Infectious disease transmission: survey of contacts between hospital-based healthcare workers and working adults from the general population

Abstract

Background: Healthcare workers (HCWs) may be the inadvertent interface between the healthcare setting and the community for infectious diseases transmission.

Aim: To investigate HCWs' contacts during a work day and compare these against working adults from the general population.

Methods: Prospective survey of contacts through 24 h self-reported diary in three public sector tertiary care hospitals and community-based working adults in Singapore. Participants were HCWs and working adults from the community.

Findings: In all, 211 HCWs and 1028 working adults reported a total of 4066 and 9206 contacts. HCWs reported more work-related contacts than community-based working adults (median of 13 versus 4), and more contacts that were neither household nor work-related (1 versus 0) but fewer household contacts (2 versus 3). HCWs reported more work-related contacts involving physical contacts, and more new contacts particularly with short duration (≤15 min) compared to community-based working adults. Among different HCW types, doctors reported the highest whereas ward-based nurses reported the lowest total work-related contacts. Around half of ward-based and clinic-based nurses' contacts involved physical touch. Work-related contacts reported by clinic-based nurses, doctors, and assorted HCWs were shorter than in ward-based nurses, with a substantial number effectively occurring with new contacts. Institutional effects significant on univariate analyses were much reduced and non-significant after adjusting for confounding by HCW type.

Conclusion: HCWs' contacts differ substantially from those of community-based working adults. HCWs may thus be at higher risk of acquiring and spreading contact-transmissible and respiratory infections due to the nature of their work. Whereas total number of contacts was fairly similar between HCW types, the characteristics of their contacts differed substantively.

Keywords: Community-based adults; Doctors; Healthcare workers; Infectious diseases; Nurses; Transmission.

Figure 1

Distribution of all contacts and work-related contacts in healthcare worker participants and in community-based working adults from the community.

Figure 2

Number of contacts for community-based working adults and healthcare workers by location of contact.

Figure 3

Comparison of three contact characteristics between community-based working and different types of healthcare workers: physical and non-physical; periodicity of contacts (whether they met this contact daily, weekly, and monthly or less); and the duration of contact (≥1 h, ≥15 min, ≥5 min, and all contacts shown in light blue, dark blue, green and orange respectively). Each circle represents a square-root contact number of 0.5.