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. 2021 Jan:39:158-161.
doi: 10.1016/j.ajem.2020.09.086. Epub 2020 Oct 7.

No evidence of increasing COVID-19 in health care workers after implementation of high flow nasal cannula: A safety evaluation

Lauren M Westafer  1 , William E Soares 3rd  2 , Doug Salvador  3 , Venkatrao Medarametla  4 , Elizabeth M Schoenfeld  2
Affiliations

No evidence of increasing COVID-19 in health care workers after implementation of high flow nasal cannula: A safety evaluation

Lauren M Westafer et al. Am J Emerg Med. 2021 Jan.

Abstract

Background: Initial recommendations discouraged high flow nasal cannula (HFNC) in COVID-19 patients, driven by concern for healthcare worker (HCW) exposure. Noting high morbidity and mortality from early invasive mechanical ventilation, we implemented a COVID-19 respiratory protocol employing HFNC in severe COVID-19 and HCW exposed to COVID-19 patients on HFNC wore N95/KN95 masks. Utilization of HFNC increased significantly but questions remained regarding HCW infection rate.

Methods: We performed a retrospective evaluation of employee infections in our healthcare system using the Employee Health Services database and unit records of employees tested between March 15, 2020 and May 23, 2020. We assessed the incidence of infections before and after the implementation of the protocol, stratifying by clinical or non-clinical role as well as inpatient COVID-19 unit.

Results: During the study period, 13.9% (228/1635) of employees tested for COVID-19 were positive. Forty-six percent of infections were in non-clinical staff. After implementation of the respiratory protocol, the proportion of positive tests in clinical staff (41.5%) was not higher than that in non-clinical staff (43.8%). Of the clinicians working in the high-risk COVID-19 unit, there was no increase in infections after protocol implementation compared with clinicians working in COVID-19 units that did not use HFNC.

Conclusion: We found no evidence of increased COVID-19 infections in HCW after the implementation of a respiratory protocol that increased use of HFNC in patients with COVID-19; however, these results are hypothesis generating.

Keywords: COVID-19; Health care worker infections; High flow nasal cannula.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Fig. 1
Fig. 1
Trends in COVID-19 infections in hospital employees. a. Comparison of trend in daily hospital census for patients with COVID-19 (bluet), daily admissions (grey*), and employee positive rate (orange*). tScale on left. *Scale on right. b. Graph of 3-day average positive tests for employees, separated by clinical versus non- clinical department.
See this image and copyright information in PMC

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