A Dynamic Response to Exposures of Health Care Workers to Newly Diagnosed COVID-19 Patients or Hospital Personnel, in Order to Minimize Cross-Transmission and the Need for Suspension From Work During the Outbreak

Abstract

Background: During the coronavirus disease (COVID-19) epidemic, many health care workers (HCWs) have been exposed to infected persons, leading to suspension from work. We describe a dynamic response to exposures of HCWs at Hadassah Hospital, Jerusalem, to minimize the need for suspension from work.

Methods: We performed an epidemiological investigation following each exposure to a newly diagnosed COVID-19 patient or HCW; close contacts were suspended from work. During the course of the epidemic, we adjusted our isolation criteria according to the timing of exposure related to symptom onset, use of personal protective equipment, and duration of exposure. In parallel, we introduced universal masking and performed periodic severe acute respiratory syndrome coronavirus 2 screening for all hospital personnel. We analyzed the number of HCWs suspended weekly from work and those who subsequently acquired infection.

Results: In the 51 investigations conducted during March-May 2020, we interviewed 1095 HCWs and suspended 400 (37%) from work, most of them, 251 (63%), during the first 2 weeks of the outbreak. The median duration of exposure (interquartile range) was 30 (15-120) minutes. Only 5/400 (1.3%) developed infection, all in the first 2 weeks of the epidemic. After introduction of universal masking and despite loosening the isolation criteria, none of the exposed HCWs developed COVID-19.

Conclusions: Relatively short exposures of HCWs, even if only either the worker or the patient wears a mask, probably pose a very low risk for infection. This allowed us to perform strict follow-up of exposed HCWs in these exposures, combined with repeated testing, instead of suspension from work.

Keywords: COVID-19; exposure; health care workers; personal protective equipment; suspension from work.

Figure 1.

Number of health care workers (HCWs) who were suspended from work (gray) or had a positive severe acute respiratory syndrome coronavirus 2 test (dotted) each week, March–May 2020. The black arrows show the changes in personal protective equipment policy during the epidemic: (A) face mask during contact with every patient and during meetings of HCWs lasting 15 minutes or more (March 20); (B) avoiding unnecessary contact between HCWs (eg, meetings, shift transfer; March 29); (C) universal masking of HCWs and visitors at all times and of patients during any contact with an HCW (April 7) (Supplementary Table 1). The line shows the number of new coronavirus disease 2019 cases every week in Israel for comparison (data were taken from the Israel Ministry of Health official website: https://govextra.gov.il/ministry-of-health/corona/corona-virus/).