Risk factors and frequency of COVID-19 among healthcare workers at a tertiary care centre in India: a case–control study

DOI record: { "DOI": "10.1093/trstmh/trab047", "ISSN": [ "0035-9203", "1878-3503" ], "URL": "http://dx.doi.org/10.1093/trstmh/trab047", "abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>There is a paucity of data on risk factors for infection among healthcare workers (HCWs) from India. Our objective was to evaluate the risk factors and frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCWs.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>We conducted this retrospective case–control study of 3100 HCWs between May and July 2020. HCWs positive for SARS-CoV-2 infection were the cases (n=506) and those negative for SARS-CoV-2 were the controls (n=253). Univariate analysis was followed by multivariate analysis of key demographic, clinical and infection control variables.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>SARS-CoV-2 infection was found in 16.32% of HCWs. Nearly 45% of infected HCWs were asymptomatic. The proportions of sanitation workers (24% vs 8%; p&amp;lt;0.0001) and technicians (10% vs 4%; p=0.0002) were higher and that of doctors was lower among cases as compared with controls (23% vs 43%; p&amp;lt;0.0001). On univariate analysis, the type of HCW, smoking, lack of training, inadequate personal protective equipment (PPE) use and taking no or fewer doses of hydroxychloroquine (HCQ) were found to be significant. On multivariate analysis, the type of HCW (risk ratio [RR] 1.67 [95% confidence interval {CI} 1.34 to 2.08], p&amp;lt;0.0001), inappropriate PPE use (RR 0.63 [95% CI 0.44 to 0.89], p=0.01) and taking fewer doses of HCQ (RR 0.92 [95% CI 0.86 to 0.99], p=0.03) were significant.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>The frequency of SARS-CoV-2 infection was 16% among HCWs. Being a sanitation worker, inappropriate PPE use and lack of HCQ prophylaxis predisposed HCWs to SARS-CoV-2 infection.</jats:p>\n </jats:sec>", "author": [ { "ORCID": "http://orcid.org/0000-0003-2486-6725", "affiliation": [ { "name": "Department of Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India 110029" } ], "authenticated-orcid": false, "family": "Dev", "given": "Nishanth", "sequence": "first" }, { "affiliation": [ { "name": "Department of Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India 110029" } ], "family": "Meena", "given": "Ramesh Chand", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India 110029" } ], "family": "Gupta", "given": "D K", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Pulmonology and Critical Care, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India 110029" } ], "family": "Gupta", "given": "Nitesh", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India 110029" } ], "family": "Sankar", "given": "Jhuma", "sequence": "additional" } ], "container-title": "Transactions of The Royal Society of Tropical Medicine and Hygiene", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2021, 3, 3 ] ], "date-time": "2021-03-03T20:34:04Z", "timestamp": 1614803644000 }, "deposited": { "date-parts": [ [ 2021, 9, 1 ] ], "date-time": "2021-09-01T10:14:31Z", "timestamp": 1630491271000 }, "indexed": { "date-parts": [ [ 2024, 1, 30 ] ], "date-time": "2024-01-30T07:58:23Z", "timestamp": 1706601503345 }, "is-referenced-by-count": 19, "issue": "5", "issued": { "date-parts": [ [ 2021, 3, 24 ] ] }, "journal-issue": { "issue": "5", "published-online": { "date-parts": [ [ 2021, 3, 24 ] ] }, "published-print": { "date-parts": [ [ 2021, 5, 8 ] ] } }, "language": "en", "license": [ { "URL": "https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2021, 3, 24 ] ], "date-time": "2021-03-24T00:00:00Z", "timestamp": 1616544000000 } } ], "link": [ { "URL": "http://academic.oup.com/trstmh/article-pdf/115/5/551/40180644/trab047.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "syndication" }, { "URL": "http://academic.oup.com/trstmh/article-pdf/115/5/551/40180644/trab047.pdf", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "286", "original-title": [], "page": "551-556", "prefix": "10.1093", "published": { "date-parts": [ [ 2021, 3, 24 ] ] }, "published-online": { "date-parts": [ [ 2021, 3, 24 ] ] }, "published-other": { "date-parts": [ [ 2021, 5 ] ] }, "published-print": { "date-parts": [ [ 2021, 5, 8 ] ] }, "publisher": "Oxford University Press (OUP)", "reference": [ { "article-title": "Novel coronavirus (2019-nCoV). Situation report – 1. 21 January 2020", "author": "World Health Organization", "key": "2021090110141259500_bib1" }, { "article-title": "WHO coronavirus (COVID-19) dashboard", "author": "World Health Organization", "key": "2021090110141259500_bib2" }, { "article-title": "COVID-19 statewise status", "author": "Ministry of Health and Family Welfare, Government of India", "key": "2021090110141259500_bib3" }, { "DOI": "10.15585/mmwr.mm6915e6", "article-title": "Characteristics of health care personnel with COVID-19 – United States, February 12–April 9, 2020", "author": "CDC COVID-19 Response Team", "doi-asserted-by": "crossref", "first-page": "477", "issue": "15", "journal-title": "MMWR Morb Mortal Wkly Rep", "key": "2021090110141259500_bib4", "volume": "69", "year": "2020" }, { "DOI": "10.1001/jamanetworkopen.2020.9666", "article-title": "Coronavirus disease 2019 (COVID-2019) infection among health care workers and implications for prevention measures in a tertiary hospital in Wuhan, China", "author": "Lai", "doi-asserted-by": "crossref", "first-page": "e209666", "issue": "5", "journal-title": "JAMA Netw Open", "key": "2021090110141259500_bib5", "volume": "3", "year": "2020" }, { "DOI": "10.1016/S1473-3099(20)30527-2", "article-title": "COVID-19 in health-care workers in three hospitals in the south of the Netherlands: a cross-sectional study", "author": "Sikkema", "doi-asserted-by": "crossref", "first-page": "1273", "issue": "12", "journal-title": "Lancet Infect Dis", "key": "2021090110141259500_bib6", "volume": "20", "year": "2020" }, { "DOI": "10.1001/jamanetworkopen.2020.9673", "article-title": "Prevalence and clinical presentation of health care workers with symptoms of coronavirus disease 2019 in 2 Dutch hospitals during an early phase of the pandemic", "author": "Kluytmans-van den Bergh", "doi-asserted-by": "crossref", "first-page": "e209673", "issue": "5", "journal-title": "JAMA Netw Open", "key": "2021090110141259500_bib7", "volume": "3", "year": "2020" }, { "DOI": "10.4081/monaldi.2020.1474", "article-title": "COVID-19 infection outbreak among health care workers: perspective from a low-middle income country", "author": "Dev", "doi-asserted-by": "crossref", "journal-title": "Monaldi Arch Chest Dis", "key": "2021090110141259500_bib8", "year": "2020" }, { "article-title": "Novel coronavirus disease 2019 (COVID-19): guidelines on rational use of personal protective equipment", "author": "Ministry of Health and Family Welfare, Government of India", "key": "2021090110141259500_bib9" }, { "DOI": "10.4103/ijmr.IJMR_2234_20", "article-title": "Healthcare workers & SARS-CoV-2 infection in India: a case-control investigation in the time of COVID-19", "author": "Chatterjee", "doi-asserted-by": "crossref", "first-page": "459", "issue": "5", "journal-title": "Indian J Med Res", "key": "2021090110141259500_bib10", "volume": "151", "year": "2020" }, { "author": "Clinical management protocol: COVID-19", "key": "2021090110141259500_bib11", "volume-title": "Ministry of Health and Family Welfare, Government of India" }, { "DOI": "10.1007/s00134-003-1662-x", "article-title": "2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference", "author": "Levy", "doi-asserted-by": "crossref", "first-page": "530", "issue": "4", "journal-title": "Intensive Care Med", "key": "2021090110141259500_bib12", "volume": "29", "year": "2003" }, { "article-title": "Advisory for managing health care workers working in COVID and non-COVID areas of the hospital", "author": "Ministry of Health and Family Welfare, Government of India", "key": "2021090110141259500_bib13" }, { "DOI": "10.1093/aje/kwaa191", "article-title": "COVID-19 in healthcare workers: a living systematic review and meta-analysis of prevalence, risk factors, clinical characteristics, and outcomes", "author": "Gómez-Ochoa", "doi-asserted-by": "crossref", "first-page": "161", "issue": "1", "journal-title": "Am J Epidemiol", "key": "2021090110141259500_bib14", "volume": "190", "year": "2021" }, { "DOI": "10.1016/j.cmi.2020.06.013", "article-title": "Characteristics of 1573 healthcare workers who underwent nasopharyngeal swab testing for SARS-CoV-2 in Milan, Lombardy, Italy", "author": "Lombardi", "doi-asserted-by": "crossref", "first-page": "1413.e9", "issue": "10", "journal-title": "Clin Microbiol Infect", "key": "2021090110141259500_bib15", "volume": "26", "year": "2020" }, { "DOI": "10.1093/cid/ciaa287", "article-title": "Risk factors of healthcare workers with corona virus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China", "author": "Ran", "doi-asserted-by": "crossref", "first-page": "2218", "issue": "16", "journal-title": "Clin Infect Dis", "key": "2021090110141259500_bib16", "volume": "71", "year": "2020" }, { "DOI": "10.1016/j.jinf.2020.05.067", "article-title": "High SARS-CoV-2 antibody prevalence among healthcare workers exposed to COVID-19 patients", "author": "Chen", "doi-asserted-by": "crossref", "first-page": "420", "issue": "3", "journal-title": "J Infect", "key": "2021090110141259500_bib17", "volume": "81", "year": "2020" }, { "DOI": "10.1016/S0140-6736(20)31142-9", "article-title": "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis", "author": "Chu", "doi-asserted-by": "crossref", "first-page": "1973", "issue": "10242", "journal-title": "Lancet", "key": "2021090110141259500_bib18", "volume": "395", "year": "2020" }, { "DOI": "10.1136/bmj.m2195", "article-title": "Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study", "author": "Liu", "doi-asserted-by": "crossref", "first-page": "m2195", "journal-title": "BMJ", "key": "2021090110141259500_bib19", "volume": "369", "year": "2020" }, { "DOI": "10.1093/cid/ciaa977", "article-title": "Comparing dynamics and determinants of SARS-CoV-2 transmissions among health care workers of adult and pediatric settings in central Paris", "author": "Contejean", "doi-asserted-by": "crossref", "first-page": "257", "issue": "2", "journal-title": "Clin Infect Dis", "key": "2021090110141259500_bib20", "volume": "72", "year": "2020" }, { "DOI": "10.1001/jamainternmed.2020.6319", "article-title": "Efficacy and safety of hydroxychloroquine vs placebo for pre-exposure SARS-CoV-2 prophylaxis among health care workers: a randomized clinical trial", "author": "Abella", "doi-asserted-by": "crossref", "first-page": "195", "issue": "2", "journal-title": "JAMA Intern Med", "key": "2021090110141259500_bib21", "volume": "181", "year": "2021" } ], "reference-count": 21, "references-count": 21, "relation": {}, "resource": { "primary": { "URL": "https://academic.oup.com/trstmh/article/115/5/551/6186057" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [ "Infectious Diseases", "Public Health, Environmental and Occupational Health", "General Medicine", "Parasitology" ], "subtitle": [], "title": "Risk factors and frequency of COVID-19 among healthcare workers at a tertiary care centre in India: a case–control study", "type": "journal-article", "volume": "115" }