key: cord-0753383-zkqfase7
authors: Alajmi, Jameela; Jeremijenko, Andrew M.; Abraham, Joji C.; Alishaq, Moza; Concepcion, Elli Gabriel; Butt, Adeel Ajwad; Abou-Samra, Abdul-Badi
title: COVID-19 Infection Among Healthcare Workers in a National Healthcare System: the Qatar Experience
date: 2020-09-16
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.09.027
sha: 0dd0046c3b2f2c1a3a2bc44027c28238bd0ebe15
doc_id: 753383
cord_uid: zkqfase7

BACKGROUND: Our aim was to determine the prevalence of COVID-19 infection in healthcare workers (HCW) in a national healthcare system and to understand the risk factors for infection. METHODS: The study was conducted at Hamad Medical Corporation in Qatar, a national healthcare system with 14 hospitals and >28,000 employees, between March 10-June 24, 2020. Data on COVID-19+ HCW were retrieved from the electronic health records and employment records, followed by an email survey and a focused telephone interview. RESULTS: Among 16,912 HCW tested, 10.6% tested positive. Hospitalization rate was 11.6%, 1.3% required supplemental oxygen, 0.6% needed intensive care unit admission and 0.3% required mechanical ventilation. There were no deaths. In a follow-up survey of 393 HCW, 5% reported acquiring infection at a COVID-19-designated facility and 95% at a non-COVID-19 facility having acquired the infection through accidental exposure to a colleague (45%) or a patient (29%). Full PPE adherence was 82% at COVID-19-designated but only 68% at non-COVID-19 facilities. CONCLUSIONS: COVID-19 infection among HCW often occurs among those not directly working with COVID-19 patients. PPE use is less stringent in such settings. Risk of exposure and need for strict PPE must be stressed upon all HCW in all settings.

Since the identification of first case cluster in Wuhan, China in December 2019, the COVID-19 pandemic has swept the entire world. The pandemic has overwhelmed hospital capacity and existing healthcare resources in many countries. Healthcare workers (HCW) are a particularly high risk group due to their close interactions with infected persons as well as lack or deficiency of personal protective equipment in many settings. The rate of infection in HCW is reported to vary between 3-17% and varies according to the history and degree of exposure and presence of symptoms. [1] [2] [3] [4] It is important to understand the prevalence and risk factors for COVID-19 infection among HCW due to the potential to transmit infection to vulnerable patients, and since a further depletion of the workforce due to infection among the HCW can lead to critical shortages and adversely impact patient care. Our aim was to determine the prevalence of COVID-19 infection in HCW in a national healthcare system and to understand the risk factors for infection.

The study was conducted at Hamad Medical Corporation in Qatar between March 10, 2020 and June 24, 2020. Hamad Medical Corporation is the public healthcare delivery organization providing approximately 85% of the acute care inpatient bed capacity in the State of Qatar.

There are 14 hospitals in the organization with a total employed staff of more than 28,000 persons. All hospitals are accredited by the Joint Commission International and the central lab is accredited by the College of American Pathologists. There is a single electronic health record system (Cerner, Kansas City, USA) across all facilities and patients and staff retain the same unique hospital identification number across the system.

The first case of COVID-19 in Qatar was identified on February 28, 2020 in a returning traveler.

However, screening of potential high risk and symptomatic persons had begun in early J o u r n a l P r e -p r o o f 6 February. Testing capacity in Qatar was ramped up rapidly and currently Qatar ranks among the countries with highest per capita testing in the world. Screening of HCW began in mid-February 2020, with initial screening performed on symptomatic HCW and those with a history of any contact with a confirmed or suspected case. Testing for COVID-19 was performed using a deep nasopharyngeal and a concomitant throat swab by trained professionals. Validated RT-PCR was performed at a single national reference lab to confirm infection. Beginning in April 2020, all HCW in intensive care units and emergency departments were required to undergo point-ofcare testing using commercial antibody kits (company name) every two weeks. Those testing positive for IgM provided a nasopharyngeal and throat swab for RT PCR testing.

All HCW at any of the HMC facilities with a RT PCR positive for COVID-19 on a nasopharyngeal swab were eligible to be included in this study. We retrieved demographic and employment related information from the electronic health records and employment records in the Human Resources department. Trained infection control practitioners at each facility approached all positive HCWs through email and follow-up telephone calls to gather data regarding exposure history, use of personal protective equipment and presence of symptoms. The WHO COVID-19 staff exposure risk assessment tool was used as a template to gather data. In addition, we used a checklist of symptoms developed for triage of suspected patients to ascertain presence of

symptoms. An open-ended question was also included to elicit any other symptoms not listed in the checklist. Hospitalization data, including admitting unit and need for supplemental oxygen were extracted from the electronic health records. 

Protection of HCW from infection is critical for resilience of the health system facing a major pandemic such as COVID-19. However, despite all efforts to protect HCW, some exposure is inevitable. Such exposure can occur at the workplace or outside the work environment in the community.

To reduce workplace exposure, increase efficiency, and pooling of resources, Qatar decided to designate certain facilities to be non-COVID-19 facilities before the pandemic hit the country. It was therefore anticipated that HCW working at non-COVID-19 facilities would be at a very low risk for infection acquired at the workplace. It was therefore surprising that 95% of the infected HCW were assigned to a non-COVID-19 facility and 72% of these reported exposure to a J o u r n a l P r e -p r o o f

COVID-19 symptoms predictive of healthcare workers' SARS-CoV-2 PCR results

COVID-19 infections among Healthcare Workers in an Infectious Diseases specialized setting in Naples, Southern Italy: results of a crosssectional surveillance study

Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study

High SARS-CoV-2 antibody prevalence among healthcare workers exposed to COVID-19 patients

Conflict of interest: The authors have no conflict of interest to declare.Funding: There was no funding for this study.

The study was approved by the Institutional Review Board of Hamad Medical Corporation with a waiver of informed consent under a pandemic response framework adopted by the institution.J o u r n a l P r e -p r o o f