|BRIEF RESEARCH ARTICLE
|Year : 2022 | Volume
| Issue : 2 | Page : 203-205
Profile of health care workers infected with SARS-CoV-2 infection in a central district in Kerala with focus on infection control practices
Aarati Krishnan1, Serin Kuriakose1, C Rohini1, Resmi S Kaimal2, S Sreedevi3
1 Assistant Surgeon, District Surveillance Unit Ernakulam, Department of Health, Government Health Services, Ernakulam, Kerala, India
2 Consultant Family Physician and Head of the Department, Department of Family Medicine, Lourdes Hospital, Post Graduate Institute of Medical Science and Research, Kochi, Kerala, India
3 Deputy Director of Health Services, District Surveillance Unit, Ernakulam, Kerala Government Health Services, Kerala, India
|Date of Submission||15-Jul-2021|
|Date of Decision||23-Dec-2021|
|Date of Acceptance||24-Dec-2021|
|Date of Web Publication||12-Jul-2022|
Kottackal House, Mekkad P.O., Mekkad, Ernakulam, Kerala
Source of Support: None, Conflict of Interest: None
| Abstract|| |
There were reports of severe acute respiratory syndrome coronavirus 2 infection cases among health-care workers from all around the world. We did a cross sectional study among 533 COVID19 affected health-care workers. About 87.43% of participants were involved in duties not directly related to COVID-19 management. About 19.6% contracted the disease from their colleagues. About 15% of the affected health-care workers had at least one comorbidity and diabetes mellitus was the most common (5%). 57% of participants presented with fever followed by body ache in 40%. Only 0.4% of the participants needed ventilator support during treatment. 36% of the participants reported household transmission from them. Adequate personal protective equipment (PPE) usage and functioning infection control committee in their hospital were reported by most of the participants. The study points towards the need of adequate PPE use in the nonCOVID settings and the need for periodical assessment of infection control practices.
Keywords: COVID 19, health-care workers, severe acute respiratory syndrome coronavirus 2 infection
|How to cite this article:|
Krishnan A, Kuriakose S, Rohini C, Kaimal RS, Sreedevi S. Profile of health care workers infected with SARS-CoV-2 infection in a central district in Kerala with focus on infection control practices. Indian J Public Health 2022;66:203-5
|How to cite this URL:|
Krishnan A, Kuriakose S, Rohini C, Kaimal RS, Sreedevi S. Profile of health care workers infected with SARS-CoV-2 infection in a central district in Kerala with focus on infection control practices. Indian J Public Health [serial online] 2022 [cited 2022 Sep 29];66:203-5. Available from: https://www.ijph.in/text.asp?2022/66/2/203/350646
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first detected in Wuhan, China, as a cluster of atypical pneumonia cases in December 2019. Cases were reported from different parts of the world and it was declared as a pandemic by the WHO. Health-care workers played a critical role not only in the clinical management of patients but also in ensuring adequate infection prevention and control measures in health-care facilities. Globally, health-care workers started getting infected and Kerala also reported cases among health-care workers. The first case reported in India was in the Trichur district of Kerala on January 30, 2020.
Health-care worker infection constituted 2.1% of the total COVID-19 cases in Ernakulam district in November 2020. The district had also witnessed four deaths among health care workers due to COVID-19. A study conducted by Nguyen et al. showed that health care workers had at least a threefold increased risk of reporting a positive COVID-19 test and predicted COVID-19 infection compared with the general community.
As per our knowledge, there were no studies that looked into the profile of COVID-19 diagnosed health care workers from Kerala. Hence, this study was done to determine the profile of COVID-19 diagnosed health-care workers of Ernakulam district and also to assess the potential factors contributing to the SARS-CoV-2 infection among the health workers. This is essential for characterizing the virus transmission patterns, preventing infections among health care workers, and preventing the health-care delivery associated spread of COVID-19.
After obtaining ethical clearance from the Institutional Ethical Committee of Lourdes Hospital Post Graduate Institute of Medical Science and Research, we conducted a descriptive cross-sectional study to study the sociodemographic profile of SARS-CoV2 infected health care workers in the Ernakulam district and assess the factors that contributed to the infection. The respondents were district residents diagnosed with COVID-19 by any accepted laboratory tests from March 1, 2020, to February 28, 2021. Based on a study done by Jameela Alajmia et al. in the International Journal of Infectious Diseases, we calculated the sample size applying the formula . The estimated sample size was 522. The study participants were selected by a simple random method using computer-generated random numbers from the list of COVID-19 affected health care workers, which was retrieved from the office of the District COVID-19 surveillance unit. The data were collected using a pretested semi-structured interview. We enquired about sociodemographic and workplace details, infection control practices, and symptom analysis. After obtaining informed verbal consent, trained volunteers collected the data through a telephonic interview. We coded the data and entered it into the Microsoft Excel spreadsheet. The statistical analysis was performed usingIBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Continuous variables were expressed as mean and standard deviation, while categorical variables were described as frequencies and percentages. We ensured the privacy and confidentiality of the data.
A total of 533 COVID-19 affected health-care workers participated in the study. The mean age of the respondents was 35.9 ± 10.4 years (range: 18–78 years). 77.86% (n = 415) were female and 69% (n = 368) worked in the private health-care sector [Table 1]. Most of the affected health-care workers (91.93%) were hospital staff who worked indoors and the remaining 8.07% were field staff. Among the total, 208 (39.02%) were nurses and 90 (16.80%) were doctors.
About 87.43% of participants were involved in duties not directly related to COVID-19 management. In comparison, only 12.57% were directly involved in dedicated COVID care. The main places of work were nonCOVID wards (15.76%), OPD (15.01%), nonCOVID intensive care unit (ICU) (11.63%), and emergency/casualty services (6.19%).
In 48.03% of the health-care workers, COVID-19 was detected using the Rapid Antigen test. 46.15% were diagnosed by RT-PCR test and 5.82% with the other molecular tests. About 50.66% of the participants got tested when they developed symptoms, while 43.53% were tested following exposure to a COVID-19 case. The remaining 5.82% were tested as a part of the sentinel surveillance among the health-care workers. [Table 2] shows the number of participants with a history of contact with a confirmed case of COVID-19.
We found that fever (56.85%) was the most common presentation. Other symptoms included body ache (39.96%), headache (36.7%), sore throat (26.64%), anosmia (20.08%), loss of taste (19.89), breathing difficulty (7.50%), and loose stools (6.38%). About 16.89% (n = 90) of the participants were asymptomatic. There were no comorbidities in the majority (85.36%) of study participants. About 6.2% and 4.87% of participants had diabetes mellitus and hypertension, respectively. Hypothyroidism was present in 2% of participants and Bronchial Asthma in 1.5%.
While almost half (49.91%) of the affected health-care workers remained in home isolation, one-third (33.02%) participants were admitted to various hospitals for treatment. About 15.95% were admitted at COVID 19 first-line treatment centers and 1.13% at COVID 19 second-line treatment centers. The mean duration of hospital stay was 8.9 (standard deviation: 5.2) days. The longest hospital stay was for 34 days. During the treatment, 22.51% (n = 120) received antiviral medications, and 2.06% were not aware of their treatment type. Only 1.13% (n = 6) required ICU care, while 0.38% required invasive ventilatory support.
Regarding the source of infection, 266 (49.91%) of the HCWs consider having contracted the disease from their workplace. Among them, 48.9% (111) had provided direct care to patients without knowing the COVID-19 status of the patient. 70.3% (n = 80) of participants among them had close face-to-face contact and 85 (74.5%) had a close contact period of more than 15 min. 19.6% (n = 52) of those whose who had workplace exposure reported that they could have contracted the disease from their co-workers and other staff during leisure time/at the time of lunch or snacks/during their staying together at the accommodation facilities provided. More than one-third (36.02%) of the health-care workers responded that at least one of the household members contracted the disease following exposure from the infected health care workers.
According to 89.43% of the participants, a functioning Infection Control Committee at their workplace monitored infection control practices regularly. About 68.29% responded that the committee had organized at least one training session on infection control practices in the last six months. About 84.24% of the total study participants attended the sessions and personal protective equipment (PPE) usage training in their hospital. About 4.37% (n = 19) were not aware of the infection control committee.
About 92.31% used adequate PPE (recommended by the WHO for the work arena) during patient interaction. Surgical masks/N95 masks were used by 94.93% of the respondents, face shield/goggles by 88.18%, and gown/apron by 67.35%. About 88.74% were using PPE according to the protocol. Almost everyone (99.49%) observed adequate hand hygiene before and after patient contact, procedure, or exposure to any patient secretions and after contact with any fomites.
Our study found a higher incidence of the disease among the nurses. This could be because nurses are directly involved in health-care delivery and nursing staff comprises the major human resource in the health system. Moreover, most of our participants were females and as per the prevailing gender norms, females are involved in the caring role of children and the elderly in households. Hence, the finding that 77.86% of affected health-care workers were females should be considered seriously to prevent spread to the vulnerable people and thus to avoid adverse outcomes among them.
A high level of patient HCW interaction occurs in the wards, ICU and emergency departments. Hence, strict adherence to infection control practices and facilities to practice them should be ensured. The majority of the HCWs thought they had contracted the infection from the workplace and our study showed that it was mainly from the nonCOVID area. This points toward the importance of adequate PPE usage and other precautions taken in the nonCOVID treatment area. Even though there was an established community transmission in the state, health care settings continue to be the vulnerable places for disease transmission. All these show the importance of screening the individuals in the hospital setting and warrant an extra precaution by the hospital staff managing nonCOVID section. Moreover, the transmission of the infection from the health-care workers to their household contacts indicated that the disease detection was delayed among the health-care workers, which might have led to the increased transmission.
Although there was an adequate adherence to infection control practices, workplace exposure was very high as per the study. This shows that it is necessary to periodically assess the quality of infection control practices. The increased incidence of COVID-19 infection among the health-care workers involved in nonCOVID duty shows the importance of proper PPE usage and disposal and infection control practices in the nonCOVID settings.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Nguyen L, Drew D, Graham M, Joshi A, Guo CG, Ma W, et al
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COVID-19 infection among healthcare workers in a national healthcare system: The Qatar experience. Int J Infect Dis 2020;100:386-9.
[Table 1], [Table 2]