Role of non-aerosols activities in the transmission of SARS-Cov-2 infection among health care workers
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Abstract
Background
Since the emergence of SARS-CoV-2, health care workers (HCWs) have been on the front line in caring for COVID-19 patients. Better knowledge of risk factors for SARS-CoV-2 infection is crucial for the prevention of disease among this population.
Methods
We conducted a seroprevalence survey among HCWs in a French university hospital after the first wave (May-June 2020), based on a validated lateral flow immuno-assay test (LFIAT) for SARS-CoV-2. Demographic characteristics as well as data on the working characteristics of COVID-19 and non-COVID-19 wards and 23 care activities were systematically recorded. The effectiveness of protective equipment was also estimated, based on self-declaration of mask use. SARS-CoV-2 IgG status was modelled by multiple imputations approach, accounting for the performance of the test and data on serum validation ELISA immunoassay.
Findings
Among the 3,234 enrolled HCWs, the prevalence of SARS-CoV-2 IgG was 3.8%. Contact with relatives or HCWs who developed COVID-19 were risk factors for SARS-CoV-2 infection, but not contact with COVID-19 patients. In multivariate analyses, suboptimal use of protective equipment during naso-pharyngeal sampling, patient mobilisation, clinical and eye examination was associated with SARS-CoV-2 infection. In addition, patients washing and dressing and aerosol-generating procedures were risk factors for SARS-CoV-2 infection with or without self-declared appropriate use of protective equipment.
Interpretation
Main routes of transmission of SARS-CoV-2 IgG among HCWs were i) contact with relatives or HCWs with COVID-19, ii) close or prolonged contact with patients, iii) aerosol-generating procedures.
Article activity feed
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SciScore for 10.1101/2021.04.22.21255922: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study obtained the agreement of the Lyon Institutional Review Board (May, 28th 2020).
Consent: All HCWs signed an informed consent form, and the study was recorded on ClinicalTrials.gov (#35RC20_9716).Sex as a biological variable not detected. Randomization For 1,832 HCWs working in COVID-19 wards and a random sample of HCWs working in non COVID-19 wards (n=1,421), a supplemental questionnaire concerning occupational exposure was addressed. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Statistical analyse were performed using the SAS® package, v9.4, with FACTOR, LOGISTIC and MIANALYSE procedures. SAS®suggested: (SASqPCR, RRID:S…SciScore for 10.1101/2021.04.22.21255922: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study obtained the agreement of the Lyon Institutional Review Board (May, 28th 2020).
Consent: All HCWs signed an informed consent form, and the study was recorded on ClinicalTrials.gov (#35RC20_9716).Sex as a biological variable not detected. Randomization For 1,832 HCWs working in COVID-19 wards and a random sample of HCWs working in non COVID-19 wards (n=1,421), a supplemental questionnaire concerning occupational exposure was addressed. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Statistical analyse were performed using the SAS® package, v9.4, with FACTOR, LOGISTIC and MIANALYSE procedures. SAS®suggested: (SASqPCR, RRID:SCR_003056)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has several limitations. First, data on the use of protective equipment, particularly masks, were only declarative, and some HCWs may have over- or under-reported their use. We tried to limit this effect by attributing the quality of protection independently of the tasks using the same algorithm throughout the database. However, we observed associations for only a few activities, and the observation of a coherent gradient of transmission risk with the quality of protection support the validity of our findings. Another limitation was the low sero-prevalence, resulting in a low statistical power. Nonetheless, we were able to highlight several activities associated with the risk of SARS-CoV-2 infection, even in multivariable analyses. We also only considered SARS-CoV-2 IgG as the LFIAT shows low performances for the detection of SARS-CoV-2 IgM 11. As we began our study at the end of May, two months after the peak of the first epidemic wave in France, the effect on our prevalence estimate was probably minimal. Finally, we only analysed the protective effect of masks, without considering gloves, visors, and lab coats. Thus, our results primarily focus mostly on the risk of of SARS-CoV-2 transmission by inhalation. Our study also has several strengths. The determination of SARS-CoV-2 status was based on a LFIA test that we previously validated12. Our knowledge of the quality of both the negative and positive predictive values allowed us to include these data in our models...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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