Bastuji-Garin Sylvie, Brouard Ludivine, Bourgeon-Ghittori Irma, Zebachi Sonia, Boutin Emmanuelle, Hemery Francois, Fourreau Frédéric, Oubaya Nadia, De Roux Quentin, Mongardon Nicolas, Fourati Slim, Decousser Jean-Winoc
IMRB, INSERM, University Paris Est Creteil, 94010 Créteil, France.
Department of Public Health, Hôpitaux Universitaires Henri-Mondor AP-HP, 94010 Créteil, France.
J Clin Med. 2023 Feb 2;12(3):1208. doi: 10.3390/jcm12031208.
The relative contributions of occupational and community sources of COVID-19 among health-care workers (HCWs) are still subject to debate. In a cohort study at a 2814-bed tertiary medical center (five hospitals) in the Paris area of France, we assessed the proportion of hospital-acquired cases among staff and identified risk factors. Between May 2020 and June 2021, HCWs were invited to complete a questionnaire on their COVID-19 risk factors. RT-PCR and serology test results were retrieved from the virology department. Mixed-effects logistic regression was used to account for clustering by hospital. The prevalence of COVID-19 was 15.6% (n = 213/1369 respondents) overall, 29.7% in the geriatric hospitals, and 56.8% of the infections were hospital-acquired. On multivariable analyses adjusted for COVID-19 incidence and contact in the community, a significantly higher risk was identified for staff providing patient care (especially nursing assistants), staff from radiology/functional assessment units and stretcher services, and staff working on wards with COVID-19 clusters among patients or HCWs. The likelihood of infection was greater in geriatric wards than in intensive care units. The presence of significant occupational risk factors after adjustment for community exposure is suggestive of a high in-hospital risk and emphasizes the need for stronger preventive measures-especially in geriatric settings. Clinicaltrials.gov NCT04386759.
医护人员感染新冠病毒的职业来源和社区来源的相对贡献仍存在争议。在法国巴黎地区一家拥有2814张床位的三级医疗中心（五家医院）进行的一项队列研究中，我们评估了工作人员中医院获得性病例的比例，并确定了风险因素。2020年5月至2021年6月期间，邀请医护人员填写一份关于其新冠病毒风险因素的问卷。从病毒学部门获取逆转录聚合酶链反应（RT-PCR）和血清学检测结果。采用混合效应逻辑回归分析来考虑医院层面的聚类情况。总体而言，新冠病毒感染率为15.6%（n = 213/1369名受访者），在老年医院中为29.7%，且56.8%的感染是医院获得性的。在针对社区中新冠病毒发病率和接触情况进行调整的多变量分析中，发现为患者提供护理的工作人员（尤其是护理助理）、来自放射科/功能评估单位和担架服务部门的工作人员，以及在有新冠病毒聚集性感染的患者或医护人员病房工作的人员感染风险显著更高。老年病房的感染可能性高于重症监护病房。在调整社区暴露因素后存在显著的职业风险因素，提示医院内风险较高，并强调需要采取更强有力的预防措施——尤其是在老年患者环境中。Clinicaltrials.gov NCT04386759。
