Seroprevalence of SARS-CoV2 Infections in Health Care Personnel in a Long-Term Care Institution After the First Wave of the Pandemic: A Cross-Sectional Study.

BACKGROUND: At the time of our study, occupational health evidence specific for long-term care employees was mostly lacking. The purpose of this study was to determine the proportion of positive cases in employees after the first COVID-19 wave in May 2020. We also determined the prevalence of asymptomatic cases. METHOD: The study population included all health care workers (HCW) employed at one mid-size long-term hospital in Spain (May 2020). A cross-sectional study design included an interviewer-administered self-reported questionnaire (including sociodemographic questions, risk factors for COVID-19 complications such as hypertension or diabetes, and previous polymerase chain reaction [PCR] results) and antibody determination (Biozek rapid test). Data were analyzed using Student's t, Fisher, and chi-square tests. Two multivariate logistic models were created to evaluate exposure factors and symptoms separately on the outcome of having had COVID-19. FINDINGS: Of the 97% of workers who participated (580/596), 300 (51.7%) suffered symptoms of COVID-19, 161 (27.8%) of the rapid antibody tests were positive for IgM and/or IgG, 160 (27.6%) workers had at least one risk factor, and 32 (19.0%) of the 168 SARS-CoV-2-positive cases were asymptomatic. The proportion of negative or unavailable PCRs, with positive antibody, was 11.7% (56/477). Casual contact without protection (odds ratio [OR]: 1.9, 95% confidence interval [CI]: 1.1-3.4), doctor occupation (OR 3.3, 95% CI: 1.1-10.2), and nursing assistant occupation (OR 2.5, 95% CI: 1.2-5.8) were independently associated with SARS-CoV-2 infection. CONCLUSION: Physicians and nursing assistants in a long-term care setting were at a higher risk of SARS-COV-2 infection over other occupations in the first wave of the pandemic, especially when in contact with patients without protection. Almost one-fifth of the workers with a positive PCR test for SARS-COV-2 were asymptomatic and seroprevalence (27.8%) was well below the approximated herd immunity cutoff (60-70%). Essential workers in long-term care must be monitored frequently by Employee Health Service and should be required to wear personal protective equipment including a fit-tested N-95 while in close contact with patients and coworkers.

[Experience of a mid-term care facility in the covid-19 with visit protocols.] / Experiencia de un hospital de media estancia en época covid-19 con protocolos de visitas.

OBJECTIVE: The Hospital Virgen de la Poveda, (Villa del Prado, Spain), assists patients in need of Continuous medical care, Rehabilitation or Palliative care; these patients have many risk-factors of COVID-19 morbility and mortality. With both healthcare humanization and contagion-prevention purposes, in July 2020 two patient visit protocols were implemented. The objective of this study is to describe these measures qualitatively and quantitatively. METHODS: A context is provided regarding COVID-19 measures in this institution. The content and follow-up indicators of visit protocols (number of visits, of outbreaks, inpatients, etc.) and of their context were provided. The empirical outbreak probabilities were calculated, and hypothesis contrast was performed against no-visits (0%) and no visit-control (7-day cumulative incidence/habitant). RESULTS: Two protocols were created. Accompanying was applied to Palliative Care cases (no appointments required, no time limits), and a short visits protocol was applied to the other patients (appointments for 1 weekly visit for 1-2 persons were given and visits last up to 45 minutes). In both protocols, visitors with symptoms or fever or particularly susceptible were forbidden entrance. Between July and April 2021, 4,759 short-visit appointments were given and 7,544 total visits took place (short visits, accompanying, exceptions). An outbreak was possibly attributed to short visits (probability=0.021% [CI95%: 0.0005-0.1171%]) and two outbreaks were possibly attributed to visits globally (probability=0.0265% [IC95%: 0.0032-0.0958%]). CONCLUSIONS: Elaborating adapted, applicable and prospectively-evaluated protocols with prevention measures at multiple levels might succeed in minimizing the risk of adverse events (in this case, COVID-19 outbreaks).

OBJETIVO: El Hospital Virgen de la Poveda atiende a pacientes con necesidades de Cuidados Continuos, Rehabilitación o Cuidados Paliativos, que presentan factores de riesgo de morbilidad y mortalidad por COVID-19. Para humanizar la asistencia sanitaria, se implementaron en julio de 2020 protocolos de visitas que minimizasen el riesgo de contagio. El objetivo de este estudio fue realizar una descripción cualitativa y cuantitativa de tales medidas. METODOS: Se contextualizó el problema de las medidas ante el COVID-19 de esta institución. Se recogió el contenido e indicadores de seguimiento de los protocolos de visitas (número de visitas, de brotes, ocupación, etc.) y de contexto. Se calcularon probabilidades empíricas de brote y contraste de hipótesis: vs. no-visitas (0%), y vs. no-control (incidencia acumulada); (distribución de Poisson). RESULTADOS: Se crearon dos protocolos: acompañamiento (para Cuidados Paliativos, sin citas y sin límite a la duración); y visitas cortas con cita previa (para los demás, limitadas a 45 minutos, 1-2 personas por paciente, 1 visita semanal). En ambos casos se controlaron el acceso de personas con síntomas o especialmente susceptibles. Entre julio 2020 y abril de 2021 se dieron 4.759 citas para visitas cortas (con 1 posible brote atribuido, probabilidad de brote=0,021% [IC95%: 0,0005-0,1171%]) y se produjeron en total 7.544 visitas (citadas, acompañamiento y excepcionales; con 2 posibles brotes atribuidos, probabilidad de brote=0,0265% [IC95%: 0,0032-0,0958%]). CONCLUSIONES: La elaboración de protocolos con medidas de prevención a múltiples niveles, adaptados, aplicables y con un adecuado seguimiento, puede conseguir minimizar el riesgo de aparición de eventos negativos (brotes en este caso).