Effectiveness of prevention of SARS-CoV-2 transmission among unvaccinated Italian healthcare workers
Main Article Content
Keywords
Covid-19, SARS-CoV-2, occupational safety, personal protective equipment, mask, health care workers, risk assessment, public health
Abstract
Background: We aimed to investigate the association between personal protective equipment (PPE) use and SARS-CoV-2 infection among healthcare workers (HCWs). Methods: We analyzed occupational surveillance contact forms followed by a PCR test notified between March and September 2020 by Italian HCWs. The odds ratios (ORs) and 95% Confidence Intervals (CIs) for positive PCR based on HCWs and contacts characteristics were calculated through multivariable logistic regression models. When multiple contacts were potentially effective for a PCR test, they were weighted by the inverse of their number. Results: Overall, 4,883 contacts reported by 2,952 HCWs were analyzed, and 224 contacts among 144 HCWs had positive PCR. No difference was found according to sex, age, employment, or job title, except for an OR of 0.30 (95%CI 0.11-0.78) for resident physicians, compared to administrative staff. The ORs for use of surgical mask were 0.59 (95%CI=0.40-0.86) for use only by HCW, 0.49 (95%CI=0.22-1.07) only by the infected person, and 0.40 (95%CI=0.27-0.60) by both, compared to use by neither. Use of other PPEs was not associated with infection, while the OR for hand sanitation was 0.61 (95%CI=0.40-0.93).
HCWs reporting fever, cough, and asthenia had a higher risk of infection. Conclusions: Use of surgical masks was associated with a 40-60% lower risk of infection, especially when both HCWs and infected individuals used them. Our results quantify the role played by mask use and hand sanitation in preventing SARS-CoV-2 transmission in high-risk circumstances.
References
2. Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395:1973-87.
3. Tabah A, Ramanan M, Laupland KB, et al. Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): An international survey. J Crit Care. 2020;59:70-5.
4. Boffetta P, Violante F, Durando P, et al. Determinants of SARS-CoV-2 infection in Italian healthcare workers: a multicenter study. Sci Rep. 2021;11:5788.
5. Luo L, Liu D, Liao X, et al. Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China: A Prospective Cohort Study. Ann Intern Med. 2020;173:879-87.
6. Cheng HY, Jian SW, Liu DP, et al. Contact Tracing Assessment of COVID-19 Transmission Dynamics in Taiwan and Risk at Different Exposure Periods Before and After Symptom Onset. JAMA Intern Med. 2020;180:1156-63.
7. Trémeaux P, Lhomme S, Abravanel F, et al. Evaluation of the Aptima™ transcription-mediated amplification assay (Hologic®) for detecting SARS-CoV-2 in clinical specimens. J Clin Virol. 2020;129:104541.
8. Garzaro G, Clari M, Ciocan C, et al. COVID-19 infection and diffusion among the healthcare workforce in a large university-hospital in northwest Italy. Med Lav. 2020;111:184-94.
9. StataCorp. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC, 2019.
10. Rader B, White LF, Burns MR, et al. Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. Lancet Digit Health. 2021;3:e148-57.
11. Tabatabaeizadeh SA. Airborne transmission of COVID-19 and the role of face mask to prevent it: a systematic review and meta-analysis. Eur J Med Res. 2021;26:1.
12. Talic S, Shah S, Wild H, et al. Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. BMJ. 2021;375:e068302.
13. Wang X, Ferro EG, Zhou G, Hashimoto D, Bhatt DL. Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA. 2020;324:703-04.
14. Wang Y, Deng Z, Shi D. How effective is a mask in preventing COVID-19 infection? Med Devices Sens. 2021:e10163.
15. Romagnani P, Gnone G, Guzzi F, et al. The COVID-19 infection: lessons from the Italian experience. J Public Health Policy. 2020;41:238-44.
16. European Center for Disease Prevention and Control. Technical Report. Use of gloves in healthcare and nonhealthcare settings in the context of the COVID-19 pandemic. Solna, Sweden: ECDC, 2020. https://www.ecdc.europa.eu/en/publications-data/gloves-healthcare-and-non-healthcare-settings-covid-19.
17. WHO Guidelines on Hand Hygiene in Health Cancer (Advanced Draft). Geneva, Switzerland: World Alliance for Patient Safety,WHO, 2006. www.who.int/gpsc/en/index.html.
18. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ. 2020;11:29.
19. Plebani M, Padoan A, Fedeli U, et al. SARS-CoV-2 serosurvey in health care workers of the Veneto Region. Clin Chem Lab Med. 2020;58:2107-11.
20. Gómez-Ochoa SA, Franco OH, Rojas LZ, et al. COVID-19 in Health-Care Workers: A Living Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes. Am J Epidemiol. 2021;190:161-75.
21. European Center for Disease Prevention and Control. Clinical characteristics of COVID-19. Solna, Sweden: ECDC, 2021. https://www.ecdc.europa.eu/en/covid-19/latest-evidence/clinical
22. Stringhini S, Wisniak A, Piumatti G, et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet. 2020;396:313-9.
23. Poustchi H, Darvishian M, Mohammadi Z, et al. SARS-CoV-2 antibody seroprevalence in the general population and high-risk occupational groups across 18 cities in Iran: a population-based cross-sectional study. Lancet Infect Dis. 2021;21:473-481.
24. Sandri MT, Azzolini E, Torri V, et al. SARS-CoV-2 serology in 4000 health care and administrative staff across seven sites in Lombardy, Italy. Sci Rep. 2021 Jun 10;11(1):12312. Doi: 10.1038/s41598-021-91773-4. PMID: 34112899; PMCID: PMC8192543.
Article Sidebar
Article Details
How to Cite
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a CC BY-NC-SA 4.0 Creative Commons Attribution-NonCommercial ShareAlike 4.0 International License.
Working Group on Sars-Cov-2 prevention, Department of Public Health and Pediatrics, University of Torino, Turin, Italy
Michele Caniglia, MD, [email protected]; Denis Longo, MD, [email protected]; Carlotta Castagneris, MD, [email protected]; Erminia Citino, MD, [email protected]; Vittorio Accardo, MD, [email protected]; Alessandro Beneduce, MD, [email protected]; Gianvito Pellecchia, MD, [email protected]; Giuseppe Clemente, MD, [email protected]; Massimiliano Victor Leone, MD, [email protected]; Nicolò Milanesio, MD, [email protected]; Roberto Frammartino, MD, [email protected]; Marco Clari, RN, [email protected]; Ida Marina Raciti, MD, [email protected]; Elena Olivero, MD, [email protected]; Carlo Silvestre, MD, [email protected].
How to Cite
