Personal Protective Equipment (PPE) is a critical aspect of preventing transmission of SARS-CoV-2 in healthcare settings. We aimed to identify factors related to lapses in PPE usage that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP).

Retrospective cohort study

Tertiary care medical center in Minnesota

A total of 345 HCP that sustained a significant occupational exposure to a patient with Coronavirus Disease 2019 (COVID-19) from May 13th, 2020 through November 30th, 2020 were evaluated.

Eight HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day post-exposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by RT-PCR during the post-exposure quarantine (RR 10.25 (95% Confidence Interval (CI) 1.28-82.39), p=.009). Overall, the most common reason for a significant exposure was the usage of a surgical facemask instead of a respirator during an aerosolizing generating procedure (AGP) (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the post-exposure quarantine (RR 0.99 (95% CI 0.96-1), p=1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19.

The use of universal eye protection is a critical aspect of PPE to prevent patient to HCP transmission of SARS-CoV-2.

To assess the potential for contamination of personnel, patients and the environment during use of contaminated N95 respirators and to compare the effectiveness of interventions to reduce contamination.

Simulation study of patient care interactions using N95 respirators contaminated with a higher and lower inoculum of the benign virus bacteriophage MS2.

Twelve healthcare personnel performed 3 standardized examinations of mannequins including: 1) Control with suboptimal respirator handling technique; 2) Improved technique with glove change after each N95 contact; and 3) Control with 1-minute ultraviolet-C light (UV-C) treatment prior to donning. The order of the examinations was randomized within subject. The frequencies of contamination were compared among groups. Observations and simulations with fluorescent lotion were used to assess routes of transfer leading to contamination.

With suboptimal respirator handling technique, bacteriophage MS2 was frequently transferred to the participants, mannequin, and environmental surfaces and fomites. Improved technique resulted in significantly reduced transfer of MS2 in the higher inoculum simulations (P<0.01), whereas UV-C treatment reduced transfer in both the higher and lower inoculum simulations (P<0.01). Observations and simulations with fluorescent lotion demonstrated multiple potential routes of transfer to participants, mannequin, and surfaces, including both direct contact with the contaminated respirator and indirect contact via contaminated gloves.

Reuse of contaminated N95 respirators can result in contamination of personnel and the environment even when correct technique is used. Decontamination technologies such as UV-C could reduce the risk for transmission.

To determine the effect of two regulations issued by the Israeli Ministry of Health on COVID-19 infections and quarantine among health care workers (HCW) in general hospitals

Before-after intervention study without a control group (interrupted time-series analysis)

All 29 Israeli general hospitals

All HCW

Two national regulations issued on March 25, 2020: one required universal masking of HCW, patients, and visitors in general hospitals and the second defined what constitutes HCW exposure to SARS-CoV-2 and when quarantine is required

There were 283 HCW infected at work or from an unknown source. Before the intervention, the number of HCW infected at work increased by 0.5 per day (95% CI: 0.2-0.7, P<0.001), peaking at 16. After the intervention, new infections declined by 0.2 per day (95% CI:-0.3- -0.1, P<0.001). Before the intervention, the number of HCW in quarantine/isolation increased by 97 per day (95% CI: 90-104, P<0.001), peaking at 2,444. After the intervention, prevalence decreased by 59 per day (95% CI: -72- -46, P<0.001). Epidemiological investigations determined that the most common source of HCW infection (58%) was a co-worker.

Universal masking in general hospitals reduced the risk of hospital-acquired COVID-19 among HCW. Universal masking combined with uniform definitions of HCW exposure and criteria for quarantine limited the absence of HCW from the workforce.

To examine the associations between factors based on the Social Cognitive Theory (SCT) and behavioral intention of free and self-paid (600 RMB or 91 USD) COVID-19 vaccination of 80% effectiveness and rare mild side effects among doctors and nurses in China.

Cross-sectional study.

Public hospitals.

362 doctors and 1702 nurses in major departments of five hospitals of three Chinese provinces.

An anonymous online survey was conducted from October to November 2020, facilitated by hospital administrators through online WeChat/QQ working groups. Data on outcome expectations, self-efficacy, norms, and COVID-19-related work experiences were collected. Multivariate logistic regression models were used for data analysis.

The logistic regression analysis showed that physical (e.g., protective effect of vaccination) and self-evaluative outcome expectations (e.g., anticipated regret), self-efficacy, norms (e.g., descriptive norm, subjective norm, professional norm, and moral norm), and job satisfaction were significantly and positively associated with the free and self-paid COVID-19 vaccination intention outcomes among doctors and nurses, adjusted for background variables. Doctors who had engaged in COVID-19-related work reported higher self-paid vaccination intention.

Health promotion is needed to improve the uptake of COVID-19 vaccination among healthcare workers. Such interventions may consider modifying the identified factors of vaccination intention, including strengthening perceived efficacy, positive feelings about vaccination, the need to avoid future regret, self-efficacy, and social norms. Future studies should examine the actual behavior patterns of COVID-19 vaccination and testing the efficacy of promotion intervention through randomized controlled studies.