key: cord-277763-ihg3te63
authors: Moynan, David; Cagney, Maura; Dhuthaigh, Aoife Ni; Foley, Margaret; Salter, Aisling; Reidy, Niamh; Reidy, Paul; de Barra, Eoghan; Fitzpatrick, Fidelma
title: The role of healthcare staff COVID-19 screening in infection prevention & control
date: 2020-06-25
journal: J Infect
DOI: 10.1016/j.jinf.2020.06.057
sha: 
doc_id: 277763
cord_uid: ihg3te63

nan

The current COVID-19 pandemic presents many unique challenges for occupational health medicine and infection prevention and control (IPC) in hospitals. While many hospital services were postponed during the pandemic's first peak, the resumption of routine services in an environment where patients still present with COVID-19 raises concerns over the potential for significant nosocomial COVID-19 transmission. We read with interest a recent study in this journal that emphasises the importance of identifying COVID-19 cases to prevent onward transmission of SARS-CoV-2 1 . While the rapid identification and subsequent testing of symptomatic healthcare workers (HCW) is paramount, we believe there is a role for testing irrespective of symptoms. While HCW can acquire infections and contribute to cross-transmission during hospital outbreaks such as influenza or norovirus, asymptomatic staff are usually not routinely screened as part of the outbreak control measures. The role of COVID-19 surveillance of asymptomatic HCW has recently been highlighted and may become increasingly pertinent with new infection waves 2,3 . However, the rapid detection of PCR-positive, asymptomatic staff is also crucial in the management of hospital clusters of COVID-19. Here, we discuss the high rate of SARS-CoV-2 PCR positivity among HCW during three inpatient ward outbreaks in Beaumont Hospital, Dublin, Ireland.

In March and April 2020, on three wards with two or more positive COVID-19 patients after three days of admission (designated as potential nosocomial infection), we implemented universal staff SARS-CoV-2 testing on that ward as part of outbreak management. A combined throat/nasopharyngeal swab was taken on HCW who had been working on the designated wards. RT-PCR was performed using Altona Diagnostics RealStar SARS-CoV-2 RT-PCR according to the manufacturer's instructions, on the Roche Light Cycler 480II 4 .

Demographics including age, sex and job title were collected. All results were disclosed to staff by occupational health and those testing positive were advised to remain off work for minimum 14 days, with appropriate follow up. In addition, details of symptoms, contacts and co-habitation were documented. Asymptomatic, SARS-CoV-2 PCR positive HCW were followed up by telephone for symptom development. Asymptomatic, SARS-CoV-2 PCR negative HCW were advised to self-monitor for symptoms and isolate if they were deemed a close contact of a known positive case. Interestingly, 11 (61%) of the symptomatic, PCR-positive HCW worked while symptomatic, similar to other reports 7 . This may reflect HCW presenteeism which has been reported previously during influenza seasons 8 . As asymptomatic (or indeed, pre-symptomatic) HCW may have similar viral loads and may be capable of transmission as much as symptomatic individuals 9 , their detection and subsequent exclusion from work is an important aspect of a hospital's COVID-19 strategy.

In conclusion, as hospitals begin to reopen to routine non-COVID-19 services, HCW SARS-CoV-2 testing irrespective of symptoms should be considered, particularly as part of outbreak management to rapidly prevent onward transmission to patients and other staff. Detecting SARS-CoV-2 positive staff will benefit not only public health measures, but in the case of staff cohabiting with other HCW, will also benefit other healthcare institutions. 

Clinical presentation of Covid-19 in health care workers from a French University Hospital

COVID-19: PCR Screening of Asymptomatic Health-Care Workers at London Hospital

COVID-19 screening of healthcare workers in a London maternity hospital

Universal Masking in Hospitals in the Covid-19 Era

Temporal dynamics in viral shedding and transmissibility of COVID-19

SARS-CoV-2 infection in 86 healthcare workers in two Dutch hospitals in

Working With Influenza-Like Illness: Presenteeism Among US Health Care Personnel During the 2014-2015 Influenza Season

SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients