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ORIGINAL ARTICLE
Year : 2022 | Volume
: 49
| Issue : 3 | Page : 318-321
Clinical presentation and infection prevention control practices in health-care workers diagnosed with COVID-19 in a dedicated COVID hospital, Mumbai
Balkrishna B Adsul1, Smita Santosh Chavhan1, Prasad Tukaram Dhikale2, Kirti V Kinge2, Chinmay N Gokhale2, Aniket R Ingale2, Nilam Jadhav3
1 Department of Community Medicine, HBTMC and Dr. RN Cooper Hospital; Seven Hills Dedicated COVID Hospital, Mumbai, Maharashtra, India
2 Department of Community Medicine, HBTMC and Dr. RN Cooper Hospital, Mumbai, Maharashtra, India
3 Seven Hills Dedicated COVID Hospital, Mumbai, Maharashtra, India
Correspondence Address:
Dr. Smita Santosh Chavhan
Department of Community Medicine, HBTMC and Dr. RN Cooper Hospital, U 15, Bhaktivedanta Swami Road, JVPD Scheme, Juhu, Mumbai - 400 056, Maharashtra
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jss.jss_95_21
Objectives: The objective of this study was to study the clinical presentation and infection prevention and control (IPC) measures in health-care workers (HCWs) diagnosed with COVID-19 in a Dedicated COVID Hospital (DCH). Materials and Methods: It was a prospective cohort study of HCWs in a DCH. The new cases found in HCWs from December 1, 2020, to January 31, 2021, were interviewed and followed up for 1 month. The study was part of an international multicenter study by the World Health Organization (WHO). The doctors, nurses, housekeeping, and other staff working in this DCH were considered as HCWs. WANTAI severe acute respiratory syndrome coronavirus 2 Ab ELISA provided by the WHO was used for qualitative testing antibody (IgM + IgG). Paired serology samples from cases were collected for serology testing – comprising one baseline serum sample taken during week 1 and another taken in the 6th week. Results: Out of the 1340 HCWs, 25 HCWs (including 15 doctors) developed COVID-19 in 60 days. Most (17, 68%) of the HCWs were from the age group of 21 to 30 years. All the HCWs reported receiving training in IPC. Most (21, 84%) of the HCWs reported following hand hygiene always, as recommended. Most (22, 88%) of the HCWs reported being using recommended personal protective equipment (PPE) always, as recommended. The duration of hospital stay was 10 ± 3.6 days (mean ± standard deviation) and the range was 4–18 days. There was no significant difference between infection prevention and control practices of doctors and other HCWs. In our study, all the patients had mild disease and the antibody titer was positive in 7 (28%) patients in the 1st week of illness and in 20 (80%) patients in the 6th week of illness. The most common symptoms were respiratory symptoms (60%), sore throat (52%), fever (48%), cough (44%), and joint ache (20%). Two (8%) HCWs were asymptomatic. Conclusion: The incidence of COVID-19 among HCWs can be kept low by proper IPC measures such as availability of PPE and training of HCWs in IPC.
Keywords: COVID-19, epidemiology, health personnel, tertiary care hospital
India has 3 crore cases (16.7% of the cases of world) of COVID-19 as of July 5, 2021.[1] Health-care workers (HCWs) are a high-risk group for COVID-19. Knowledge about infection prevention control (IPC) practices is important to find the transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health workers, preventing the future infection of health workers and patients, and for informing and updating IPC measures at the health-care facilities.[2] Knowledge about the clinical profiles can help in modifying screening and treatment guidelines. There is no clarity regarding the incidence of SARS-CoV-2 infection among HCWs, IPC measures, and clinical features.
The objective was to study the clinical presentation and IPC measures in HCWs diagnosed with COVID-19 in a DCH.
Materials and MethodsStudy setting
The study was done in a DCH with 1600 beds including 300 intensive care unit (ICU) beds in a metropolitan city.
Study design and population
It was a prospective cohort study of HCWs in a DCH. The new cases found in HCWs from December 1, 2020, to January 31, 2021, were interviewed and followed up for 1 month. The study was part of an international multicenter study by the World Health Organization (WHO).[2] The detail protocol of this study is published by the WHO.[2] The questions were in Likert scale.[2] A part of this study is presented here. The doctors, nurses, housekeeping, and other staff working in this DCH were considered as HCWs. WANTAI SARS-CoV-2 Ab ELISA provided by the WHO was used for qualitative testing antibody (IgM + IgG). Paired serology samples from cases were collected for serology testing – comprising one baseline serum sample taken during week 1 and another taken in the 6th week. The government guidelines for the management of COVID-19 were followed in this institute.[3] Institutional ethical committee clearance was taken and informed consent from the participants was taken. The outcome variables were incidence of COVID-19, risk factors for COVID-19 in HCWs, effectiveness of current COVID-19 IPC measures among HCWs, clinical presentation of COVID-19 patients, and serological response following SARS-CoV-2 infection.
Statistical analysis
Data entry was done by using Microsoft Excel version 2010 and statistical analysis was done using IBM SPSS Statistics for Windows version 16 (IBM, Bangalore, Karnataka). In addition to the descriptive analysis, Chi-square test, t-test, and Fisher's exact test were used. The level of significance was fixed at 0.05.
ResultsOut of the 1340 HCWs, 25 HCWs developed COVID-19 in 60 days. None of the HCWs were immunized against COVID-19. No one was taking any drug for prophylaxis in the prior 14 days of onset of symptoms.
As shown in [Table 1], out of the 25 HCWs who developed COVID-19, 15 were doctors, 5 were nurses, 4 were housekeeping, and 1 was the administrative staff. Most (17, 68%) of the HCWs were from the age group of 21–30 years. Most (21, 84%) of the HCWs reported following hand hygiene always, as recommended. The duration of hospital stay was 10 ± 3.6 days (mean ± standard deviation) and the range was 4–18 days.
Table 1: Sociodemographic features of health-care workers having coronavirus disease 2019All the HCWs reported that they were trained in IPC at the time of recruitment and then periodic refreshing trainings were conducted. None of the HCWs reported being in contact with a person known to have been diagnosed with COVID-19 outside their occupational duties. Most (22, 88%) of the HCWs reported being using recommended personal protective equipment (PPE) always, as recommended. As shown in [Table 2]. there was no significant difference between infection prevention and control practices of doctors and other HCWs.
Table 2: Infection prevention and control of health-care workers having coronavirus disease 2019As shown in [Table 3], the most common symptoms were respiratory symptoms (60%), sore throat (52%), fever (48%), cough (44%), and joint ache (20%). Two (8%) HCWs were asymptomatic. No HCW had a rash, conjunctivitis, seizures, altered consciousness, and neurological disorders. Doctors had more respiratory symptoms as compared to other HCWs. All were mild cases and none required ICU or oxygen support. Only 2 (8%) HCWs were having comorbidities asthma and hypothyroidism. [Table 4] shows antibody response to COVID- 19 among health care workers in the 1st and 6th week of illness.
Table 4: Antibody response to coronavirus disease 2019 among health-care workersThe duration between the date of symptom onset and sample collection (median ± interquartile range) for the first and follow-up sample was 5 ± 5 days and 38.2 ± 8 days, respectively.
DiscussionThe incidence of COVID-19 among HCWs was 1.8% in 60 days in our study. Despite the heavy workload of cases in this DCH, the incidence of COVID-19 in HCWs was low. In a retrospective study, done in a DCH, the prevalence of COVID-19 was 11% from April 6 to August 20, 2020.[4] In a study in Delhi and Mumbai from March 23 to April 30, 2020, the prevalence was 1.8% (20/1113).[5] In a meta-analysis, the prevalence was 11%.[6] The risk of COVID-19 disease in HCWs depends on infection prevention and control practices and exposure to COVID-19 patients.
All HCWs were trained in IPC and most of them reported following hand hygiene and using recommended PPE always, as recommended. There was no significant difference between infection prevention and control practices of doctors and other HCWs. A study in Delhi showed that when HCWs are posted in high-risk zones for COVID-19 with adequate PPE, the risk of COVID-19 positivity was not increased.[5]
The most common symptoms were respiratory symptoms (60%), sore throat (52%), fever (48%), cough (44%), and joint ache (20%). Two (8%) HCWs were asymptomatic. All were mild cases and none of them required oxygen or ICU support, none died. In a study in a DCH in Mumbai, the asymptomatic infection was 14.8%.[4] In another study, the asymptomatic infection was 50%.[5] In a meta-analysis, the most common symptoms in HCWs were fever and cough.[6] Encouraging self-reporting of COVID-19 symptoms and promptly testing them is important to prevent further spread.
In this study, all the patients had mild disease and the antibody titer was positive in 28% of patients in the 1st week of illness and in 80% of patients in the 6th week of illness. Those who have milder disease have lesser levels of antibody response as compared to those with severe disease.[7] In a systematic review IgM level was at its peak between weeks 2 to 5, IgG level was at its peak between weeks 3 to 7 after symptom onset then plateaued, persisting for at least 8 weeks.[8]
In this study, HCWs were prospectively followed up to study the incidence of COVID-19. The IPC practices were thoroughly enquired, but sample size was small as it was part of a multicentric study.
ConclusionThe incidence of COVID-19 among HCWs can be kept low by proper IPC measures such as availability of PPE and training of HCWs in IPC. The most common symptoms in HCWs were respiratory symptoms, sore throat, fever, and cough and all were mild cases.
Financial support and sponsorship
The study was funded by the WHO.
Conflicts of interest
There are no conflicts of interest.
References
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