Characterization and evolution of infection control practices among severe acute respiratory coronavirus virus 2 (SARS-CoV-2)-infected healthcare workers in acute-care hospitals and long-term care facilities in Québec, Canada, Spring 2020

Abstract

Objectives: In this study, we aimed to (1) estimate the severe acute respiratory coronavirus 2 (SARS-CoV-2) infection rate and the secondary attack rate among healthcare workers (HCWs) in Québec, the most affected province of Canada during the first wave; (2) describe the evolution of work-related exposures and infection prevention and control (IPC) practices in infected HCWs; and (3) compare the exposures and practices between acute-care hospitals (ACHs) and long-term care facilities (LTCFs).

Design: Survey of cases.

Participants: The study included Québec HCWs from private and public institutions with laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnosed between March 1 and June 14, 2020. HCWs aged ≥18 years who worked during the exposure period and survived their illness were eligible for the survey.

Methods: After obtaining consent, 4,542 HCWs completed a standardized questionnaire. COVID-19 rates and proportions of exposures and practices were estimated and compared between ACHs and LTCFs.

Results: HCWs represented 13,726 (25%) of 54,005 reported COVID-19 cases in Québec and had an 11-times greater rate of COVID-19 than non-HCWs. Their secondary household attack rate was 30%. Most affected occupations were healthcare support workers, nurses and nurse assistants working in LTCFs (45%) and ACHs (30%). Compared to ACHs, HCWs in LTCFs had less training, higher staff mobility between working sites, similar PPE use, and better self-reported compliance with at-work physical distancing. Suboptimal IPC practices declined over time but were still present at the end of the first wave.

Conclusion: Québec HCWs and their families were severely affected during the first wave of COVID-19. Insufficient pandemic preparedness and suboptimal IPC practices likely contributed to high transmission in both LTCFs and ACHs.

Fig.1.

Number and percentage of reported COVID-19 cases, reported infected healthcare workers and participants to the study per day of symptom onset (or day of testing) and proportion of healthcare workers among all reported infections. Note. HCW, healthcare worker.

Fig. 2.

COVID-19 rates and 95% confidence intervals for general population non-healthcare workers aged 20 to 69 years old (excluding healthcare workers), for healthcare workers and for some health occupations in Québec, March 1–June 14, 2020. Note. HCW, healthcare worker; public, working for the public health system. Source of denominators to estimate different rates:Québec Statistic Institute, population of 2019.Statistics Canada, 2016 Census (with an added 5% growth of HCW according to other sources).College of Physicians of Québec, data updated in 2019.Québec Order of Nurses, data updated 2019.Québec Order of Nurse Assistants, data updated 2019.

Fig. 3.

Temporal evolution of the infection prevention and control practices among HCWs infected with COVID-19. Note. HCW, healthcare worker; PPE, personal protective equipment.

Fig. 4.

Reasons for incorrect hand hygiene after patient contact, incorrect PPE use during contacts with COVID-19 patients, and noncompliance with PPE doffing protocol. Note. PPE, personal protective equipment.