention consisted of a memorial service that included music by a music therapist, chaplain support, and mindfulness-promoting provisions.Results: Results showed that 33.9 percent of participants reported currently feeling burned out and 98.1 percent of participants found the intervention helpful. Feedback from participants showed that they thoroughly appreciated the opportunity to pause and remember.Conclusion: Given the promising results of this pilot study, coupled with increased burden of the COVID-19 pandemic, burnout interventions for HCWs should be further explored.
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Apisarnthanarak, Anucha, Timothy M. Uyeki, Pilaipan Puthavathana, Rungrueng Kitphati, and Linda M. Mundy. "Reduction of Seasonal Influenza Transmission among Healthcare Workers in an Intensive Care Unit: A 4-Year Intervention Study in Thailand." Infection Control & Hospital Epidemiology 31, no. 10 (October 2010): 996–1003. http://dx.doi.org/10.1086/656565.
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Objective.To evaluate the feasibility and effectiveness of an influenza control bundle to minimize healthcare-associated seasonal influenza transmission among healthcare workers (HCWs) in an intensive care unit (ICU) equipped with central air conditioning.Methods.A quasi-experimental study was conducted in a 500-bed tertiary care center in Thailand from July 1, 2005, through June 30, 2009. The medical ICU (MICU) implemented an influenza control bundle including healthcare worker (HCW) education, influenza screening of adult community-acquired pneumonia patients, antiviral treatment of patients and ill HCWs who tested positive for influenza, promotion of influenza vaccination among HCWs, and reinforcement of standard infection control policies. The surgical ICU (SICU) and coronary care unit (CCU) received no intervention.Results.The numbers of influenza infections among HCWs during the pre- and postintervention periods were 18 cases in 5,294 HCW-days and 0 cases in 5,336 HCW-days in the MICU (3.4 vs 0 cases per 1,000 HCW-days; P < .001), 19 cases in 4,318 HCW-days and 20 cases in 4,348 HCW-days in the SICU (4.4 vs 4.6 cases per 1,000 HCW-days; P = .80), and 18 cases in 5,000 HCW-days and 18 cases in 5,143 HCW-days in the CCU (3.6 vs 3.5 cases per 1,000 HCW-days; P = .92), respectively. Outbreak-related influenza occurred in 7 MICU HCWs, 6 SICU HCWs, and 4 CCU HCWs before intervention and 0 MICU HCWs, 9 SICU HCWs, and 8 CCU HCWs after intervention. Before and after intervention, 25 (71%) and 35 (100%) of 35 MICU HCWs were vaccinated, respectively (P < .001); HCW vaccination coverage did not change significantly in the SICU (21 [70%] of 30 vs 24 [80%] of 30; P = .89) and CCU (19 [68%] of 28 vs 21 [75%] of 28; P = .83). The estimated costs of US $6,471 per unit for postintervention outbreak investigations exceeded the intervention costs of US $4,969.Conclusion.A sustained influenza intervention bundle was associated with clinical and economic benefits to a Thai hospital.
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Mirtskhulava, Veriko, Jennifer A. Whitaker, Maia Kipiani, Drew A. Harris, Nino Tabagari, Ashli A. Owen-Smith, Russell R. Kempker, and Henry M. Blumberg. "Determinants of Tuberculosis Infection Control–Related Behaviors Among Healthcare Workers in the Country of Georgia." Infection Control & Hospital Epidemiology 36, no. 5 (February 4, 2015): 522–28. http://dx.doi.org/10.1017/ice.2015.5.
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OBJECTIVETo better understand tuberculosis (TB) infection control (IC) in healthcare facilities (HCFs) in Georgia.DESIGNA cross-sectional evaluation of healthcare worker (HCW) knowledge, beliefs and behaviors toward TB IC measures including latent TB infection (LTBI) screening and treatment of HCWs.SETTINGGeorgia, a high-burden multidrug-resistant TB (MDR-TB) country.PARTICIPANTSHCWs from the National TB Program and affiliated HCFs.METHODSAn anonymous self-administered 55-question survey developed based on the Health Belief Model (HBM) conceptual framework.RESULTSIn total, 240 HCWs (48% physicians; 39% nurses) completed the survey. The overall average TB knowledge score was 61%. Only 60% of HCWs reported frequent use of respirators when in contact with TB patients. Only 52% of HCWs were willing to undergo annual LTBI screening; 48% were willing to undergo LTBI treatment. In multivariate analysis, HCWs who worried about acquiring MDR-TB infection (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.28–2.25), who thought screening contacts of TB cases is important (aOR, 3.4; 95% CI, 1.35–8.65), and who were physicians (aOR, 1.7; 95% CI, 1.08–2.60) were more likely to accept annual LTBI screening. With regard to LTBI treatment, HCWs who worked in an outpatient TB facility (aOR, 0.3; 95% CI, 0.11–0.58) or perceived a high personal risk of TB reinfection (aOR, 0.5; 95% CI, 0.37–0.64) were less likely to accept LTBI treatment.CONCLUSIONThe concern about TB reinfection is a major barrier to HCW acceptance of LTBI treatment. TB IC measures must be strengthened in parallel with or prior to the introduction of LTBI screening and treatment of HCWs.Infect Control Hosp Epidemiol 2015;00(0): 1–7
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Daskalaki, Irini, Patricia Hennessey, Robin Hubler, and Sarah S. Long. "Resource Consumption in the Infection Control Management of Pertussis Exposure Among Healthcare Workers in Pediatrics." Infection Control & Hospital Epidemiology 28, no. 4 (April 2007): 412–17. http://dx.doi.org/10.1086/513121.
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Objective.To assess consumption of resources in the infection control management of healthcare workers (HCWs) exposed to pertussis and to assess avoidability of exposure.Setting.Tertiary care children's medical center.Methods.Analysis of the extent of and reasons for HCW exposure to pertussis during contact with children with the disease, whether exposures were avoidable (because of the failure to recognize a case or to order or adhere to isolation precautions) or unavoidable (because the case was not recognizable or because another diagnosis was confirmed), and the cost of implementing exposure management.Interventions.Interventions consisted of an investigation of every HCW encounter with any patient who was confirmed later to have pertussis from the time of hospital admission of the patient, use of azithromycin as postexposure prophylaxis (PEP) for exposed HCWs, performance of 21-day surveillance for cough illness, testing of symptomatic exposed HCWs forBordetella pertussis, and enhanced preexposure education of HCWs.Results.From September 2003 through April 2005, pertussis was confirmed in 28 patients (median age, 62 days); 24 patients were admitted. For 11 patients, pertussis was suspected, appropriate precautions were taken, and no HCW was exposed. Inadequate precautions for 17 patients led to 355 HCW exposures. The median number of HCWs exposed per exposing patient was 9 (range, 1-86 HCWs; first quartile mean, 2; fourth quartile mean, 61). Exposure was definitely avoidable for only 61 (17%) of 355 HCWs and was probably unavoidable for 294 HCWs (83%). The cost of 20-month infection control management of HCWs exposed to pertussis was $69,770. The entire cohort of HCWs involved in direct patient care at the facility could be immunized for approximately $60,000.Conclusions.Exposure of HCWs to pertussis during contact with children who have the disease is largely unavoidable, and management of this exposure is resource intensive. Universal preexposure vaccination of HCWs is a better utilization of resources than is case-based postexposure management.
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Kozjek, Tatjana, and Vanja Ida Erčulj. "Mistreatment by patients: An analysis of the patient-related social stressors among Slovenian healthcare workers." Slovenian Journal of Public Health 60, no. 2 (March 18, 2021): 90–96. http://dx.doi.org/10.2478/sjph-2021-0014.
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Abstract Introduction Healthcare workers (HCWs) are often exposed to mistreatment by patients, which has negative effects on both staff and institutions. To take appropriate action to help HCWs in this context, patient-related social stressors (PSS) should be explored. The purpose of the research was to identify the most pronounced patient behaviour contributing to the social stress (SS) of HCWs, and compare PSS between different HCWs and different types of healthcare institutions. Methods 750 HCWs from Slovenian public health centres and hospitals participated in the online survey. Although the non-probability sampling was used, the sample was representative according to gender and HCW type (doctors, nurses and other HCWs). Results The results show that the most pronounced patient behaviour contributing to the SS of HCWs are attitudes and behaviour of patients that are challenging in terms of what is – from the HCWs’ point of view – considered as acceptable and reasonable (disproportionate patient expectations), and unpleasant, humourless, and hostile patients. HCWs in primary institutions meet less verbally aggressive and unpleasant patients than in tertiary ones. Although among all HCWs less educated ones are more exposed to inappropriate behaviour, doctors are those HCWs who experience more inappropriate behaviour. Conclusion Managers should enable HCWs to get comprehensive patient service training, oriented towards improving relationship management and patient-HCW relationships.
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Shah, Syed M., David Bonauto, Barbara Silverstein, and Michael Foley. "Workers' Compensation Claims for Needlestick Injuries Among Healthcare Workers in Washington State, 1996-2000." Infection Control & Hospital Epidemiology 26, no. 9 (September 2005): 775–81. http://dx.doi.org/10.1086/502616.
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AbstractObjectives:To characterize accepted workers' compensation claims for needlestick injuries filed by healthcare workers (HCWs) in non-hospital compared with hospital settings in Washington State.Design:Descriptive study of all accepted workers' compensation claims filed between 1996 and 2000 for needlestick injuries.Participants:All Washington State HCWs eligible to file a state fund workers' compensation claim and those who filed a workers' compensation claim for a needlestick injury.Results:There were 3,303 accepted state fund HCW needlestick injury claims. The incidence of needlestick injury claims per 10,000 full-time-equivalent HCWs in hospitals was 158.6; in dental offices, 104.7; in physicians' offices, 87.0; and in skilled nursing facilities, 80.8. The most common mechanisms of needlestick injury by work location were as follows: for hospitals, suturing and other surgical procedures (16.7%), administering an injection (12.7%), and drawing blood (10%); for dentists' offices, recapping (21.3%) and cleaning trays and instruments (18.2%); for physicians' offices, disposal (22.2%) and administering an injection (10.2%); and for skilled nursing facilities, disposal (23.7%) and administering an injection (14.9%). Nurses accounted for the largest (29%) proportion of HCWs involved, followed by dental assistants (17%) and laboratory technicians and phlebotomists (12%) in non-hospital settings. Rates of needlestick injury claims increased for non-hospital settings by 7.5% annually (95% confidence interval [CI95], 4.89% to 10.22%; P < .0001). Rates decreased for hospital settings by 5.8% annually, but the decline was not statistically significant (CI95, -12.50% to 1.34%; P < .1088). HCWs were exposed to hepatitis B, hepatitis C, and human immunodeficiency viruses in non-hospital settings.Conclusion:There was a difference in the incidence rate and mechanisms of needlestick injuries on review of workers' compensation claim records for HCWs in non-hospital and hospital settings.
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JIANG, L., H. L. NG, H. J. HO, Y. S. LEO, K. PREM, A. R. COOK, and M. I. CHEN. "Contacts of healthcare workers, patients and visitors in general wards in Singapore." Epidemiology and Infection 145, no. 14 (September 8, 2017): 3085–95. http://dx.doi.org/10.1017/s0950268817002035.
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SUMMARYTo characterize contacts in general wards, a prospective survey of healthcare workers (HCWs), patients and visitors was conducted using self-reported diary, direct observation and telephone interviews. Nurses, doctors and assorted HCWs reported a median of 14, 18 and 15 contact persons over one work shift, respectively. Within 1 h, we observed 3·5 episodes with 25·6 min of cumulative contact time for nurses, 2·9 episodes and 22·1 min for doctors and 5·0 episodes with 44·3 min for assorted-HCWs. In interactions with patients, nurses had multiple brief episodes of contact; doctors had fewer episodes and less cumulative contact time; assorted-HCWs had fewer contact episodes of longer durations (than for nurses and doctors). Assortative mixing occurred amongst HCWs: those of the same HCW type were the next most frequent class of contact after patients. Over 24-h, patients contacted 14 persons with 23 episodes and 314·5 min of contact time. Patient-to-patient contact episodes were rare, but a maximum of five were documented from one patient participant. 22·9% of visitors reported contact with patients other than the one they visited. Our study revealed differences in the characteristics of contacts among different HCW types and potential transmission routes from patients to others within the ward environment.
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Rebmann, Terri, Kathleen S. Wright, John Anthony, Richard C. Knaup, and Eleanor B. Peters. "Seasonal Influenza Vaccine Compliance among Hospital-Based and Nonhospital-Based Healthcare Workers." Infection Control & Hospital Epidemiology 33, no. 3 (March 2012): 243–49. http://dx.doi.org/10.1086/664057.
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Background.Influenza vaccination among nonhospital healthcare workers (HCWs) is imperative, but only limited data are available for factors affecting their compliance.Objective.To examine the factors influencing influenza vaccine compliance among hospital and nonhospital HCWs.Design and Setting.A vaccine compliance questionnaire was administered to HCWs working in myriad healthcare settings in March-June 2011.Methods.Online and paper surveys were used to assess compliance with the 2010/2011, 2009/2010, and H1N1 influenza vaccines and to examine factors that predicted the uptake of the 2010/2011 seasonal influenza vaccine.Results.In all, 3,188 HCWs completed the survey; half of these (n = 1,719) reported no hospital work time. Compliance rates for all 3 vaccines were significantly higher (P< .001) among hospital versus nonhospital HCWs. In logistic regression stratified by hospital versus nonhospital setting, and when controlling for demographics and past behavior, the determinants of vaccination against the 2010/2011 seasonal influenza among nonhospital-based HCWs included having a mandatory vaccination policy, perceived importance, no fear of vaccine adverse effects, free and on-site access, and perceived susceptibility to influenza. Determinants of hospital-based HCW vaccine compliance included having a mandatory vaccination policy, belief that HCWs should be vaccinated every year, occupational health encouragement, perceived importance of vaccination, on-site access, and no fear of vaccine adverse effects. The strongest predictor of compliance for both worker groups was existence of a mandatory vaccination policy.Conclusions.The reasons for vaccine uptake among nonhospital-based versus hospital-based HCWs differed. Targeted interventions should be aimed at workers in these settings to increase their vaccine compliance, including implementing a mandatory vaccination policy.Infect Control Hosp Epidemiol 2012;33(3):243-249
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Hosoglu, Salih, Zana Ahmad, Mohammed Sami Tahseen, Zehra Diyar, Sami Selbes, and Ali Colak. "High incidence of occupational exposures among healthcare workers in Erbil, Iraq." Journal of Infection in Developing Countries 8, no. 10 (October 15, 2014): 1328–33. http://dx.doi.org/10.3855/jidc.4280.
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Introduction: The current status of percutaneous injury and mucous exposures (PMEs) of hospital workers and factors associated with the injuries have not been studied in Iraq. This study aimed to evaluate the epidemiology of PMEs with blood or body fluids that leads serious risks for healthcare workers (HCWs). Methodology: An analytic, cross-sectional survey study was conducted among HCWs in Erbil city center, Iraq. The study was performed at sevenhospitals, and 177 participants were included. The dependent variable was the occurrence of PMEs in the last year, and the independent variables were age, sex, occupation of HCWs, working site, and work duration. Results: A total of 177 HCW participants included 57 nurses/midwives (32.2%), 59 doctors (33.3%), 27 laboratory workers (15.3%), and 34 paramedics/multipurpose workers (19.2%) from seven hospitals. The study concluded that 67.8% of the participants reported at least one occupational PME in the last year. In all, 13.3/person/year PME incidents were reported for nurses, 9.74/person/year for paramedics/multipurpose workers, 6.71/person/year for doctors, and 3.37/person/year laboratory workers. The mean number of PME incidents was 8.91/person/year. HCWs showed 85.0% compliance with wearing mask in risky situations. The most dangerous action for occupational exposure was blood taking (39.0%). In the univariate analysis, none of the investigated variables were found to be significantly related to PME. Conclusions: Occupational injuries and exposures in Iraqi HCWs are extremely common; awareness about protection is not sufficient. Nurses were found to be the highest risk group among HCWs. Preventive actions should be taken to avoid infection.
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Phan, Linh T., Dayana Maita, Donna C. Mortiz, Susan C. Bleasdale, and Rachael M. Jones. "Environmental Contact and Self-contact Patterns of Healthcare Workers: Implications for Infection Prevention and Control." Clinical Infectious Diseases 69, Supplement_3 (September 13, 2019): S178—S184. http://dx.doi.org/10.1093/cid/ciz558.
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Abstract Background Respiratory viruses on fomites can be transferred to sites susceptible to infection via contact by hands or other fomites. Methods Care for hospitalized patients with viral respiratory infections was observed in the patient room for 3-hour periods at an acute care academic medical center for over a 2 year period. One trained observer recorded the healthcare activities performed, contacts with fomites, and self-contacts made by healthcare workers (HCWs), while another observer recorded fomite contacts of patients during the encounter using predefined checklists. Results The surface contacted by HCWs during the majority of visits was the patient (90%). Environmental surfaces contacted by HCWs frequently during healthcare activities included the tray table (48%), bed surface (41%), bed rail (41%), computer station (37%), and intravenous pole (32%). HCWs touched their own torso and mask in 32% and 29% of the visits, respectively. HCWs’ self-contacts differed significantly among HCW job roles, with providers and respiratory therapists contacting themselves significantly more times than nurses and nurse technicians (P < .05). When HCWs performed only 1 care activity, there were significant differences in the number of patient contacts and self-contacts that HCWs made during performance of multiple care activities (P < .05). Conclusions HCWs regularly contact environmental surfaces, patients, and themselves while providing care to patients with infectious diseases, varying among care activities and HCW job roles. These contacts may facilitate the transmission of infection to HCWs and susceptible patients.
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Raymond, Nigel J., Neville Berry, Tim K. Blackmore, Sarah Jefferies, Katherine Norton, Kyle Perrin, and Richard Beasley. "Pandemic Influenza A(H1N1)2009 in Hospital Healthcare Workers in New Zealand." Infection Control & Hospital Epidemiology 33, no. 2 (February 2012): 196–99. http://dx.doi.org/10.1086/663705.
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We evaluated A/H1N1 influenza in healthcare workers (HCWs) and in a flu room during the 2009 pandemic. The flu room aided HCW care and management by facilitating rapid diagnosis and treatment. Absence of fever was common, and symptoms were nonspecific. A higher rate of H1N1 occurred in HCWs deployed in acute services.Infect Control Hosp Epidemiol2012;33(2):196-199
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Gehanno, Jean-François, Martine Pestel-Caron, Michèle Nouvellon, and Jean-François Caillard. "Nosocomial Pertussis in Healthcare Workers From a Pediatric Emergency Unit in France." Infection Control & Hospital Epidemiology 20, no. 8 (August 1999): 549–52. http://dx.doi.org/10.1086/501667.
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AbstractObjective:After pertussis was diagnosed in July 1997 in a 55-year-old nurse (case) from a pediatric emergency unit who had a respiratory illness and paroxysmal cough for 5 weeks, an epidemiological investigation was initiated to determine if other healthcare workers (HCWs) from the same unit also had pertussis.Design:Interviews were conducted to assess symptoms occurring in the previous months. Two sera were collected 2 to 3 months apart for 59 of 61 HCWs of the unit. The IgG response to pertussis toxin was determined using Western blot assay.Setting:Pediatric emergency unit (61 HCWs) of a 2,500-bed university hospital.Results:There was a total of 10 (5 confirmed and 5 probable) cases of pertussis identified in this outbreak. Nine HCWs (15%) had results suggesting recent or acute pertussis. To avoid transmission to patients and other HCWs, all HCWs with cough were treated for 14 days with erythromycin, and those having acute cough were given a 5-day sick leave. Despite these measures, a new acute pertussis case was identified in a 41-year-old nurse, with a positive culture from nasopharyngeal aspirates. Thus, all HCWs in the unit were prescribed spiramycin for 10 days to prevent any further spread of pertussis.Conclusion:Pertussis should be considered a threat to HCWs who are in contact with children. For HCWs, diagnosis of pertussis should be made on a clinical basis, giving greater importance to sensitivity of diagnosis criteria, and on early bacterial identification by culture of the organism or by polymerase chain reaction.Recommendations:In case of pertussis in an HCW, all staff in the unit who have had unprotected and intensive contact with that person should be provided with macrolide treatment to stop any transmission to colleagues and to young patients. Furthermore, the possibility of providing these HCWs with acellular pertussis vaccines warrants further investigation.
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Lamorde, Mohammed, Matthew Lozier, Maureen Kesande, Patricia Akers, Olive Tumuhairwe, Martin Watsisi, Winifred Omuut, et al. "Access to Alcohol-Based Hand Rub Is Associated With Improved Hand Hygiene in an Ebola-Threatened District of Western Uganda." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s457. http://dx.doi.org/10.1017/ice.2020.1130.
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Background: Ebola virus disease (EVD) is highly transmissible and has a high mortality rate. During outbreaks, EVD can spread across international borders. Inadequate hand hygiene places healthcare workers (HCWs) at increased risk for healthcare-associated infections, including EVD. In high-income countries, alcohol-based hand rub (ABHR) can improve hand hygiene compliance among HCWs in healthcare facilities (HCF). We evaluated local production and district-wide distribution of a WHO-recommended ABHR formulation and associations between ABHR availability in HCF and HCW hand hygiene compliance. Methods: The evaluation included 30 HCF in Kabarole District, located in Western Uganda near the border with the Democratic Republic of the Congo, where an EVD outbreak has been ongoing since August 2018. We recorded baseline hand hygiene practices before and after patient contact among 46 healthcare workers across 20 HCFs in August 2018. Subsequently, in late 2018, WHO/UNICEF distributed commercially produced ABHR to all 30 HCFs in Kabarole as part of Ebola preparedness efforts. In February 2019, our crossover evaluation distributed 20 L locally produced ABHR to each of 15 HCFs. From June 24–July 5, 2019, we performed follow-up observations of hand hygiene practices among 68 HCWs across all 30 HCFs. We defined hand hygiene as handwashing with soap or using ABHR. We conducted focus groups with healthcare workers at baseline and follow-up. Results: We observed hand hygiene compliance before and after 203 and 308 patient contacts at baseline and follow-up, respectively. From baseline to follow-up, hand hygiene compliance before patient contact increased for ABHR use (0% to 17%) and handwashing with soap (0% to 5%), for a total increase from 0% to 22% (P < .0001). Similarly, hand hygiene after patient contact increased from baseline to follow-up for ABHR use (from 3% to 55%), and handwashing with soap decreased (from 12% to 7%), yielding a net increase in hand hygiene compliance after patient contact from 15% to 62% (P < .0001). Focus groups found that HCWs prefer ABHR to handwashing because it is faster and more convenient. Conclusions: In an HCF in Kabarole District, the introduction of ABHR appeared to improve hand hygiene compliance. However, the confirmation of 3 EVD cases in Uganda 120 km from Kabarole District 2 weeks before our follow-up hand hygiene observations may have influenced healthcare worker behavior and hand hygiene compliance. Local production and district-wide distribution of ABHR is feasible and may contribute to improved hand hygiene compliance among healthcare workers.Funding: NoneDisclosures: Mohammed Lamorde, Contracted Research - Janssen Pharmaceutica, ViiV, Mylan
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Goins, William P., William Schaffner, Kathryn M. Edwards, and Thomas R. Talbot. "Healthcare Workers' Knowledge and Attitudes About Pertussis and Pertussis Vaccination." Infection Control & Hospital Epidemiology 28, no. 11 (November 2007): 1284–89. http://dx.doi.org/10.1086/521654.
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Objective.To determine knowledge and attitudes about pertussis and pertussis vaccination among healthcare workers (HCWs).Design.Self-administered, Web-based survey.Setting.Tertiary-care academic medical center.Participants.Medical center employees who participated in direct patient care were recruited to complete the survey through institutional e-mail.Results.Of 14,893 potentially eligible employees, 1,819 (12%) completed the survey. Most respondents (87%) did not plan to receive the pertussis vaccine. Intent to receive vaccination (which included recent history of vaccination) was associated with the following 4 factors: receipt of a physician recommendation for vaccination (odds ratio [OR], 9.01), awareness of Centers for Disease Control and Prevention recommendations for pertussis vaccination for HCWs (OR, 6.89), receipt of encouragement to be vaccinated from a coworker (OR, 4.72), the belief that HCWs may spread pertussis to patients and family (OR, 1.80). Two factors were negatively associated with intent to receive vaccination: the presence of children in the HCW's home (OR, 0.69) and employment as a nurse (OR, 0.59). Reasons cited by those who did not intend to receive vaccination included lack of a personal recommendation for vaccination (78%), receipt of vaccination as a child (51%), and perception that there was no significant risk for contracting pertussis (38%).Conclusions.Of the HCWs surveyed, only 13% intended to receive the pertussis vaccine. A perceived lack of recommendation for vaccination and inaccurate conceptions about pertussis and pertussis vaccination were cited as reasons HCWs did not intend to be vaccinated. Institutional pertussis vaccination campaigns should focus on the risks of healthcare-associated pertussis and new recommendations for pertussis vaccination.
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Kim, Sun Kyung, Jiwon Jung, Sun Hee Kwak, Min Jee Hong, Eun Ok Kim, and Sung-Han Kim. "Seroprevalence of Measles in Healthcare Workers in South Korea." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s386—s387. http://dx.doi.org/10.1017/ice.2020.1022.
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Background: Measles is a highly contagious disease that is transmissible by airborne particles but is preventable by vaccination. South Korea has maintained a highly immunized adult population; however, small local outbreaks of measles continued to occur, and there have been some reports of pockets of underimmunity among the young adult population. It is important to know the seroepidemiology of healthcare workers (HCWs) for policy-making process, but data on the seroprevalence of measles in HCWs in South Korea are limited. Methods: We investigated the seroprevalence of HCWs at Asan Medical Center, a 2,705-bed tertiary-care hospital in Seoul, South Korea, with 8,329 HCWs. In 2014, after an outbreak of measles occurred in a university in Seoul, Asan Medical Center required measles IgG tests for all HCWs born in and after 1967 for point-prevalence surveillance. In addition, we have routinely performed measles antibody test for new HCWs since 2014. In 2018, antibody tests were administered to HCWs who were born before 1967 or who had taken a leave of absence in 2014. We provided MMR vaccination to all HCWs whose antibody tests yielded negative results. Results: In total, 7,411 HCWs (89%) underwent measles antibody tests from 2014 to 2018. The overall seropositivity was 73% (95% CI, 72%–74%); seroprevalence was 73% in HCWs born in of after 1967, whereas the seroprevalence in HCWs born before 1967 was 98%. The seroprevalence sharply decreased from 85% in the 1986 birth cohort to 42% in the 1995 birth cohort. Conclusions: In conclusion, the proportion of measles-susceptible individuals was substantially high in HCWs, especially in young adults. Because the impact of measles outbreak in healthcare facilities would be critical, a policy regarding routine serologic screening followed by measles vaccination or routine measles vaccination in healthcare facilities should be considered, especially for young Korean HCWs.Funding: NoneDisclosures: None
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Lambert, Lauren A., Robert H. Pratt, Lori R. Armstrong, and Maryam B. Haddad. "Tuberculosis among Healthcare Workers, United States, 1995–2007." Infection Control & Hospital Epidemiology 33, no. 11 (November 2012): 1126–31. http://dx.doi.org/10.1086/668016.
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Objective.We examined surveillance data to describe the epidemiology of tuberculosis (TB) among healthcare workers (HCWs) in the United States during the period 1995–2007.Design.Cross-sectional descriptive analysis of existing surveillance data.Setting and Participants.TB cases reported to the Centers for Disease Control and Prevention from the 50 states and the District of Columbia from 1995 through 2007.Results.Of the 200,744 reported TB cases in persons 18 years of age or older, 6,049 (3%) occurred in individuals who were classified as HCWs. HCWs with TB were more likely than other adults with TB to be women (unadjusted odds ratio [95% confidence interval], 4.1 [3.8–4.3]), be foreign born (1.3 [1.3–1.4]), have extrapulmonary TB (1.6 [1.5–1.7]), and complete TB treatment (2.5 [2.3–2.8]).Conclusions.Healthcare institutions may benefit from intensifying TB screening of HCWs upon hire, especially persons from countries with a high incidence of TB, and encouraging treatment for latent TB infection among HCWs to prevent progression to TB disease.
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Godin, Gaston, Lydi-Anne Vézina-Im, and Herminé Naccache. "Determinants of Influenza Vaccination among Healthcare Workers." Infection Control & Hospital Epidemiology 31, no. 7 (July 2010): 689–93. http://dx.doi.org/10.1086/653614.
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Objective.To identify the determinants of influenza vaccination and the moderators of the intention-behavior relationship among healthcare workers (HCWs).Design.Prospective survey with 2-month follow-up.Setting.Three university-affiliated public hospitals.Participants.Random sample of 424 HCWs.Methods.The intention of an HCW to get vaccinated against influenza was measured by means of a self-administered questionnaire based on an extended version of the theory of planned behavior. An objective measure of behavior was extracted 2 months later from the vaccination database of the hospitals.Results.Controlling for past behavior, we found that the determinants of influenza vaccination were intention (odds ratio [OR], 8.32 [95% confidence interval {CI}, 2.82–24.50]), moral norm (OR, 3.01 [95% CI, 1.17–7.76]), anticipated regret (OR, 2.33 [95% CI, 1.23–4.41]), and work status (ie, full time vs part time; OR, 1.99 [95% CI, 1.92–3.29]). Moral norm also interacted with intention as a significant moderator of the intention-behavior relationship (OR, 0.09 [95% CI, 0.03–0.30]). Again, apart from the influence of past behavior, intention to get vaccinated was predicted by use of the following variables: attitude (ß = .32;P< .001), professional norm (β = .18;P< .001), moral norm (β = .18;P< .001), subjective norm (ß = .09;P< .001), and self-efficacy (ß = .08;P< .001). This latter model explained 89% of the variance in HCWs' intentions to get vaccinated against influenza during the next vaccination campaign.Conclusions.Our study suggests that influenza vaccination among HCWs is mainly a motivational issue. In this regard, it can be suggested to reinforce the idea that getting vaccinated can reduce worry and protect family members.
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Kamacooko, Onesmus, Jonathan Kitonsa, Ubaldo M. Bahemuka, Freddie M. Kibengo, Anne Wajja, Vincent Basajja, Alfred Lumala, et al. "Knowledge, Attitudes, and Practices Regarding COVID-19 among Healthcare Workers in Uganda: A Cross-Sectional Survey." International Journal of Environmental Research and Public Health 18, no. 13 (June 30, 2021): 7004. http://dx.doi.org/10.3390/ijerph18137004.
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Healthcare workers (HCWs) are at high risk of COVID-19. However, data on HCWs’ knowledge, attitudes, and practices (KAP) toward COVID-19 are limited. Between September and November 2020, we conducted a questionnaire-based COVID-19 KAP survey among HCWs at three hospitals in Uganda. We used Bloom’s cut-off of ≥80% to determine sufficient knowledge, good attitude, and good practice, and multivariate Poisson regression with robust variance for statistical analysis. Of 717 HCWs invited to participate, 657 (91.6%) agreed and were enrolled. The mean age (standard deviation) of enrollees was 33.2 (10.2) years; most were clinical HCWs (64.7%) and had advanced secondary school/other higher-level education (57.8%). Overall, 83.9% had sufficient knowledge, 78.4% had a positive attitude, and 37.0% had good practices toward COVID-19. Factors associated with KAP were: Knowledge: being a clinical HCW (aRR: 1.12; 95% CI: 1.02–1.23) and previous participation in health research (aRR: 1.10; 95% CI: 1.04–1.17); Attitude: age > 35 years (aRR: 0.88; 95% CI: 0.79–0.98); Practice: being a clinical HCW (aRR: 1.91; 95% CI: 1.41–2.59). HCWs in Uganda have good knowledge and positive attitude but poor practices towards COVID-19. Differences in COVID-19 KAP between clinical and non-clinical HCWs could affect uptake of COVID-19 interventions including vaccination.
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Michaels, Jessica, Dariusz Olszyna, Frank Ng, Cheng Chuan Lee, and Sophia Archuleta. "1326. Inter-Professional Education and Training to Build Capacity Among Healthcare Workers in Singapore." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S405. http://dx.doi.org/10.1093/ofid/ofy210.1159.
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Abstract Background People Living with HIV (PLHIV) in Singapore continue to face stigma and confidentiality concerns in their interactions with Healthcare Workers (HCWs). There is a recognized gap in HIV-related knowledge and lack of training opportunities for HCWs in Singapore, particularly amongst nonphysicians and other HCWs who do not regularly care for PLHIV. The HCW HIV Education Series was conceptualized to address these issues and to improve the HIV-related knowledge, attitudes and practices of HCWs in Singapore. Methods The HCW HIV Education Series is organized by an interprofessional organizing committee. The series is made up of four half day modules which are conducted quarterly. The modules are designed and implemented to cater to as many HCWs as possible. The modules function as a series but can also be run as standalone education sessions. The modules are: HIV Basics, Working with PLHIV, Basic HIV Clinical Care and Advanced HIV Clinical Care. In its pilot year (2016–2017), 334 HCWs, predominantly nurses, pharmacists, and social workers attended the series. The HCWs attended from diverse healthcare settings, including public and private hospitals, nursing homes, faith based and community organizations. Pre- and post-module evaluations were completed by participants. Results Only 5% of Module 1 attendees had previously received training in HIV. Across all four modules, there was a marked improvement in knowledge and confidence pre- and post-training. 95% of attendees across all modules felt that they had gained new skills that would add value to their work. While 97% of attendees of Module 1 planned to attend future modules, the attrition rate between modules was high. Conclusion The HCW HIV Education Series is highly evaluated and well attended. Efforts to maintain and strengthen attendance across all modules is needed, the delivery of the modules over a 2-day period may be an effective way to achieve this. Research into the experiences of PLHIV in healthcare facilities should also be considered. Disclosures All authors: No reported disclosures.
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Snyder, Graham M., Kerri A. Thorn, Jon P. Furuno, Eli N. Perencevich, Mary-Claire Roghmann, Sandra M. Strauss, Giora Netzer, and Anthony D. Harris. "Detection of Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci on the Gowns and Gloves of Healthcare Workers." Infection Control & Hospital Epidemiology 29, no. 7 (July 2008): 583–89. http://dx.doi.org/10.1086/588701.
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Objective.To assess the rate of and the risk factors for the detection of methicillin-resistantS. aureus(MRSA) and vancomycin-resistant enterococci (VRE) on the protective gowns and gloves of healthcare workers (HCWs).Methods.We observed the interactions between HCWs and patients during routine clinical activities in a 29-bed medical intensive care unit at the University of Maryland Medical Center, an urban tertiary care academic hospital. Samples for culture were obtained from HCWs' hands prior to their entering a patient's room, from HCWs' disposable gowns and gloves after they completed patient care activities, and from HCWs' hands immediately after they removed their protective gowns and gloves.Results.Of 137 HCWs caring for patients colonized or infected with MRSA and/or VRE, 24 (17.5%; 95% confidence interval, 11.6%–24.4%) acquired the organism on their gloves, gown, or both. HCW contact with the endotracheal tube or tracheostomy site of a patient (P< .05), HCW contact with the head and/or neck of a patient (P< .05), and HCW presence in the room of a patient with a percutaneous endoscopic gastrostomy and/or jejunostomy tube (P< .05) were associated with an increased risk of acquiring these organisms.Conclusions.The gloves and gowns of HCWs frequently become contaminated with MRSA and VRE during the routine care of patients, and particularly during care of the patient's respiratory tract and any associated indwelling devices. As part of a larger infection control strategy, including high-compliance hand disinfection, they likely provide a useful barrier to transmitting antibiotic-resistant organisms among patients in an inpatient setting.
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Ong, Adrian, Irina Rudoy, Leah C. Gonzalez, Jennifer Creasman, L. Masae Kawamura, and Charles L. Daley. "Tuberculosis in Healthcare Workers: A Molecular Epidemiologic Study in San Francisco." Infection Control & Hospital Epidemiology 27, no. 5 (May 2006): 453–58. http://dx.doi.org/10.1086/504504.
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Objective.Healthcare workers (HCWs) are at risk of becoming infected with Mycobacterium tuberculosis through occupational exposure. To identify HCWs who became infected and developed tuberculosis as a result of their work, we studied the molecular epidemiology of tuberculosis in HCWs.Design.Eleven-year prospective cohort molecular epidemiology study.Setting.City and County of San Francisco, California.Patients.All persons reported with tuberculosis between 1993 and 2003. HCWs were identified from the San Francisco Tuberculosis Control Section's database, and mycobacterial isolates from culture-positive subjects were analyzed by IS6110-based genotyping. RESULTS. Of 2510 cases of tuberculosis reported during the study period, 31 (1.2%) occurred in HCWs: the median age of the HCWs was 37 years, and 11 (35%) were male. HCWs were more likely than non-HCWs to be younger (P= .0036), born in the United States (P= .0004), and female (P= .0003) and to not be homeless (P= .010). The rate of tuberculosis among HCWs remained constant during the study period, despite a significant decrease in the overall case rate in San Francisco. Work-related transmission was documented in at least 10 (32%) of 31 HCWs, including 4 of 8 HCWs whose isolates were part of genotypically determined clusters. Only 1 of 7 cases of tuberculosis in HCWs after 1999 was documented as being work related.Conclusions.Although most cases of tuberculosis in HCWs, as in non-HCWs, developed as a result of endogenous reactivation of latent infection, at least half of clustered cases of tuberculosis in HCWs were related to work. The number of work-related cases of tuberculosis in HCWs decreased during the study period.
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Cabarkapa, Sonja, Joel A. King, and Chee H. Ng. "The psychiatric impact of COVID-19 on healthcare workers." Australian Journal of General Practice 49, no. 12 (December 1, 2020): 791–95. http://dx.doi.org/10.31128/ajgp-07-20-5531.
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Background Healthcare workers (HCWs) are a vulnerable population who have been exposed to high work-related stress during the COVID-19 pandemic because of the high risk of infection and excessive workloads. HCWs are at greater risk of mental illness, particularly sleep disturbances, post-trauma stress syndromes, depression and anxiety. Objective The aim of this article is to highlight the psychiatric impact of the COVID-19 pandemic on frontline HCWs, the need for screening and early diagnosis by general practitioners (GPs), and the appropriate psychosocial strategies and treatments to address this. Discussion Opportunistic screening for mental health issues among HCWs is especially important during the current pandemic. Various tools and strategies can be used for efficient assessment and treatment of the common mental health issues HCWs are likely to face.
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Kim, Sun Kyung, Jiwon Jung, Sun Hee Kwak, Min Jee Hong, Eun Ok Kim, and Sung-Han Kim. "Seroprevalence of Mumps in Healthcare Workers in South Korea." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s387—s388. http://dx.doi.org/10.1017/ice.2020.1023.
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Background: Mumps, a contagious disease, is transmissible by respiratory droplet particles and is preventable by vaccination. In South Korea, mandatory vaccination against mumps has markedly reduced its incidence. However, both the incidence and the number of reported cases of mumps have persistently increased in South Korea since 2007. Despite high vaccination rates, mumps outbreaks continue to occur, and many studies have been conducted on mumps seroprevalence in children and adolescents. In comparison, few reports have been published regarding mumps seroprevalence in healthcare workers (HCWs) in South Korea. Objective: We investigated the seroprevalence of HCWs in South Korea. Methods: This study was conducted at Asan Medical Center, a 2,705-bed tertiary-care hospital in Seoul, South Korea, with 8,329 HCWs. In 2018, we performed mumps antibody testing for HCWs. We administered MMR vaccination to all HCWs whose antibody test yielded equivocal or negative results. However, we did not repeat mumps antibody testing after MMR vaccination. Results: In total, 6,055 HCWs (73%) underwent mumps antibody testing. The overall mumps seropositivity rate was 87% (95% CI, 86%–87%). Seropositivity rates of all birth cohorts ranged from 72% to 92%. Mumps seropositivity rates were 88% in HCWs born before 1970, 87% in those born between 1970 and 1989, and 88% in those born between 1990 and 1995 (P = .59). Mumps seropositivity rates for both women and men HCWs were 87% (3,770 of 4,311 women and 1,517 of 1,744 men); the difference was not statistically significant (P = .62). The overall mumps seropositivity rate was 87%, which was above the herd immunity threshold of 75%–86%. Conclusions: Our results revealed that the overall mumps seropositivity rate in South Korean HCWs was above the herd immunity threshold. On the basis of this finding, we recommend that MMR vaccination after serologic testing may be a more reasonable approach than universal MMR vaccination alone in Korea.Funding: NoneDisclosures: None
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Morgan, Daniel J., Stephen Y. Liang, Catherine L. Smith, J. Kristie Johnson, Anthony D. Harris, Jon P. Furuno, Kerri A. Thorn, Graham M. Snyder, Hannah R. Day, and Eli N. Perencevich. "Frequent Multidrug-ResistantAcinetobacter baumanniiContamination of Gloves, Gowns, and Hands of Healthcare Workers." Infection Control & Hospital Epidemiology 31, no. 7 (July 2010): 716–21. http://dx.doi.org/10.1086/653201.
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Background.Multidrug-resistant (MDR) gram-negative bacilli are important nosocomial pathogens.Objective.To determine the incidence of transmission of MDRAcinetobacter baumanniiandPseudomonas aeruginosafrom patients to healthcare workers (HCWs) during routine patient care.Design.Prospective cohort study.Setting.Medical and surgical intensive care units.Methods.We observed HCWs who entered the rooms of patients colonized with MDRA. baumanniior colonized with both MDRA. baumanniiand MDRP. aeruginosa. We examined their hands before room entry, their disposable gloves and/or gowns upon completion of patient care, and their hands after removal of gloves and/or gowns and before hand hygiene.Results.Sixty-five interactions occurred with patients colonized with MDRA. baumanniiand 134 with patients colonized with both MDRA. baumanniiand MDRP. aeruginosa. Of 199 interactions between HCWs and patients colonized with MDRA. baumannii, 77 (38.7% [95% confidence interval {CI}, 31.9%–45.5%]) resulted in HCW contamination of gloves and/or gowns, and 9 (4.5% [95% CI, 1.6%–7.4%]) resulted in contamination of HCW hands after glove removal before hand hygiene. Of 134 interactions with patients colonized with MDRP. aeruginosa, 11 (8.2% [95% CI, 3.6%–12.9%]) resulted in HCW contamination of gloves and/or gowns, and 1 resulted in HCW contamination of hands. Independent risk factors for contamination with MDRA. baumanniiwere manipulation of wound dressing (adjusted odds ratio [aQR], 25.9 [95% CI, 3.1–208.8]), manipulation of artificial airway (aOR, 2.1 [95% CI, 1.1–4.0]), time in room longer than 5 minutes (aOR, 4.3 [95% CI, 2.0–9.1]), being a physician or nurse practitioner (aOR, 7.4 [95% CI, 1.6–35.2]), and being a nurse (aOR, 2.3 [95% CI, 1.1–4.8]).Conclusions.Gowns, gloves, and unwashed hands of HCWs were frequently contaminated with MDRA. baumannii. MDRA. baumanniiappears to be more easily transmitted than MDRP. aeruginosaand perhaps more easily transmitted than previously studied methicillin-resistantStaphylococcus aureusor vancomycin-resistantEnterococcus. This ease of transmission may help explain the emergence of MDRA. baumannii.
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Campbell, Melissa, Rupak Datta, Anne Wyllie, Arnau Casanovas-Massana, Ryan Handoko, Lorenzo Sewanan, Albert I. Ko, and Richard A. Martinello. "493. Clinical and Epidemiological Features of Healthcare Workers Detected with Coronavirus Disease." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S313. http://dx.doi.org/10.1093/ofid/ofaa439.686.
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Abstract Background Data early in the SARS-CoV-2 pandemic suggested frontline healthcare workers (HCW) may account for 10–20% of all infections. CDC estimated 600,000 infections in HCWs. Symptom screening is a strategy to prevent healthcare-associated transmission. This method may not identify asymptomatic or pre-symptomatic carriers. Methods We conducted a prospective cohort study in asymptomatic or minimally symptomatic healthcare workers in a 1541-bed academic medical center. Although recruitment began in designated COVID-19 units, we expanded to all HCWs providing care to hospitalized patients during the pandemic. Data was gathered on demographics, work area in the hospital and daily questionnaires were sent listing symptoms of SARS-CoV-2. Protocol included twice weekly self-collected nasopharyngeal swab and saliva for SARS-CoV-2 N1 and N2.Those with positive PCR result, underwent telephone survey to assess symptomatology and severity of illness. Results A total 525 HCWs began the study protocol and 16 were identified as PCR positive. Samples included concordant saliva and NP samples on 9 (56%), exclusively NP samples on 5 (31%) and 2 (12%) HCWs were positive by saliva PCR only. Majority were female, and all were nursing staff; with 19% reported not working in a designated COVID-19 unit. During the course of this active surveillance, universal masking was mandated in the institution. Rhinorrhea and headache were reported by 6 (38%), 5 (31%) reported cough and 3 (19%) developed myalgia. Changes in smell and taste preceded the positive PCR test in 2 (12%). One HCW reported developing a fever with acute illness. All were notified about their PCR positive status by institution’s occupational health department and self-isolated to monitor for symptoms. Conclusion The spectrum of disease in this HCW cohort is similar to mild disease in the community. Due to high incidence of asymptomatic or mildly symptomatic HCWs, active surveillance with routine testing proves be beneficial to prevent hospital transmission of SARS-CoV-2. Universal masking significantly decreased the HCW positive rate in our study, underscoring the need for universal efforts to mitigate healthcare-associated transmission with self-monitoring, face mask use, and other infection prevention behaviors like hand hygiene. Disclosures All Authors: No reported disclosures
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Henderson, David K. "Position Paper: The HIV-Infected Healthcare Worker." Infection Control & Hospital Epidemiology 11, no. 12 (December 1990): 647–56. http://dx.doi.org/10.1086/646116.
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Consensus statements bearing on issues related to healthcare workers (HCWs) who are, or may be, infected by the human immunodeficiency virus (HIV) have been developed by the Centers for Disease Control (CDC), the American Medical Association (AMA), the American Academy of Pediatrics, the American Hospital Association (AHA), the American Academy of Orthopedic Surgeons, the American College of Obstetricians and Gynecologists8 and the British working groups. In general, these organizations conclude that few, if any, special procedures are required to accommodate an HIV-infected HCW. All except one oppose routine screening of HCWs for HIV infection; all except one oppose broad practice proscriptions for HIV-infected HCWs. Only one of these consensus statements focuses on the HIV-infected HCW. None address important related questions that confront hospitals and other healthcare institutions. These issues are difficult to resolve because: 1) there are insufficient data to establish a scientific basis for their solution; 2) the questions involve medicolegal, ethical or public relations issues that are beyond the usual scope of scientific consensus body recommendations; and/or 3) the situations occur infrequently. Nevertheless, in actual hospital practice, decisions about these questions, at least occasionally, must be made.
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Zhu, Bingke, Hao Fan, Bingbing Xie, Ran Su, Chaofeng Zhou, and Jianping He. "Mapping the Scientific Research on Healthcare Workers’ Occupational Health: A Bibliometric and Social Network Analysis." International Journal of Environmental Research and Public Health 17, no. 8 (April 11, 2020): 2625. http://dx.doi.org/10.3390/ijerph17082625.
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In the last few years, the occupational health (OH) of healthcare workers (HCWs) has been shown increasing concern by both health departments and researchers. This study aims to provide academics with quantitative and qualitative analysis of healthcare workers’ occupational health (HCWs+OH) field in a joint way. Based on 402 papers published from 1992 to 2019, we adopted the approaches of bibliometric and social network analysis (SNA) to map and quantify publication years, research area distribution, international collaboration, keyword co-occurrence frequency, hierarchical clustering, highly cited articles and cluster timeline visualization. In view of the results, several hotspot clusters were identified, namely: physical injuries, workplace, mental health; occupational hazards and diseases, infectious factors; community health workers and occupational exposure. As for citations, we employed document co-citation analysis to detect trends and identify seven clusters, namely tuberculosis (TB), strength training, influenza, healthcare worker (HCW), occupational exposure, epidemiology and psychological. With the visualization of cluster timeline, we detected that the earliest research cluster was occupational exposure, then followed by epidemiology and psychological; however, TB, strength training and influenza appeared to gain more attention in recent years. These findings are presumed to offer researchers, public health practitioners a comprehensive understanding of HCWs+OH research.
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Tenna, Admasu, Edward A. Stenehjem, Lindsay Margoles, Ermias Kacha, Henry M. Blumberg, and Russell R. Kempker. "Infection Control Knowledge, Attitudes, and Practices among Healthcare Workers in Addis Ababa, Ethiopia." Infection Control & Hospital Epidemiology 34, no. 12 (December 2013): 1289–96. http://dx.doi.org/10.1086/673979.
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Objective.To better understand hospital infection control practices in Ethiopia.Design.A cross-sectional evaluation of healthcare worker (HCW) knowledge, attitudes, and practices about hand hygiene and tuberculosis (TB) infection control measures.Methods.An anonymous 76-item questionnaire was administered to HCWs at 2 university hospitals in Addis Ababa, Ethiopia. Knowledge items were scored as correct/incorrect. Attitude and practice items were assessed using a Likert scale.Results.In total, 261 surveys were completed by physicians (51%) and nurses (49%). Fifty-one percent of respondents were male; mean age was 30 years. While hand hygiene knowledge was fair, self-reported practice was suboptimal. Physicians reported performing hand hygiene 7% and 48% before and after patient contact, respectively. Barriers for performing hand hygiene included lack of hand hygiene agents (77%), sinks (30%), and proper training (50%) as well as irritation and dryness (67%) caused by hand sanitizer made in accordance with the World Health Organization formulation. TB infection control knowledge was excellent (more than 90% correct). Most HCWs felt that they were at high risk for occupational acquisition of TB (71%) and that proper TB infection control can prevent nosocomial transmission (92%). Only 12% of HCWs regularly wore a mask when caring for TB patients. Only 8% of HCWs reported that masks were regularly available, and 76% cited a lack of infrastructure to isolate suspected/known TB patients.Conclusions.Training HCWs about the importance and proper practice of hand hygiene along with improving hand sanitizer options may improve patient safety. Additionally, enhanced infrastructure is needed to improve TB infection control practices and allay HCW concerns about acquiring TB in the hospital.
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Phan, Linh T., Dagmar Sweeney, Dayana Maita, Donna C. Moritz, Susan C. Bleasdale, and Rachael M. Jones. "Respiratory viruses on personal protective equipment and bodies of healthcare workers." Infection Control & Hospital Epidemiology 40, no. 12 (October 31, 2019): 1356–60. http://dx.doi.org/10.1017/ice.2019.298.
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AbstractObjective:To characterize the magnitude of virus contamination on personal protective equipment (PPE), skin, and clothing of healthcare workers (HCWs) who cared for patients having acute viral infections.Design:Prospective observational study.Setting:Acute-care academic hospital.Participants:A total of 59 HCWs agreed to have their PPE, clothing, and/or skin swabbed for virus measurement.Methods:The PPE worn by HCW participants, including glove, face mask, gown, and personal stethoscope, were swabbed with Copan swabs. After PPE doffing, bodies and clothing of HCWs were sampled with Copan swabs: hand, face, and scrubs. Preamplification and quantitative polymerase chain reaction (qPCR) methods were used to quantify viral RNA copies in the swab samples.Results:Overall, 31% of glove samples, 21% of gown samples, and 12% of face mask samples were positive for virus. Among the body and clothing sites, 21% of bare hand samples, 11% of scrub samples, and 7% of face samples were positive for virus. Virus concentrations on PPE were not statistically significantly different than concentrations on skin and clothing under PPE. Virus concentrations on the personal stethoscopes and on the gowns were positively correlated with the number of torso contacts (P < .05). Virus concentrations on face masks were positively correlated with the number of face mask contacts and patient contacts (P < .05).Conclusions:Healthcare workers are routinely contaminated with respiratory viruses after patient care, indicating the need to ensure that HCWs complete hand hygiene and use other PPE to prevent dissemination of virus to other areas of the hospital. Modifying self-contact behaviors may decrease the presence of virus on HCWs.
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Dev, Nishanth, Ramesh Chand Meena, D. K. Gupta, Nitesh Gupta, and Jhuma Sankar. "Risk factors and frequency of COVID-19 among healthcare workers at a tertiary care centre in India: a case–control study." Transactions of The Royal Society of Tropical Medicine and Hygiene 115, no. 5 (March 24, 2021): 551–56. http://dx.doi.org/10.1093/trstmh/trab047.
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Abstract Background There is a paucity of data on risk factors for infection among healthcare workers (HCWs) from India. Our objective was to evaluate the risk factors and frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCWs. Methods We conducted this retrospective case–control study of 3100 HCWs between May and July 2020. HCWs positive for SARS-CoV-2 infection were the cases (n=506) and those negative for SARS-CoV-2 were the controls (n=253). Univariate analysis was followed by multivariate analysis of key demographic, clinical and infection control variables. Results SARS-CoV-2 infection was found in 16.32% of HCWs. Nearly 45% of infected HCWs were asymptomatic. The proportions of sanitation workers (24% vs 8%; p<0.0001) and technicians (10% vs 4%; p=0.0002) were higher and that of doctors was lower among cases as compared with controls (23% vs 43%; p<0.0001). On univariate analysis, the type of HCW, smoking, lack of training, inadequate personal protective equipment (PPE) use and taking no or fewer doses of hydroxychloroquine (HCQ) were found to be significant. On multivariate analysis, the type of HCW (risk ratio [RR] 1.67 [95% confidence interval {CI} 1.34 to 2.08], p<0.0001), inappropriate PPE use (RR 0.63 [95% CI 0.44 to 0.89], p=0.01) and taking fewer doses of HCQ (RR 0.92 [95% CI 0.86 to 0.99], p=0.03) were significant. Conclusions The frequency of SARS-CoV-2 infection was 16% among HCWs. Being a sanitation worker, inappropriate PPE use and lack of HCQ prophylaxis predisposed HCWs to SARS-CoV-2 infection.
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Garzillo, Elpidio Maria, Antonio Arnese, Nicola Coppola, AnnaRita Corvino, Daniela Feola, Maria Grazia Lourdes Monaco, Giuseppe Signoriello, Luigi Tonino Marsella, Paola Arena, and Monica Lamberti. "HBV vaccination status among healthcare workers: A cross-sectional study." Journal of Infection Prevention 21, no. 1 (September 25, 2019): 23–27. http://dx.doi.org/10.1177/1757177419873043.
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Objective: The development of a vaccine against hepatitis B virus (HBV) is one of the improvements in strategy prevention during the last decades. Aim: To evaluate HBV-related vaccine status in healthcare workers (HCW) exposed to biological risk. Methods: The serum markers for HBV were collected from HCWs in two tertiary care hospitals in Naples (Italy). Multivariate statistical analysis was then performed to identify associated factors linked to the long-term immunogenicity of the HCWs. Results: All HBV vaccinated individuals were screened for whole marker patterns; all were HBsAg/anti-HBc negative. Of individuals, 20% had an anti-HB antibody titre < 10 IU/L. Multivariate statistical analysis highlighted that women were more protected than men (73.6% vs. 26.4%, P < 0.05). Additionally, nurses seem to maintain a higher antibody titre than doctors and other staff, such as auxiliary technicians ( P < 0.05). Conclusions: Our data support the evidence of a strong immunogenicity against HBV, assessed through the circulating antibody titre, when prophylactic vaccination is conducted in non-infantile age, particularly for women. The outcome of the study supports the central role of occupational physicians within the hospital districts in terms of primary prevention and maximum protection of HCWs.
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Patel, Leena N., Samantha Kozikott, Rodrigue Ilboudo, Moreen Kamateeka, Mohammed Lamorde, Marion Subah, Fatima Tsiouris, Anna Vorndran, and Christopher T. Lee. "Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative." BMJ Global Health 6, no. 6 (June 2021): e005833. http://dx.doi.org/10.1136/bmjgh-2021-005833.
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Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.
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Sweet, Michael A., Jonathan A. McCullers, Paul R. Lasala, Frank E. Briggs, Anne Smithmyer, and Rashida A. Khakoo. "Comparison of Immune Response to the Influenza Vaccine in Obese and Nonobese Healthcare Workers." Infection Control & Hospital Epidemiology 36, no. 3 (January 2, 2015): 249–53. http://dx.doi.org/10.1017/ice.2014.59.
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OBJECTIVETo determine whether there is a difference in antibody titers and functionality after receipt of the influenza vaccine for obese versus nonobese healthcare workers (HCW).DESIGNProspective observational study.SETTINGTertiary medical center.PARTICIPANTSHealthcare workers.METHODSBaseline influenza antibody titers for obese and nonobese HCW were recorded during the hospital’s 2011 annual influenza vaccination day and follow-up antibody titers were measured 4 weeks later. Antibodies were measured using the hemagglutination inhibition assay and functionality was measured using the micro-neutralization method.RESULTSOf 200 initial HCWs, 190 completed the study (97 obese and 93 nonobese). Seroprotection after immunization was not significantly different for nonobese compared with obese HCW for each strain (influenza A [H1N1], 99% and 99%; influenza A [H3N2], 100% and 99%; and influenza B, 67% and 71%, respectively)All geometric mean titers measured by micro-neutralization showed statistically significant increases in activity. In comparison, there was no difference in the 4-fold increase in H1N1 or B titers. There was a significant difference in the 4-fold increase of H3N2 titers between the nonobese and obese HCWs (82/93 [88%] vs 64/97 [66%], P=.003)In an ad hoc analysis we found that obese HCWs had a statistically greater number of 4-fold decreases in titers with H1N1 and H3N2.CONCLUSIONSThere was no significant difference in protection from influenza between obese and nonobese HCWs after immunization.Infect Control Hosp Epidemiol 2014;00(0): 1–5
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Wee, Liang En, Xiang Ying Jean Sim, Edwin Philip Conceicao, May Kyawt Aung, Jia Qing Goh, Dennis Wu Ting Yeo, Wee Hoe Gan, et al. "Containment of COVID-19 cases among healthcare workers: The role of surveillance, early detection, and outbreak management." Infection Control & Hospital Epidemiology 41, no. 7 (May 11, 2020): 765–71. http://dx.doi.org/10.1017/ice.2020.219.
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AbstractObjective:Staff surveillance is crucial during the containment phase of a pandemic to help reduce potential healthcare-associated transmission and sustain good staff morale. During an outbreak of SARS-COV-2 with community transmission, our institution used an integrated strategy for early detection and containment of COVID-19 cases among healthcare workers (HCWs).Methods:Our strategy comprised 3 key components: (1) enforcing reporting of HCWs with acute respiratory illness (ARI) to our institution’s staff clinic for monitoring; (2) conducting ongoing syndromic surveillance to obtain early warning of potential clusters of COVID-19; and (3) outbreak investigation and management.Results:Over a 16-week surveillance period, we detected 14 cases of COVID-19 among HCWs with ARI symptoms. Two of the cases were linked epidemiologically and thus constituted a COVID-19 cluster with intrahospital HCW–HCW transmission; we also detected 1 family cluster and 2 clusters among HCWs who shared accommodation. No transmission to HCWs or patients was detected after containment measures were instituted. Early detection minimized the number of HCWs requiring quarantine, hence preserving continuity of service during an ongoing pandemic.Conclusions:An integrated surveillance strategy, outbreak management, and encouraging individual responsibility were successful in early detection of clusters of COVID-19 among HCWs. With ongoing local transmission, vigilance must be maintained for intrahospital spread in nonclinical areas where social mingling of HCWs occurs. Because most individuals with COVID-19 have mild symptoms, addressing presenteeism is crucial to minimize potential staff and patient exposure.
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Christini, Amanda Banks, Kathleen A. Shutt, and Karin E. Byers. "Influenza Vaccination Rates and Motivators Among Healthcare Worker Groups." Infection Control & Hospital Epidemiology 28, no. 2 (February 2007): 171–77. http://dx.doi.org/10.1086/511796.
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Background.The rate of influenza vaccination among healthcare workers (HCWs) is approximately 40%. Differences in vaccination rates among HCW groups and reasons for accepting or rejecting vaccination are poorly understood.Objectives.To determine vaccination rates and motivators among different HCW groups during the 2004-2005 influenza season.Design.Cross-sectional survey conducted between July 10 and September 30, 2005.Setting.Two tertiary care teaching hospitals in an urban center.Participants.Physicians, nurses, nursing aides, and other staff. Surveys were collected from 1,042 HCWs (response rate, 42%).Results.Sixty-nine percent of physicians (n = 282) and 63% of medical students (n = 145) were vaccinated, compared with 46% of nurses (n = 336), 42% of nursing aides (n = 135), and 29% of administrative personnel (n = 144). Physicians and medical students were significantly more likely to be vaccinated than all other groups (P < .0001). Pediatricians (84%) were more likely than internists (69%) and surgeons (43%) to be vaccinated (P < .0001). Among the HCWs who were vaccinated, 33.4% received the live attenuated influenza vaccine (LAIV) and 66.6% received trivalent inactivated influenza vaccine (TIV). Vaccinated HCWs were less likely than unvaccinated HCWs to report an influenza-like illness (P = .03). Vaccination with LAIV resulted in fewer episodes of influenza-like illness than did receiving no vaccine (P = .03). The most common reason for rejecting vaccination was a concern about availability. Understanding that HCWs may transmit the virus to patients correlated with vaccine acceptance (P = .0004).Conclusions.Significant differences in vaccination exist among physician specialties and employee groups, and there are inadequate vaccination rates among those with the greatest amount of patient contact, potentially providing a basis for group-specific interventions.
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Ledda, Caterina, Diana Cinà, Serena Matera, Nicola Mucci, Massimo Bracci, and Venerando Rapisarda. "High HOMA-IR Index in Healthcare Shift Workers." Medicina 55, no. 5 (May 22, 2019): 186. http://dx.doi.org/10.3390/medicina55050186.
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Background and objectives: Evidence shows that shift work may be correlated with insulin resistance (IR). Therefore its estimation in clinical and prevention practice is of great significance. A cross-sectional study was performed to examine the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) Index among healthcare shift workers (HCSW). Materials and Methods: A total of 272 healthcare workers (HCWs) were invited to participate in the study within an occupational surveillance framework, 137 were HCSW while 135 were healthcare non-shift workers (HCNSW). Fasting glucose, insulin, and HOMA-IR Index were evaluated in each participant and correlated with shift workers. Results: Indicators of glucose metabolism were significantly higher in HCSW p < 0.001, and logistic regression analysis confirmed a significant positive association between increased values of HOMA-IR Index and shift workers (p < 0.05). Conclusions: Shift work could be a risk factor in developing insulin resistance and metabolic syndrome.
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Walker, Frances J., James A. Singleton, Pengjun Lu, Karen G. Wooten, and Raymond A. Strikas. "Influenza Vaccination of Healthcare Workers in the United States, 1989-2002." Infection Control & Hospital Epidemiology 27, no. 3 (March 2006): 257–65. http://dx.doi.org/10.1086/501538.
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Objectives.We sought to estimate influenza vaccination coverage among healthcare workers (HCWs) in the United States during 1989-2002 and to identify factors associated with vaccination in this group. The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for HCWs to reduce transmission of influenza to patients at high risk for serious complications of influenza.Design.Analysis of cross-sectional data from 1989-2002 surveys conducted by the National Health Interview Survey (NHIS). The outcome measure was self-reported influenza vaccination in the past 12 months. Bivariate and multivariate analysis of 2002 NHIS data.Setting.Household interviews conducted during 1989-2002, weighted to reflect the noninstitutionalized, civilian US population.Participants.Adults aged 18 years or older participated in the study. A total of 2,089 were employed in healthcare occupations or settings in 2002, and 17,160 were employed in nonhealthcare occupations or settings.Results.The influenza vaccination rate among US HCWs increased from 10.0% in 1989 to 38.4% in 2002, with no significant change since 1997. In a multivariate model that included data from the 2002 NHIS, factors associated with a higher rate of influenza vaccination among HCWs aged 18-64 years included age of 50 years or older (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.1), hospital employee status (OR, 1.5; 95% CI, 1.2-1.9), 1 or more visits to the office of a healthcare professional in the past 12 months (OR, 1.5; 95% CI, 1.1-2.2), receipt of employer-provided health insurance (OR, 1.5; 95% CI, 1.1-2.1), a history of pneumococcal vaccination (OR, 3.9; 95% CI, 2.5-6.1), and history of hepatitis B vaccination (OR, 1.9; 95% CI, 1.4-2.4). Non-Hispanic black persons were less likely to be vaccinated (OR, 0.6; 95% CI, 0.5-0.9) than non-Hispanic white persons. There were no significant differences in vaccination levels according to HCW occupation category.Conclusions.Influenza immunization among HCWs reached a plateau during 1997-2002. New strategies are needed to encourage US HCWs to receive influenza vaccination to prevent influenza illness in themselves and transmission of influenza to vulnerable patients.
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Weterings, Veronica, Heidi Kievits, Miranda van Rijen, and Jan Kluytmans. "Methicillin-Resistant Staphylococcus aureus Prevalence Among Healthcare Workers in Contact Tracings in a Dutch Hospital." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s316—s317. http://dx.doi.org/10.1017/ice.2020.910.
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Background: In The Netherlands, the national guidelines on Methicillin-Resistant Staphylococcus aureus (MRSA) prevention and control advocate screening of healthcare workers (HCWs) after unprotected exposure to MRSA carriers. Although this strategy is largely successful, contact tracing of staff is a time-consuming and costly component. We evaluated our contact tracing policy for HCWs over the years 2010–2018. Methods: A retrospective, observational study was performed in a Dutch teaching hospital. All HCWs who had unprotected contact with an MRSA carrier were included in contact tracing. When there had been a long period of unprotected admission prior to an MRSA finding, or when the index case was an HCW, the entire (nursing) team was tested. All samples of HCWs who were tested for MRSA carriage as part of contact tracing from 2010 until 2018 were included. A pooled nose, throat, and perineum swab was collected using the eSwab medium (Copan) and inoculated on chromID MRSA agar plates (bioMérieux) after enrichment in a broth. Molecular typing was performed using multiple-locus variable number of tandem repeat analysis (MLVA). Results: In total, we included 8,849 samples (range, 677–1,448 samples per year) from 287 contact tracings (range, 26–55 contact tracings per year). Overall, 32 HCWs were colonized with MRSA (0.36%; 95% CI, 0.26%–0.51%). None of them developed a clinical infection. Moreover, 8 HCWs (0.10%; 95% CI, 0.05%–0.19%) were colonized with the same MLVA type as the index case and were detected in 6 of 287 contact tracings (2%). In 4 of 8 of these cases, a positive HCW was the index for undertaking contact tracing. In 3 of 8 cases, it was clear that the HCW who was identified in the contact tracing was the source of the outbreak and was the cause of invasive MRSA infections in patients. Notably, a different MLVA type as the index case was found in 24 HCWs (0.27%; 95% CI, 0.18%–0.40%) of whom 7 of 24 HCWs (29.2%) were intermittent carriers. Conclusions: This study revealed a sustained low MRSA prevalence among samples in contact tracing of HCWs over 9 years. Furthermore, it shows that when MRSA contact tracing is performed according to the national guideline, only 1 of 1,000 samples results in a secondary case. This is similar to the population carriage rate of MRSA in The Netherlands. More frequently, an unrelated strain is found. These findings raise questions regarding the efficacy of the current strategy to perform contact tracing after unprotected exposure.Funding: NoneDisclosures: None
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Rakita, Robert M., Beverly A. Hagar, Patricia Crome, and Joyce K. Lammert. "Mandatory Influenza Vaccination of Healthcare Workers: A 5-Year Study." Infection Control & Hospital Epidemiology 31, no. 9 (September 2010): 881–88. http://dx.doi.org/10.1086/656210.
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Background.The rate of influenza vaccination among healthcare workers (HCWs) is low, despite a good rationale and strong recommendations for vaccination from many health organizations.Objective.To increase influenza vaccination rates by instituting the first mandatory influenza vaccination program for HCWs.Design and Setting.A 5-year study (from 2005 to 2010) at Virginia Mason Medical Center, a tertiary care, multispecialty medical center in Seattle, Washington, with approximately 5,000 employees.Methods.All HCWs of the medical center were required to receive influenza vaccination. HCWs who were granted an accommodation for medical or religious reasons were required to wear a mask at work during influenza season. The main outcome measure was rate of influenza vaccination among HCWs.Results.In the first year of the program, there were a total of 4,703 HCWs, of whom 4,588 (97.6%) were vaccinated, and influenza vaccination rates of more than 98% were sustained over the subsequent 4 years of our study. Less than 0.7% of HCWs were granted an accommodation for medical or religious reasons and were required to wear a mask at work during influenza season, and less than 0.2% of HCWs refused vaccination and left Virginia Mason Medical Center.Conclusion.A mandatory influenza vaccination program for HCWs is feasible, results in extremely high vaccination rates, and can be sustained over the course of several years.
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Wei, Jia-Te, Zhi-Dong Liu, Zheng-Wei Fan, Lin Zhao, and Wu-Chun Cao. "Epidemiology of and Risk Factors for COVID-19 Infection among Health Care Workers: A Multi-Centre Comparative Study." International Journal of Environmental Research and Public Health 17, no. 19 (September 29, 2020): 7149. http://dx.doi.org/10.3390/ijerph17197149.
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Healthcare workers (HCWs) worldwide are putting themselves at high risks of coronavirus disease 2019 (COVID-19) by treating a large number of patients while lacking protective equipment. We aim to provide a scientific basis for preventing and controlling the COVID-19 infection among HCWs. We used data on COVID-19 cases in the city of Wuhan to compare epidemiological characteristics between HCWs and non-HCWs and explored the risk factors for infection and deterioration among HCWs based on hospital settings. The attack rate (AR) of HCWs in the hospital can reach up to 11.9% in Wuhan. The time interval from symptom onset to diagnosis in HCWs and non-HCWs dropped rapidly over time. From mid-January, the median time interval of HCW cases was significantly shorter than in non-HCW cases. Cases of HCWs and non-HCWs both clustered in northwestern urban districts rather than in rural districts. HCWs working in county-level hospitals in high-risk areas were more vulnerable to COVID-19. HCW cases working in general, ophthalmology, and respiratory departments were prone to deteriorate compared with cases working in the infection department. The AR of COVID-19 in HCWs are higher than in non-HCWs. Multiple factors in hospital settings may play important roles in the transmission of COVID-19. Effective measures should be enhanced to prevent HCWs from COVID-19 infection.
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O’Sullivan, G., S. Jacob, P. M. Barrett, and J. Gallagher. "Covid-19 presentation among symptomatic healthcare workers in Ireland." Occupational Medicine 71, no. 2 (February 15, 2021): 95–98. http://dx.doi.org/10.1093/occmed/kqab012.
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Abstract Background It is recognized that healthcare workers (HCWs) are at high risk of contracting Covid-19. It is incumbent on occupational health staff to recognize potential symptoms of Covid-19 among HCWs. Aims The aims of the study were to describe the presenting symptoms of HCWs who developed Covid-19 in Ireland, and to estimate the odds of specific symptoms being associated with a positive Covid-19 polymerase chain reaction (PCR) result. Methods A retrospective chart review of all symptomatic HCWs who self-presented for Covid-19 testing in Cork from March to May 2020 was conducted. A sex-matched case–control study was carried out to compare presenting features among those who tested positive compared to those who tested negative. Univariate and multivariable-adjusted conditional logistic regression models were run using Stata 15.0 to identify the symptoms associated with positive Covid-19 swab results. Results Three hundred and six HCWs were included in the study; 102 cases and 204 controls. Common presenting features among cases were fever/chills (55%), cough (44%) and headache (35%). The symptoms which were significantly associated with a positive Covid-19 swab result were loss of taste/smell (adjusted odds ratio [aOR] 12.15, 95% confidence interval [CI] 1.36–108.79), myalgia (aOR 2.36, 95% 1.27–4.38), fatigue (aOR 2.31, 95% CI 1.12–4.74), headache (aOR 2.11, 95% CI 1.19–3.74) and fever/chills (aOR 1.88, 95% CI 1.12–3.15). Conclusions Fever, fatigue, myalgia, loss of taste/smell and headache were associated with increased odds of a Covid-19 diagnosis among symptomatic self-referred HCWs compared with those had negative swab results. Testing criteria for HCWs should reflect the broad range of possible symptoms of Covid-19.
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Horton, Lucy E., Randy Taplitz, Francesca J. Torriani, Shira R. Abeles, Lydia Ikeda, and Tyson Ikeda. "437. Asymptomatic Healthcare Worker COVID-19 Testing Program." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S286—S287. http://dx.doi.org/10.1093/ofid/ofaa439.630.
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Abstract Background The SARS-CoV-2 pandemic remains a major threat worldwide. Healthcare workers (HCWs) are particularly impacted by the COVID-19 pandemic with high infection rates reported from HCWs in hard-hit regions2,3, raising concerns about nosocomial infections and the effectiveness of personal protective equipment in protecting HCWs. Asymptomatic infection is estimated 17.9% to 33.3%4 and is a common source of transmission5. We designed a HCW testing program to address patient and employee concerns about exposures in the healthcare setting at our 808-bed health system. During the time of employee testing, the mean (range) number of inpatients with a diagnosis of COVID was 30 (22–38) of a mean (range) daily census of 560 (492–602) (approximately 5.4%). Methods This opt-in program offered SARS-CoV-2 testing of asymptomatic HCWs with paired nasopharyngeal or mid-turbinate swab for PCR (Roche) and serum IgG antibody testing (Diazyme). While initially designed as a pilot project in the Emergency Departments and COVID-19 units, it was quickly expanded to a health system-wide initiative. Results From April 22 to June 2, PCR testing was performed on 5826 asymptomatic HCWs with four PCR tests resulting positive (0.09%). Of 5589 serologic tests (anti-SARS-CoV-2 IgG) performed, 57 tested positive (1.02 %). All HCW with a positive IgG had a concurrent negative PCR. Conclusion In this cross-sectional evaluation, the point prevalence of SARS-CoV-2 IgG in asymptomatic HCWs at UC San Diego was less than 1%, supporting modeling estimations at the San Diego County level of very low levels of community exposure at the time of this testing. Further analyses of incidence rates and potential risk factors such as employee roles within the healthcare system, community and healthcare exposures, and home zip code are underway. Asymptomatic HCW testing is a strategy that can provide the perception of additional safety to both the workforce and patients as the health system reopens, while potentially reduce transmission from asymptomatic persons through active case finding and isolation. Disclosures Randy Taplitz, MD, Merck (Advisor or Review Panel member)
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Lena, Pavlina, Angela Ishak, Spyridon A. Karageorgos, and Constantinos Tsioutis. "Presence of Methicillin-Resistant Staphylococcus aureus (MRSA) on Healthcare Workers’ Attire: A Systematic Review." Tropical Medicine and Infectious Disease 6, no. 2 (March 31, 2021): 42. http://dx.doi.org/10.3390/tropicalmed6020042.
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Contaminated healthcare workers’ (HCW) clothing risk transferring methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. We performed a systematic review in Pubmed and Scopus for 2000–2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to analyze evidence of MRSA on HCW attire. The primary study outcome was MRSA isolation rates on HCW clothing in healthcare settings. Out of 4425 articles, 23 studies were included: 18 with 1760 HCWs, four with 9755 HCW–patient interactions and one with 512 samples. There was a notable variation in HCWs surveyed, HCW attires, sampling techniques, culture methods and laundering practices. HCW attire was frequently colonized with MRSA with the highest rates in long-sleeved white coats (up to 79%) and ties (up to 32%). Eight studies reported additional multidrug-resistant bacteria on the sampled attire. HCW attire, particularly long-sleeved white coats and ties, is frequently contaminated with MRSA. Banning certain types and giving preference to in-house laundering in combination with contact precautions can effectively decrease MRSA contamination and spread.
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Ferragut, Mariano Jose, Deborah Barry, and Martina Cummins. "Understanding why healthcare workers refuse the flu vaccine." Journal of Infection Prevention 21, no. 3 (May 2020): 115–18. http://dx.doi.org/10.1177/1757177420908000.
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Background: Vaccination is one of the most effective interventions used to reduce infections. Nonetheless, concerns and misconceptions about vaccines have resulted in an increased rate of refusal of vaccination among healthcare workers (HCWs) and within the general population. Aim/ Objective: To understand the factors that underlie vaccination-refusal. Methods: A questionnaire was given to the HCWs in the inpatient area of an acute London hospital during May 2019. The sample was one of convenience, i.e. the wards where the principle investigator covered. All staff were approached: 306 in total completed the questionnaire. Findings/results: In total, 212 (69.28%) healthcare professionals had the flu vaccine during the 2018–2019 campaign, 94 (30.62%) did not have the flu vaccine and 37 (39.36%) of the HCWs that did not receive the flu vaccine reported they had previously a bad reaction following administration of the vaccine. Discussion: This report will provide the Trust and other healthcare settings with information integrating the disconnection between misconceptions and vaccination knowledge, which may inform practical interventions to address the challenges of vaccination in future campaigns. Increasing HCWs’ knowledge of flu vaccine side effects could address this and may increase rates of vaccination compliance.