Professional practice for COVID-19 risk reduction among health care workers: A cross-sectional study with matched case-control comparison

  1. Sarah Wilson
  2. Audrey Mouet
  3. Camille Jeanne-Leroyer
  4. France Borgey
  5. Emmanuelle Odinet-Raulin
  6. Xavier Humbert
  7. Simon Le Hello
  8. Pascal Thibon

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Abstract

Health care workers (HCWs) are particularly exposed to COVID-19 and therefore it is important to study preventive measures in this population.

Aim

To investigate socio-demographic factors and professional practice associated with the risk of COVID-19 among HCWs in health establishments in Normandy, France.

Methods

A cross-sectional and 3 case-control studies using bootstrap methods were conducted in order to explore the possible risk factors that lead to SARS-CoV2 transmission within HCWs. Case-control studies focused on risk factors associated with (a) care of COVID-19 patients, (b) care of non COVID-19 patients and (c) contacts between colleagues.

Participants

2,058 respondents, respectively 1,363 (66.2%) and 695 (33.8%) in medical and medico-social establishments, including HCW with and without contact with patients.

Results

301 participants (14.6%) reported having been infected by SARS-CoV2. When caring for COVID-19 patients, HCWs who declared wearing respirators, either for all patient care (ORa 0.39; 95% CI: 0.29–0.51) or only when exposed to aerosol-generating procedures (ORa 0.56; 95% CI: 0.43–0.70), had a lower risk of infection compared with HCWs who declared wearing mainly surgical masks. During care of non COVID-19 patients, wearing mainly a respirator was associated with a higher risk of infection (ORa 1.84; 95% CI: 1.06–3.37). An increased risk was also found for HCWs who changed uniform in workplace changing rooms (ORa 1.93; 95% CI: 1.63–2.29).

Conclusion

Correct use of PPE adapted to the situation and risk level is essential in protecting HCWs against infection.

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  1. Version published to 10.1371/journal.pone.0264232
  2. Version published to 10.1101/2021.09.09.21263315v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.09.09.21263315: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: [14] Rights and ethics: The study was approved by the local ethics committee for health research of Caen university hospital (ID 2293) on March 24th 2021.
    Sex as a biological variablenot detected.
    RandomizationAs selecting a single set of controls could have led to an incorrect measurement of association due to random variations of ORs, we used a bootstrap method to perform 1,000 random samplings of controls, with replacement.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Participants: Healthcare personnel (medical and paramedical professionals, as well as personnel from laboratories, hospital pharmacies and administration) working in health establishments (hospitals, clinics, rehabilitation and recuperation care facilities and establishments specializing in psychiatry), nursing homes and establishments for handicapped children and adults in Normandy, France, were invited to participate in the study.
    Participants: Healthcare
    suggested: None
    The analyses were performed in R version 4.1.1 (R Development Core Team).
    R Development Core
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)

    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:
    This study presents some limitations. The questionnaire was filled in retrospectively by participants, and for respondents with history of COVID-19, the questions covered a short period of time before infection. HCWs were likely to not remember exactly what measures they applied during this period, although the infection was a noticeable event and had raised questions about its origin. This recall bias is unavoidable with studies based on questionnaires. Studies with a prospective measure of exposures and PPE use would help minimize this bias, observations of practices being more reliable than declarations, but are more difficult to conduct. Moreover, the use of an online questionnaire may have prevented certain profiles of caregivers from participating in the study. Another bias may result from an involuntary overestimation of PPE use by HCWs who declared a history of COVID-19 infection, explaining our results for PPE being a risk factor (namely respirators, face shields and protective goggles) during care of non COVID-19 positive patients. Another issue is that cases and controls who completed the questionnaire did so voluntarily. Therefore, respondents may not be fully representative of the general population of HCWs in France. Unfortunately, no estimation of the global response rate within HCWs in Normandy was able to be performed. The questionnaire was sent to health establishments’ management and then relayed to HCWs. There was no feedback as to how many HCWs had access...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.09.09.21263315v1 on medRxiv