Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria.
Cochrane Database Syst Rev. 2024 Apr 10;4(4):CD015112. doi: 10.1002/14651858.CD015112.pub3.
BACKGROUND: Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become more urgent with the potential psychological toll imposed by the coronavirus disease 2019 (COVID-19) pandemic. Controlling exposures to occupational hazards is the fundamental method of protecting workers. When it comes to the transmission of viruses, workplaces should first consider control measures that can potentially have the most significant impact. According to the hierarchy of controls, one should first consider elimination (and substitution), then engineering controls, administrative controls, and lastly, personal protective equipment. This is the first update of a Cochrane review published 6 May 2022, with one new study added. OBJECTIVES: To assess the benefits and harms of interventions in non-healthcare-related workplaces aimed at reducing the risk of SARS-CoV-2 infection compared to other interventions or no intervention. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science Core Collections, Cochrane COVID-19 Study Register, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and medRxiv to 13 April 2023. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and non-randomised studies of interventions. We included adult workers, both those who come into close contact with clients or customers (e.g. public-facing employees, such as cashiers or taxi drivers), and those who do not, but who could be infected by coworkers. We excluded studies involving healthcare workers. We included any intervention to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace, defining categories of intervention according to the hierarchy of hazard controls (i.e. elimination; engineering controls; administrative controls; personal protective equipment). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were incidence rate of SARS-CoV-2 infection (or other respiratory viruses), SARS-CoV-2-related mortality, adverse events, and absenteeism from work. Our secondary outcomes were all-cause mortality, quality of life, hospitalisation, and uptake, acceptability, or adherence to strategies. We used the Cochrane RoB 2 tool to assess risk of bias, and GRADE methods to evaluate the certainty of evidence for each outcome. MAIN RESULTS: We identified 2 studies including a total of 16,014 participants. Elimination-of-exposure interventions We included one study examining an intervention that focused on elimination of hazards, which was an open-label, cluster-randomised, non-inferiority trial, conducted in England in 2021. The study compared standard 10-day self-isolation after contact with an infected person to a new strategy of daily rapid antigen testing and staying at work if the test is negative (test-based attendance). The trialists hypothesised that this would lead to a similar rate of infections, but lower COVID-related absence. Staff (N = 11,798) working at 76 schools were assigned to standard isolation, and staff (N = 12,229) working at 86 schools were assigned to the test-based attendance strategy. The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of symptomatic polymerase chain reaction (PCR)-positive SARS-CoV-2 infection (rate ratio (RR) 1.28, 95% confidence interval (CI) 0.74 to 2.21; 1 study; very low-certainty evidence). The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of any PCR-positive SARS-CoV-2 infection (RR 1.35, 95% CI 0.82 to 2.21; 1 study; very low-certainty evidence). COVID-related absenteeism rates were 3704 absence days in 566,502 days-at-risk (6.5 per 1000 working days) in the control group and 2932 per 539,805 days-at-risk (5.4 per 1000 working days) in the intervention group (RR 0.83, 95% CI 0.55 to 1.25). We downgraded the certainty of the evidence to low due to imprecision. Uptake of the intervention was 71% in the intervention group, but not reported for the control intervention. The trial did not measure our other outcomes of SARS-CoV-2-related mortality, adverse events, all-cause mortality, quality of life, or hospitalisation. We found seven ongoing studies using elimination-of-hazard strategies, six RCTs and one non-randomised trial. Administrative control interventions We found one ongoing RCT that aims to evaluate the efficacy of the Bacillus Calmette-Guérin (BCG) vaccine in preventing COVID-19 infection and reducing disease severity. Combinations of eligible interventions We included one non-randomised study examining a combination of elimination of hazards, administrative controls, and personal protective equipment. The study was conducted in two large retail companies in Italy in 2020. The study compared a safety operating protocol, measurement of body temperature and oxygen saturation upon entry, and a SARS-CoV-2 test strategy with a minimum activity protocol. Both groups received protective equipment. All employees working at the companies during the study period were included: 1987 in the intervention company and 1798 in the control company. The study did not report an outcome of interest for this systematic review. Other intervention categories We did not find any studies in this category. AUTHORS' CONCLUSIONS: We are uncertain whether a test-based attendance policy affects rates of PCR-positive SARS-CoV-2 infection (any infection; symptomatic infection) compared to standard 10-day self-isolation amongst school and college staff. A test-based attendance policy may result in little to no difference in absenteeism rates compared to standard 10-day self-isolation. The non-randomised study included in our updated search did not report any outcome of interest for this Cochrane review. As a large part of the population is exposed in the case of a pandemic, an apparently small relative effect that would not be worthwhile from the individual perspective may still affect many people, and thus become an important absolute effect from the enterprise or societal perspective. The included RCT did not report on any of our other primary outcomes (i.e. SARS-CoV-2-related mortality and adverse events). We identified no completed studies on any other interventions specified in this review; however, eight eligible studies are ongoing. More controlled studies are needed on testing and isolation strategies, and working from home, as these have important implications for work organisations.
背景:尽管许多感染严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)的人没有或只有轻微症状,但有些人会患上严重疾病,甚至可能死亡,尤其是老年人和有潜在医疗问题的人。随着 2019 年冠状病毒病(COVID-19)大流行对人们心理造成的潜在影响,提供基于证据的干预措施以预防 SARS-CoV-2 感染变得更加紧迫。控制职业危害暴露是保护工人的基本方法。在病毒传播方面,工作场所应首先考虑可能产生最大影响的控制措施。根据控制措施的层次,首先应考虑消除(和替代),然后是工程控制、行政控制,最后是个人防护设备。这是 2022 年 5 月 6 日发表的 Cochrane 综述的首次更新,增加了一项新研究。
目的:评估非医疗相关工作场所旨在降低 SARS-CoV-2 感染风险的干预措施与其他干预措施或无干预措施相比的获益和危害。
检索策略:我们检索了 Cochrane 对照试验中心注册库(CENTRAL)、MEDLINE、Embase、Web of Science 核心合集、Cochrane COVID-19 研究注册库、世界卫生组织(WHO)关于冠状病毒病的全球文献、ClinicalTrials.gov、WHO 国际临床试验注册平台和 medRxiv,检索时间截至 2023 年 4 月 13 日。
纳入排除标准:我们纳入了随机对照试验(RCT)和非随机研究的干预措施。我们纳入了成年工人,包括那些与客户或顾客密切接触的工人(例如面向公众的员工,如收银员或出租车司机),以及那些不会与同事接触但可能被同事感染的工人。我们排除了涉及医护人员的研究。我们将预防或减少工人在工作场所接触 SARS-CoV-2 的任何干预措施都归入危害控制的类别(即消除;工程控制;行政控制;个人防护设备)。
数据收集与分析:我们使用了标准的 Cochrane 方法。我们的主要结局是 SARS-CoV-2 感染(或其他呼吸道病毒)的发病率、SARS-CoV-2 相关死亡率、不良事件和旷工率。我们的次要结局是全因死亡率、生活质量、住院治疗以及策略的接受度、可接受性或依从性。我们使用 Cochrane RoB 2 工具评估偏倚风险,并使用 GRADE 方法评估每个结局的证据确定性。
主要结果:我们确定了 2 项研究,共纳入 16014 名参与者。消除暴露的干预措施:我们纳入了一项研究,该研究检验了一项侧重于消除危害的干预措施,这是一项在 2021 年于英格兰进行的开放标签、聚类随机、非劣效性试验。该研究比较了接触感染患者后的 10 天标准自我隔离与一种新的策略,即每日快速抗原检测,如果检测结果为阴性则继续工作(基于检测的出勤)。试验人员假设,这将导致相似的感染率,但 COVID 相关缺勤率较低。在 76 所学校工作的员工(N=11798)被分配到标准隔离组,在 86 所学校工作的员工(N=12229)被分配到基于检测的出勤策略组。基于检测的出勤与标准 10 天自我隔离的结果对于有症状的聚合酶链反应(PCR)阳性 SARS-CoV-2 感染的发生率没有定论(率比(RR)1.28,95%置信区间(CI)0.74 至 2.21;1 项研究;极低确定性证据)。基于检测的出勤与标准 10 天自我隔离的结果对于任何 PCR 阳性 SARS-CoV-2 感染的发生率也没有定论(RR 1.35,95%CI 0.82 至 2.21;1 项研究;极低确定性证据)。COVID 相关旷工率为在 566502 个工作天内有 3704 天缺勤(每 1000 个工作日 6.5 天),在对照组中,在 539805 个工作天内有 2932 天缺勤(每 1000 个工作日 4.4 天)(RR 0.83,95%CI 0.55 至 1.25)。我们因精确度不足将证据的确定性降为低。干预组的参与率为 71%,但对照组的参与率未报告。该试验未测量我们的其他结局,包括 SARS-CoV-2 相关死亡率、不良事件、全因死亡率、生活质量或住院治疗。我们发现了 7 项正在进行的消除危害策略研究,其中 6 项为 RCT,1 项为非随机试验。行政控制的干预措施:我们发现了一项正在进行的 RCT,旨在评估卡介苗(BCG)疫苗在预防 COVID-19 感染和降低疾病严重程度方面的疗效。组合的干预措施:我们纳入了一项正在进行的非随机研究,该研究检验了消除危害、行政控制和个人防护设备的组合。该研究于 2020 年在意大利的两家大型零售公司进行。该研究比较了安全操作方案、进入时测量体温和氧饱和度,以及 SARS-CoV-2 检测策略与最低活动方案。两组均提供防护设备。所有在研究期间在公司工作的员工均包括在内:干预公司 1987 人,对照组 1798 人。该研究未报告本系统评价的任何结局。其他干预类别:我们未在这一类别中发现任何研究。
作者结论:我们不确定基于检测的出勤政策与标准 10 天自我隔离相比,是否会影响学校和学院员工的 PCR 阳性 SARS-CoV-2 感染(任何感染;症状性感染)率。基于检测的出勤政策可能导致与标准 10 天自我隔离相比,旷工率几乎没有差异。我们更新搜索中纳入的非随机研究未报告本 Cochrane 综述的任何结局。由于在大流行期间很大一部分人群都受到了影响,因此,个体视角下看似微小但无意义的相对效果,可能对企业或社会层面上的许多人来说仍然是重要的绝对效果。纳入的 RCT 未报告我们的任何其他主要结局(即 SARS-CoV-2 相关死亡率和不良事件)。我们未发现任何指定在本综述中的其他干预措施的已完成研究;然而,有 8 项研究正在进行中。需要更多的对照研究来检验和隔离策略,以及居家办公,因为这些对工作组织有重要影响。
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