COVID-19 hospital outbreaks: Protecting healthcare workers to protect frail patients. An Italian observational cohort study

OBJECTIVES: to determine the prevalence of SARS-CoV-2 infection among exposed HCWs after preventive protocol implementation. METHODS: 5750 HCWs. Those in contact with COVID-19 patients were allocated into a highrisk or a low-risk group based on contact type (PPE- or non-PPE-protected); high risk workers underwent nasopharyngeal swab tests, while for low-risk workers swab tests were carried out only for symptomatic workers (active surveillance). The prevalence was determined by real-time reverse transcriptase–polymerase chain reaction on nasopharyngeal samples. RESULTS: 3570 HCWs had contact with 1065 COVID-19 patients. Among them, 3494 were subjected to active surveillance (low-risk group); 2886 (82.60%) were subjected to a swab test and 15 were positive (0.52%). 76 HCWs (2.13% of exposed) were included in the high-risk group, and a swab test was mandatory for each participant. Overall, 66 (86.84% of high-risk) were negative, and 10 positive (13.16%), resulting in a higher risk of infection than in the low-risk group [OR= 29.00; 95% CI:12.56-66.94; p<0.0001]. CONCLUSION: To date, the SARS-CoV-2 infection prevalence is 0.70% among exposed HCWs and 0.435% among all HCWs working at the examined university hospital. The correct use of PPE and the early identification of symptomatic workers are essential factors to avoiding nosocomial clusters.