Should healthcare workers with SARS-CoV-2 household exposures work? A Cohort Study
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Abstract
Importance
Due to high community transmission of the Omicron variant, healthcare workers (HCWs) have been increasingly reporting household exposures to confirmed COVID-19 cases. Quebec (Canada) provincial guidelines required to quarantine these HCWs. Facing the risk of staffing shortages, our hospital decided to allow them to work.
Objective
To evaluate the risk for HCWs, who were household contacts, to become positive for COVID-19 by RT-PCR and evaluate the risk of nosocomial COVID-19 transmission.
Design
Cohort of HCWs with a history of household exposure to a confirmed case of COVID-19.
Setting
CHU Sainte-Justine, a tertiary care mother and child center in Montreal (QC) Canada
Participants
Consecutive HCWs who contacted OHS between December 20, 2021 and January 17, 2022 for a history of household exposure to COVID-19.
Exposure
Confirmed case of COVID-19 in the household
Main outcome and measures
The main outcome was a positive RT-PCR for SARS-CoV-2. Outbreaks and nosocomial cases were identified through daily analysis of COVID-19 cases, by sector and part of the usual Infection Prevention and Control surveillance process.
Results
Overall, 237 of 475 (50%) HCWs who declared a known household contact with a confirmed COVID-19 case remained negative. Of those who became positive, 196 (82.4%) were positive upon initial testing and were quarantined. Only 42 (15%) of 279 HCWs who were allowed to work became positive, a median of 4 days after the initial test. The absence of symptoms at initial evaluation (OR 3.8, 95% CI 2.5-5.7) and having received a third vaccine dose more than 7 days before (OR 1.88, 95% CI 1.3 – 2.8) were associated with an increased odds of remaining negative. There was no outbreak among HCWs and no nosocomial transmission to patients from a HCW that was allowed to work, while a known household contact.
Conclusion and relevance
Measures taken to protect the health care environment from COVID-19 must be cautiously balanced with the risk of staffing shortage. Allowing vaccinated asymptomatic HCWs who are known household contacts of confirmed COVID-19 cases to work is likely a safe alternative, when staff shortage is anticipated.
Article activity feed
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SciScore for 10.1101/2022.01.23.22269719: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical consideration: Because this was an quality improvement evaluation using data collected through our usual process of care, we obtained a waiver from the Research Ethics Committee. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All analyses were done using STATA version 17.0 (StataCorp LLC, College Station, TX). STATAsuggested: (Stata, RRID:SCR_012763)StataCorpsuggested: (Stata, RRID:SCR_012763)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).
Res…SciScore for 10.1101/2022.01.23.22269719: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical consideration: Because this was an quality improvement evaluation using data collected through our usual process of care, we obtained a waiver from the Research Ethics Committee. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All analyses were done using STATA version 17.0 (StataCorp LLC, College Station, TX). STATAsuggested: (Stata, RRID:SCR_012763)StataCorpsuggested: (Stata, RRID:SCR_012763)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 had some limitations. Although HCWs may not report all known household exposures, they need to be assessed by OHS to have access to their paid sick/contact leaves. We expect that completeness of data is likely. Given our province-wide availability of RT-PCR results, all results were accessible. As this is real-life setting, it was impossible to have a complete cohort that would include all known and unknown household index cases. Our objective was not to document household SARs but rather to evaluate if it was safe to let HCWs with known household exposures work. Measures taken to protect the health care environment from COVID-19 must be cautiously balanced with the risk of staffing shortage. Appropriately worn personal protective equipment, is effective against transmission. We thus need to weigh 1) the possible impact of COVID-19 transmission to patients in a mother-child hospital where most would fare well even if infected, 2) the risk of COVID-19 transmission to HCWs whose risk of complications given high vaccination rates is low, to 3) the risk to patients and colleagues (mandatory overtime, errors) of highly specialised staff shortages. Allowing vaccinated asymptomatic HCWs who are known household contacts of confirmed COVID-19 cases to work is likely a safe alternative, when staff shortage is anticipated.
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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