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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Study: Healthcare Workers Acquiring COVID-19 in the Community

By Gary Evans, Medical Writer

The Occupational Safety and Health Administration (OSHA) recently announced a special emphasis program to protect healthcare workers from COVID-19. This effort is no doubt warranted to protect workers at many hospitals, but there is something of a confounding variable to the general assumption that healthcare workers acquire SARS-CoV-2 on the job. Researchers are finding the majority of COVID-19 infections in healthcare workers are being acquired in the community.

In a recently published study, researchers did a cross-sectional study of 24,749 healthcare personnel (HCP) in three U.S. states, finding that contact with a known COVID-19 case in the community was the strongest risk factor associated infection.

Also predictive of SARS-CoV-2 seropositivity was living in a zip code with higher prevalence of COVID-19. Remarkably, none of the assessed workplace factors were associated with seropositivity. But this was to some degree expected, as the a priori hypothesis was that community exposure — not healthcare exposure — would be linked to seropositivity.

“This cross-sectional study was conducted among volunteer HCP at 4 large health care systems in 3 US states,” the authors note. “Sites shared deidentified data sets, including previously collected serology results, questionnaire results on community and workplace exposures at the time of serology, and 3-digit residential zip code prefix of HCP.

Cumulative incidence of COVID-19 per 10,000 in the community up to 1 week prior to serology testing ranged from 8.2 to 275.6. However, 20,072 (81%) of the healthcare workers reported no community contact with a person confirmed or suspected of having COVID-19. Seropositivity was 4.4% overall, representing 1,080 workers.

“In multivariable analysis, community COVID-19 contact and community COVID-19 cumulative incidence were associated with seropositivity,” they concluded. “No assessed workplace factors were associated with seropositivity, including nurse job role, working in the emergency department, or workplace contact with patients with COVID-19.”

Of significance, the Centers for Disease Control and Prevention (CDC) participated in the study, which was conducted at four sites in the CDC Prevention Epicenters Program: Emory Healthcare in Atlanta; Rush University in Chicago; and Johns Hopkins Medicine and the University of Maryland Medical System, both in Baltimore.

These academic institutions collaborate with each other and the CDC to perform cutting edge infection prevention research, so they may have better compliance with PPE and other measures than, for example, small community and rural hospitals.