For Infection Preventionists Battling COVID: Beware of the Break Room

September 10, 2020

As these healthcare worker serology studies are designed and performed, we need more insight beyond just PPE use and symptoms, but also internal and external exposures.

With the widespread transmission of coronavirus disease 2019 (COVID-19) in the community, cases are not unique to those in a healthcare setting. In fact, the challenges of infection prevention outside of work really emphasize how we view risk in this COVID-19 world.

Perhaps one of the biggest challenges I’ve seen within infection prevention during this time has been risk awareness and perception. Too commonly we focus on the risk of patient-facing interactions and not those outside of those care environments. For example, we often think the highest risk interaction is in the patient’s room but not in the breakroom, where people are eating and talking without masks on.

Understanding this piece, coupled with the prevalence of healthcare worker COVID-19 cases, can help us improve education, communication, and infection prevention efforts. A recent study published in the Center for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report (MMWR) discusses this very topic. Knowing that healthcare workers are inherently at greater risk for infection due to the nature of their work, what is the true prevalence and features of such infections? From April 3 to June 19, 2020, researchers collected serum specimens from frontline healthcare workers across 13 medical centers in the United States. These 3,248 healthcare workers had worked with COVID-19 patients and were asked about symptoms and use of personal protective equipment (PPE).

The researchers reported that “among 3,248 participants, 194 (6.0%) had positive test results for SARS-CoV-2 antibodies. Seroprevalence by hospital ranged from 0.8% to 31.2% (median = 3.6%). Among the 194 seropositive participants, 56 (29%) reported no symptoms since February 1, 2020, 86 (44%) did not believe that they previously had COVID-19, and 133 (69%) did not report a previous COVID-19 diagnosis. Seroprevalence was lower among personnel who reported always wearing a face covering (defined in this study as a surgical mask, N95 respirator, or powered air purifying respirator [PAPR]) while caring for patients (5.6%), compared with that among those who did not (9.0%) (p = 0.012).”

Not surprisingly, these findings matched prevalence of asymptomatic and minimally symptomatic cases in the community. Of those participants, 44% were nurses, 29% were physicians/nurse practitioners/physician assistants, 7% were respiratory therapists, and 20% had other clinical roles. Eighty percent reported no underlying medical conditions and the majority worked in the intensive care unit, followed by the emergency department at their respective medical centers. Moreover, 89% reported face coverings during all clinical encounters. In 8 of the 13 medical centers, over 10% of participants reported PPE shortages, of whom there was a higher percentage with detectable antibodies.

Ultimately this sheds light on not only issues surrounding PPE availability and the true efficacy of PPE, but I believe points to the need to address exposures that might have occurred outside the healthcare setting. Moreover, were their exposures at work? As these healthcare worker serology studies are designed and performed, we need more insight beyond just PPE use and symptoms, but also internal and external exposures, awareness and knowledge of infection prevention, and if they felt supported in their efforts to wear PPE.