engleski

Effective prevention of occupational SARS‐CoV‐2 infection among healthcare workers during the first wave of the COVID‐19 pandemic at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia

Because of their often extensive and close contact with infected individuals in the healthcare setting, healthcare workers (HCWs) are at increased risk for occupational acquisition of SARS‐CoV‐2 infection. Therefore, intense and strict implementation of pre‐exposure Infection Prevention and Control (IPC) recommendations and post‐exposure management are necessary to prevent nosocomial spread of SARS‐CoV‐2. The University Hospital for Infectious Diseases “Dr. Fran Mihaljević” in Zagreb was the first hospital to admit patients with COVID‐19 in Croatia with the first patient hospitalized on February 25, 2020. The aim of the study was to demonstrate the prevention of occupational SARSCoV‐2 infection among HCWs at the University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb, during the first wave of the COVID‐19 pandemic (between February 24 and May 27, 2020). During the study period, preventive measures against SARS‐ CoV‐2 infection were introduced in the Hospital, in accordance with CDC, ECDC and WHO recommendations, with enhanced aerosol precautionary measures. The Hospital also introduced continuous monitoring of the implementation of preventive measures, daily contact tracing among employees for potential contacts with persons infected with SARS‐CoV‐2, reporting of risky contacts with obligatory 14 (10)‐day self‐isolation, and regular screening with PCR test. In case of symptoms of COVID‐19 and/or suspicion of contact with a SARS‐CoV‐2 infected person, all employees were tested by RT‐ PCR for SARS‐CoV‐2 infection. For persons with proven contact with a PCR‐positive patient, an epidemiological self‐isolation measure lasting for 14 (later on 10) days was mandatory. At the end of the study period (May 2020), all employees were offered serological testing for SARS‐CoV‐2 in order to detect persons who had COVID‐19 and no PCR‐proven and/or asymptomatic infection. Prior to testing, all employees were interviewed about the possibilities, forms and intensity of occupational exposure, self‐isolation measures and possible infection. In the study period, the Hospital had a total of 705 employees. All employees were monitored for the detection of occupational infection throughout the study period, and serological screening and surveys were applied in 565 (80.1%) employees, of whom 467 (82.7%) were female ; the median age was 44 (range 19–66). Regarding formal education levels among tested employees, the highest (university) education was recorded in 116 (20.5%), higher (post‐secondary) education in 121 (21.2%), secondary education in 226 (40.0%), and lower basic education in 102 (18.1%) employees. Of these, 395 (69.9%) were healthcare professionals and 170 (30.1%) non‐ healthcare professionals: 45 (8.0%) administrative and 125 (22.1%) technical staff. Among those tested, there were 70 (12.4%) medical doctors, 195 (34.5%) nurses/technicians, 98 (17.3%) laboratory workers, 11 (2.0%) engineers in radiology, and 21 (3.7%) other healthcare professions. In the studied period, a total of 3118 persons with suspected COVID‐19 were examined at the Hospital, ranging from 3 to 159 per day (median 28.5), in 297 of whom molecular RTPCR test confirmed SARS‐ CoV‐2 infection, and 170 of them was hospitalized. Of all subjects, 143 (25.3%) had symptoms of COVID‐19 at least once during the study period, and 157 (27.8%) were tested due to suspected contact with an infected person. Epidemiological measure of self‐isolation due to proven contact with a sick person was imposed on 93 (16.5%) employees. SARS‐CoV‐2 infection was detected by PCR in only two employees (0.35%), however, occupational acquisition of COVID‐19 could not be confirmed in any of these cases. Subsequent serological testing confirmed the presence of IgG antibodies to SARS‐CoV‐2 as evidence of previous infection in only one employee ; while the other employee who had previously tested positive for PCR, was negative (this was probably a false positive laboratory result). Adherance to adequate preventive measures, and timely and adequate epidemiological measures, can successfully protect HCWs working with COVID‐19 positive patients from occupational infection with SARS‐CoV‐2.

COVID‐19 ; SARS‐CoV‐2 ; healthcare workers ; occupational exposure ; prevention

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