SARS-CoV-2 exposures of healthcare workers from primary care, long-term care facilities and hospitals: a nationwide matched case-control study

Martin Belan; Tiffany Charmet; Laura Schaeffer; Sarah Tubiana; Xavier Duval; Jean-Christophe Lucet; Arnaud Fontanet; Gabriel Birgand; Solen Kernéis

doi:10.1016/j.cmi.2022.05.038

SARS-CoV-2 exposures of healthcare workers from primary care, long-term care facilities and hospitals: a nationwide matched case-control study

Clin Microbiol Infect. 2022 Nov;28(11):1471-1476. doi: 10.1016/j.cmi.2022.05.038. Epub 2022 Jun 29.

Authors

Martin Belan¹, Tiffany Charmet², Laura Schaeffer², Sarah Tubiana³, Xavier Duval³, Jean-Christophe Lucet⁴, Arnaud Fontanet⁵, Gabriel Birgand⁶, Solen Kernéis⁴

Affiliations

¹ Université de Paris, INSERM, IAME, Paris, France. Electronic address: martin.belan@aphp.fr.
² Institut Pasteur, Université de Paris, Emerging Diseases Epidemiology Unit, Paris, France.
³ Université de Paris, INSERM, IAME, Paris, France; Centre d'Investigation Clinique, Inserm CIC 1425, F-75018, Paris, France.
⁴ Université de Paris, INSERM, IAME, Paris, France; Equipe de Prévention du Risque Infectieux (EPRI), AP-HP, Hôpital Bichat, Paris, France.
⁵ Institut Pasteur, Université de Paris, Emerging Diseases Epidemiology Unit, Paris, France; Conservatoire National des Arts et Métiers, Unité PACRI, Paris, France.
⁶ Centre d'Appui à la Prévention des Infections Associées aux Soins (CPias) des Pays de la Loire, Nantes, France; NIHR Health Protection Research Unit in Healthcare-Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK.

Abstract

Objectives: This study assessed the roles of various exposures and personal protective equipment (PPE) use on healthcare workers' (HCWs) risk of COVID-19 working in primary care, long-term-care facilities or hospitals.

Methods: We conducted a matched case-control (1:1) study (10 April through 9 July 2021). Cases (HCWs with confirmed COVID-19) and controls (HCWs without any COVID-19-positive test or symptoms) were invited by E-mail to complete an online questionnaire on their exposures and PPE use over the 10-day period preceding inclusion. Risk factors were analysed using multivariable conditional logistic regression.

Results: A total of 2076 cases and 2076 matched controls were included. The analysis retained exposure to an infected person outside work (adjusted OR 19.9 (95% CI, 12.4-31.9)), an infected colleague (OR 2.26 (95% CI, 1.53-3.33)) or COVID-19 patients (OR 2.37 (95% CI, 1.66-3.40)), as independent predictors of COVID-19 in HCWs, while partial (OR 0.30 (95% CI, 0.22-0.40)) or complete (OR 0.19 (95% CI, 0.14-0.27)) immunisation was protective. Eye protection (OR 0.57 (95% CI, 0.37-0.87)) and wearing a gown (OR 0.58 (95% CI, 0.34-0.97)) for COVID-19 patient care were protective, while wearing an apron slightly increased the risk of infection (OR 1.47 (95% CI, 1.00-2.18)). Protection of N95 respirators and surgical face masks did not differ. Compared to medical professions, being a nurse (OR 3.79 (95% CI, 2.50-5.76)) or a nurse's aide (OR 9.08 (95% CI, 5.30-15.5)) was associated with COVID-19. Results were consistent across all healthcare settings.

Discussion: HCWs were more likely to get COVID-19 in their personal sphere than during occupational activities. Our results suggest that eye protection for HCWs during patient care should be actively promoted.

Keywords: COVID-19; Healthcare workers; Infection control and prevention; Personal protective equipments; Risk factors.

MeSH terms

COVID-19* / epidemiology
COVID-19* / prevention & control
Case-Control Studies
Health Personnel
Hospitals
Humans
Long-Term Care
SARS-CoV-2*