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Transmission of COVID-19 to Healthcare Personnel During Exposures to a Hospitalized Patient
TAKE-HOME MESSAGE
- Among 121 healthcare personnel who were exposed to a patient who tested positive for SARS-CoV-2, 37 were interviewed, including 3 who had positive test results. Healthcare personnel with laboratory-confirmed COVID-19 more frequently reported performing physical examinations and having exposure to the patient during nebulizer treatments compared with those without COVID-19. Healthcare personnel with COVID-19 also reported longer duration of exposures to the patient.
- These findings highlight the importance of early recognition and isolation of patients with possible COVID-19 and the use of PPE to minimize exposure of healthcare personnel.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOn February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California (1). The patient was initially evaluated at hospital A on February 15; at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient’s transfer to hospital B, a real-time reverse transcription–polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2; three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19; HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.
Additional Info
Disclosure statements are available on the authors' profiles:
COVID-19 toll on healthcare personnel
Healthcare workers are on the front line of COVID-19 response, and, in this position, we are voluntarily placed into arenas of heightened risk. A couple of recent CDC assessments clarify this risk. The very nature of medical practice is communal; we come together to provide comprehensive and multidisciplinary care. This community of care is illustrated in a case study of 1 hospitalized COVID-19 patient in California.1 During a 4-day stay, no fewer than 121 healthcare personnel (HCP) were exposed to this individual; it should be said that COVID-19 was not suspected during this hospitalization. Of those exposed, 43 (36%) became symptomatic and 3 (2.4%) were found to be positive for SARS-CoV-2. All 3 of the secondary cases had unprotected patient contact. Moreover, they spent significantly longer time in the patient‘s hospital room than did those not contracting SARS-CoV-2.
In a larger analysis, the CDC COVID-19 Response Team analyzed data from nearly 50,000 COVID-19 cases associated with completed standardized data forms, of which 9282 (19%) were HCP.2 This percentage is likely inflated, however, by the likelihood of HCP to complete forms; in another population-based assessment, HCPs account for about 11% of COVID-19 cases. The median age of cases was 42 years, 73% were female, and 38% had an underlying health condition. Moreover, 55% of HCP cases reported that their only exposures to SARS-CoV-2 were within healthcare settings, with household exposures accounting for an additional 27%. Most cases (92%) reported fever, cough, and/or shortness of breath.
The great majority of HCP cases were not hospitalized (90%), but 2% to 5% were admitted to an ICU and 0.3% to 0.6% died of COVID-19. As noted elsewhere, increasing age was a significant factor in hospitalization, ICU admission, and death.
The take-home lessons for primary care clinicians and other healthcare personnel are summarized here:
Early recognition and isolation of COVID-19 cases is essential for safe care management.
Prolonged and unprotected exposures as well as some aerosol-generating procedures are associated with HCP acquisition of SARS-CoV-2 infection.
Consistent use of the appropriate PPE is required for patient care.
All HCP should be screened for fever and respiratory symptoms at the beginning of shifts or upon entry to healthcare facilities.
HCP should be prioritized for SARS-CoV-2 testing.
HCP should be discouraged from working while ill.
Older HCP and those with underlying health conditions should consult with their healthcare providers and employee health programs to better understand and manage risk.
References