Increased Bloodborne Pathogen Exposure Hotline Utilization During the COVID-19 Pandemic: An Unexpected Phenomenon.

Background: Mitigating bloodborne pathogen exposure (BBPE) risk among healthcare workers is a major focus of hospital-based occupational health programs. The COVID-19 pandemic has placed added demands on occupational health services for healthcare workers. Its impact on BBPE incidence is unreported. Methods: As part of quality improvement efforts, we examined BBPE case incidence at two affiliated health centers during a 24-month period, 12 months preceding and following the COVID-19 pandemic onset. We used Year 1 to Year 2 change in incidence at the larger health center as the referent value to generate predicted incidence rates at the study health center. We tested the ratio of observed to predicted values at the study health center as a Poisson variable to its expectation. We defined a BBPE consistent with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. Results: The BBPE case incidence at Health Center One (HC1), totaled 46 cases in Year 1, increasing 19% to 55 cases in Year 2. The cumulative incidence at Health Center Two (HC2), the referent facility, was 664 cases in Year 1, declining 24% to 503 in Year 2. The ratio of 55 events at HC1 to the expected incidence of 35, based on the experience at HC2, was 1.6 (p < .05). Discussion/Applications to Practice: The incidence of BBPE events at HC1 paradoxically increased during the COVID-19 pandemic, contrasting to the expected decrease that we observed at HC2. These data suggest that during times of increased stress to employee healthcare delivery from an infectious disease outbreak, the burden of ongoing practice demands may increase.

Testing for SARS-CoV-2 in Symptomatic Vaccinated and Unvaccinated Health Care Workers During the Delta Variant Surge.

BACKGROUND: Infection with SARS- CoV- 2 in health care workers (HCWs) challenges employee health services. METHODS: We analyzed telephone Coronavirus Disease 2019 (COVID-19) hotline data over 8 weeks in 2021 during SARS- CoV- 2 Delta variant surge. We calculated COVID-19 case rates among persons-under-investigation (PUIs) for illness at two health care centers (HCs). RESULTS: There were 41 COVID-19 cases among the 285 PUIs (14.4%) at the study HC and 549 (16.9%) of 3244 at the comparison HC. At the study HC, 11.7% of vaccinated PUIs versus 36.6% of unvaccinated PUIs were COVID-19 positive. The COVID-19 positivity rates among vaccinated and unvaccinated PUIs at the comparison HC were 16.1% and 33.3%, respectively. DISCUSSION: In the SARS-CoV-2 Delta variant surge, COVID-19 test positivity rates among unvaccinated symptomatic HCWs are dramatically elevated. Aggressive testing of HCW PUIs is particularly critical during periods of disease upsurge.

Association between household exposure and cycle threshold in COVID-19 infected health care workers.

OBJECTIVE: Household SARS-COV-2 contact constitutes a high-risk exposure for health care workers (HCWs). Cycle threshold (Ct) of reverse transcriptase-polymerase chain reaction testing provides an estimate of COVID-19 viral load, which can inform clinical and workplace management. We assessed whether Ct values differed between HCWs with COVID-19 with and without household exposure. METHODS: We analyzed HCW COVID-19 cases whose Ct data could be compared. We defined low Ct at a cut-point approximating a viral load of 4.6 × 106 copies per ml. Logistic regression tested the association of household exposure and symptoms at diagnosis with a low Ct value. RESULTS: Of 77 HCWs with COVID-19, 20 were household exposures cases and 34 were symptomatic at testing (7 were both household-exposed and symptomatic at testing). Among household exposures, 9 of 20 (45%) manifested lower Ct values compared to 14 of 57 (25%) for all others. In a bivariate model, household exposure was not statistically associated with lower Ct (Odds Ratio [OR] 1.20; 95% Confidence Interval [CI] 0.97-1.51). In multivariable modelling both household exposure (OR] 1.3; 95% CI 1.03-1.6) and symptoms at diagnosis (OR 1.4; 95% CI 1.15-1.7) were associated with a low Ct value. DISCUSSION: Household exposure in HCWs with newly diagnosed COVID-19 was associated with lower Ct values, consistent with a higher viral load, supporting the hypothesis that contracting COVID-19 in that manner leads to a greater viral inoculum.

Temporal Trends in COVID-19 Incidence in Two Healthcare Worker Cohorts.

BACKGROUND: Health care workers (HCWs) experience increased occupational risk of contracting COVID-19, with temporal trends that might inform surveillance. METHODS: We analyzed data from a Veterans Affairs hospital-based COVID-19 worker telephone hotline collected over 40 weeks (2020). We calculated the proportion of COVID-19+ cases among persons-under-investigation (PUIs) for illness compared to rates from a nearby large university-based health care institution. RESULTS: We observed 740 PUIs, 65 (8.8%) COVID-19+. Time trends were similar at the study and comparison hospitals; only for the first of 10 four-week observation periods was the ratio for observed to expected COVID-19+ significant (P < 0.001). DISCUSSION: These data suggest that employee health COVID-19+ to PUI ratios could be utilized as a barometer of community trends. Pooling experience among heath care facilities may yield insights into occupational infectious disease outbreaks.

Shoulder Injury Related to Vaccine Administration (SIRVA): An Occupational Case Report.

Transient shoulder pain is a common complaint following intramuscular vaccine administration into the deltoid. More severe vaccination-associated shoulder complications comprising of weakness and decreased range of motion are categorized under the construct "shoulder injury related to vaccine administration" (SIRVA) that subsumes both subjective and objective findings consistent with injury. We describe the presentation and management of a case of SIRVA in a health care worker following seasonal influenza vaccine administration as part of a hospital-based employee health program and review the relevant biomedical literature. We present a case from a single medical center. All data were collected by professionals in occupational health by interviewing, performing physical examinations, and reviewing medical records associated with the injured worker. Severe pain and limited range of shoulder motion developed following an influenza vaccination that was administered using a poorly positioned, larger than recommended needle. Magnetic resonance imaging (MRI) demonstrated moderate glenohumeral joint effusion and synovitis, with fluid accumulating in the subscapularis recess within 1 week of injury. At 8 months after initial injury, MRI showed persistent mild tenosynovitis of the long head of the biceps tendon, interval accumulation of a large glenohumeral joint effusion, and infraspinatus tendinitis with subjacent reactive bone marrow edema. The affected worker experienced work restrictions but had no complete lost workdays to date due to the injury. Occupationally related SIRVA is a preventable adverse event that should be considered in workplace vaccine administration programs, and appropriate education and training provided to vaccine administrators to address this.

Off the Courts: Occupational "Tennis Leg".

OBJECTIVE: Injury to the gastrocnemius muscle (tennis leg) is a presenting complaint often associated with athletic pursuits. Despite that label, this form of injury is likely to be common to a variety of salaried and nonsalaried pursuits beyond sports. METHOD: We describe the presentation and management of two cases of "tennis leg" injury occurring in an occupational rather than athletic setting and review the relevant medical literature. RESULTS: Partial tears of the medial insertion of the gastrocnemius tendon were documented in both cases, in the first through magnetic resonance imaging and in the second by ultrasound. CONCLUSION: Rupture of the tendon to the medial head of the gastrocnemius, the so-called "tennis leg" injury, should be considered as potentially work-related trauma, rather than taken to be solely a sports injury.

Lung function in adults following in utero and childhood exposure to arsenic in drinking water: preliminary findings.

PURPOSE: Evidence suggests that arsenic in drinking water causes non-malignant lung disease, but nearly all data concern exposed adults. The desert city of Antofagasta (population 257,976) in northern Chile had high concentrations of arsenic in drinking water (>800 µg/l) from 1958 until 1970, when a new treatment plant was installed. This scenario, with its large population, distinct period of high exposure, and accurate data on past exposure, is virtually unprecedented in environmental epidemiology. We conducted a pilot study on early-life arsenic exposure and long-term lung function. We present these preliminary findings because of the magnitude of the effects observed. METHODS: We recruited a convenience sample consisting primarily of nursing school employees in Antofagasta and Arica, a city with low drinking water arsenic. Lung function and respiratory symptoms in 32 adults exposed to >800 µg/l arsenic before age 10 were compared to 65 adults without high early-life exposure. RESULTS: Early-life arsenic exposure was associated with 11.5% lower forced expiratory volume in 1 s (FEV(1)) (P = 0.04), 12.2% lower forced vital capacity (FVC) (P = 0.04), and increased breathlessness (prevalence odds ratio = 5.94, 95% confidence interval 1.36-26.0). Exposure-response relationships between early-life arsenic concentration and adult FEV(1) and FVC were also identified (P trend = 0.03). CONCLUSIONS: Early-life exposure to arsenic in drinking water may have irreversible respiratory effects of a magnitude similar to smoking throughout adulthood. Given the small study size and non-random recruitment methods, further research is needed to confirm these findings.