感染预防策略在 COVID-19 病房中具有高度保护作用，而医护人员的主要风险来自同事和社区。
Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community.
机构信息
Epidemiology and Infection Prevention Program, Irvine Health (UC Irvine Health), University of California, Irvine, USA.
Division of Infectious Diseases, Department of Medicine, Irvine School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92617, USA.
出版信息
Antimicrob Resist Infect Control. 2021 Nov 22;10(1):163. doi: 10.1186/s13756-021-01031-5.
BACKGROUND
Early evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks.
METHODS
Prior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology.
RESULTS
Of 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05-3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28-3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00-2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12-3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30-0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01).
CONCLUSIONS
Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission. Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.
背景
在个人防护设备不足和检测不成比例的情况下，对医护人员（HCP）COVID-19 风险的早期评估导致人们认为医护人员在患者护理方面面临较高的风险。我们在考虑社区因素和同事疫情后，评估了 COVID-19 血清阳性的 HCP。
方法
在普遍戴口罩之前，我们进行了一项单中心回顾性队列加横断面研究。所有 HCP（1）因 COVID 样症状（无论检测结果如何）到职业健康就诊，或（2）被分配到专门的 COVID-19 病房，（3）有 COVID-19 HCP 疫情的病房，或（4）从 2020 年 1 月 1 日至 4 月 15 日在控制病房工作的医护人员都接受了由 FDA 授权的检测和针对 67 种呼吸道病毒（包括 11 种 SARS-CoV-2 抗原）的研究性检测的血清学检测。多变量模型评估了人口统计学、工作角色、合并症、照顾 COVID-19 患者以及地理编码的社会经济状况与阳性血清学之间的关联。
结果
在 654 名参与者中，有 87 人（13.3%）血清阳性；其中 60.8%（N=52）从未照顾过 COVID-19 患者。男性（比值比 1.79，95%置信区间 1.05-3.04，p=0.03）、在有同事疫情的病房工作（比值比 2.21，95%置信区间 1.28-3.81，p<0.01）、居住在低自有住房社区（比值比 1.63，95%置信区间 1.00-2.64，p=0.05）和拉丁裔（比值比 2.10，95%置信区间 1.12-3.96，p=0.02）与 COVID-19 血清阳性呈正相关，而在专门的 COVID-19 病房工作与 COVID-19 血清阳性呈负相关（比值比 0.53，95%置信区间 0.30-0.94，p=0.03）。研究性检测还发现了 25 例额外的血清阳性个体（78[12%]与 53[8%]，p<0.01）。
结论
在普遍戴口罩之前，HCP 的 COVID-19 风险主要由工作场所和社区暴露导致，而在专门的 COVID-19 病房工作则具有保护作用，这表明感染预防方案可以防止患者向 HCP 传播。在普遍戴口罩之前，HCP 的 COVID-19 风险主要由工作场所和社区暴露导致，而在专门的 COVID-19 病房工作则具有保护作用，这表明感染预防方案可以防止患者向 HCP 传播。
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