Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : LC27 - LC32 Full Version

Potential Risk Factors for COVID-19 Infection among Healthcare Workers in a Tertiary Care Centre, Kerala, India


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53122.16537
Ashajoan Murali, Rajith, A Sobha, Rsajith Kumar, Anitha Bhaskar, Geetha Devi Madha Vikutty, Anupa Lucas

1. Assistant Professor, Department of Community Medicine, Government Medical College Kottayam, Kerala, India. 2. Assistant Professor, Department of Community Medicine, Government Medical College Kottayam, Kerala, India. 3. Professor, Department of Community Medicine, Government Medical College Kottayam, Kerala, India. 4. Professor, Department of Infectious Disease, Government Medical College Kottayam, Kerala, India. 5. Professor, Department of Community Medicine, Government Medical College Thrissur Thrissur, Kerala, India. 6. Assistant Professor, Department of Community Medicine, Government Medical College Kottayam, Kerala, India. 7. Assistant Professor, Department of Community Medicine, Government Medical College Kottayam, Kerala, India.

Correspondence Address :
Asha Joan Murali,
Thuruthy P.O, Kottayam, Kerala, India.
E-mail: ashajoan1611@gmail.com

Abstract

Introduction: Understanding the virus transmission patterns and routes of transmission among Healthcare Workers (HCWs) is limiting the amplification events in health care facilities.

Aim: To estimate the secondary infection rate and to describe the clinical presentation of infection and the risk factors for infection among healthcare worker contacts of Coronavirus Disease-2019 (COVID-19) cases.

Materials and Methods: A descriptive cross-sectional study was conducted from June 2020 to July 2021, at a tertiary care centre, in central Kerala, India, among all the healthcare workers with exposure to a COVID-19 confirmed cases within the institution, between 15 July 2020 to 15 August 2020. Data including demographic details, information on contact and possible exposure with the COVID-19 infected patient was obtained using a questionnaire adapted from the World Health Organisation (WHO) questionnaire. Data was entered into Microsoft Excel and analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 22.0.

Results: A total of 433 healthcare workers (382 females and 51 males, mean age: 34.33±10.79 years) were found to be exposed to COVID-19 confirmed cases in the institution. The 21.1% of the healthcare worker contacts were exposed while working in non-COVID Intensive Care Unit (ICU) setting. Out of the 433 HCWs who were exposed to COVID-19 patients, 9 tested positive for COVID-19 (secondary infection rate was 2.07% with a Confidence Interval (CI) of 0.7-3.4%). All 9 of the positive HCWs were females, of which 88.89% were symptomatic.

Conclusion: Healthcare workers are at risk of transmission of COVID-19 while providing care, hence further explorative studies, including serologic studies are recommended to further understand the epidemiology.

Keywords

Coronavirus disease 2019, Healthcare setting, Kerala, Secondary infection rate

Coronavirus Disease-2019 (COVID-19) is a novel viral disease with over 182,319,261 confirmed cases worldwide and the total global deaths has surpassed 3,954,324 (1) by July 2021. Knowledge regarding the epidemiology of the disease and clinical presentation has been evolving since the initial identification of the virus.

Other coronaviruses which have caused pandemics like the Middle East respiratory syndrome-Coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) are known to have caused outbreaks in health care settings (2). Similarly, SARS CoV-2 also has the potential for grave impact on healthcare settings (3). Systematic reviews have reported SARS CoV-2 test positivity among healthcare workers as high as 51% (4). This high incidence is alarming as healthcare workers are not only critical for the clinical management of patients, but they are also important links in the chain of transmission (4). They are both vulnerable to infection while providing care, due to their close interaction with the patients, and they are at the highest risk of transmission to others both within the institution and outside the institution (5),(6). Moreover, infection among health care workers will lead to depletion of the work force and in turn have an adverse effect on patient care (6).

Understanding the virus transmission patterns and routes of transmission among health care workers will be an important step in limiting the amplification events in health care facilities (2). To better understand the transmission dynamics, and an overall risk of infection among healthcare worker contacts, secondary infection rate which is a measure of the frequency of new cases of COVID-19 among the contacts of a confirmed case in a defined period may be explored (2). Since the studies regarding same are lesser in number (7),(8),(9) with pretty limitations, hence this study was conducted in a tertiary care setting, to estimate the secondary infection rate and to describe the clinical presentation of infection and the risk factors for infection among the healthcare worker contacts of COVID-19 cases.

Material and Methods

This cross-sectional descriptive study was conducted at a tertiary care centre, in the central part of Kerala, after obtaining approval from the Institutional Review Board (No:16/2020 dated 28.06.2020) between June 2020 and July 2021. All the healthcare workers who were involved in care of COVID-19 confirmed cases between 15th of July and 15th of August 2020 were enlisted. From the list, of all those involved in the care, those who disclosed a history of exposure to COVID-19 positive patients, either due to breach of Personal Protective Equipment (PPE), or because the status of the patient was unknown at the time of exposure was contacted through telephone and information was gathered. After assessment, they were classified as those with high-risk exposure and low risk exposure. A total of 433 healthcare workers at Government Medical College, Kottayam, Kerala, India, were found to be exposed to 15 COVID-19 confirmed cases in the institution.

Inclusion criteria: All healthcare workers with exposure to a COVID-19 confirmed case, including those with direct exposure and those with exposure to the patient’s blood and body fluids, and to contaminated materials or devices and equipment linked to the patient.

Exclusion criteria: Healthcare workers who have been exposed to another implicated source of confirmed COVID-19, for example a COVID-19 positive case among his/her household/close contacts/ occupational contacts working in the same or outside institutions, or any other outside source were excluded from the study.

Operational definition

Health care worker was defined as all staff in the healthcare facility involved in the provision of care for a coronavirus infected patient, including those who have been present in the same area as the patient, as well as those who may not have provided direct care to the patient, but who have had contact with the patient’s body fluids, potentially contaminated items, or environmental surfaces. This includes health care professionals, allied health workers, auxiliary health workers (e.g., cleaning and laundry personnel, x-ray physicians and technicians, clerks, phlebotomists, respiratory therapist, social workers, physical therapists, lab personnel, cleaners, admission/reception clerks, patient transporters etc) (2).

Secondary Infection rate was defined as the proportion of healthcare worker contacts of a primary case who tested positive for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) by Reverse Transcriptase Polymerase Chain Reaction (RTPCR) or rapid antigen test (2).

Secondary infection rate= Number of healthcare workers confirmed to have COVID-19 / Total number of healthcare workers enrolled as contacts of the case

High risk exposure: The details of exposure among the healthcare worker contacts of COVID-19 confirmed cases, including the duration of exposure, history of close contact and use of personal protective equipment were assessed and the risk of exposure was classified as ‘high-risk exposure’ in cases where there was close contact for a duration of more than 15 minutes and appropriate personal protective equipment was not used (10),(11). Otherwise classified as, low risk exposure.

Procedure

Once a case of COVID-19 infection was identified in the institution, all healthcare workers with any exposure to COVID-19 patient was listed. This was done in consultation with supervisors and colleagues, duty rosters and the medical file of the patient to understand all the areas of the healthcare facility the patient has visited. From the list, of all those involved in the care, those who disclosed a history of exposure to COVID-19 positive patients, either due to breach of PPE, or because the status of the patient was unknown at the time of exposure was contacted through telephone and information was gathered. Telephonic interview was conducted, and the purpose of the investigation was explained to all known healthcare worker contacts. Data including demographic details, information on contact and possible exposure with the COVID-19 infected patient as well as laboratory results of respiratory specimen was obtained using a questionnaire [Annexure-1] adapted from WHO questionnaire for the assessment of potential risk factors for 2019-novel coronavirus infection among healthcare workers in a health care setting (2). and was translated into the native language Malayalam and back translated. The content validation was done by subject experts. Data was collected within a week of exposure to avoid recall bias. After assessment, they were classified as those with high-risk exposure and low-risk exposure.

Statistical Analysis

Data was entered using Microsoft Excel and analysed using statistical package for social sciences (SPSS) version 22.0. The variables were summarized as mean with standard deviation and frequency with percentage.

Results

The mean age of the health care worker contacts was 34.33±10.79 years, ranging between 19 and 61 years. Among them 88.22% were females (n=382) and 11.78% were males (n=51). The department wise distribution and category of health care workers is depicted (Table/Fig 1). On enquiring regarding the adherence to infection prevention and control measures, invariably all the healthcare staff reported that they adhered to infection prevention control measures while caring for patients routinely (Table/Fig 2). It was observed that 21.1% of the healthcare worker (n=91) were exposed while working in non-COVID-Intensive Care Unit (ICU) setting and 78.9% (n=342) were exposed while working in non-COVID wards.

On exploring the details of exposure, 81.9% of the healthcare workers (n=355) reported close contact with a COVID-19 patient, 45.7% (n=198) reported direct contact with the patient’s materials like personal belongings, linen and medical equipment that the patient may have had contact with) and 89.3% (n=387) reported direct contact with the surfaces around the patient (bed, bathroom, ward corridor, patient table, bedside table, dining table, medical gas panel etc) (Table/Fig 3).

After assessing the details of exposure, 28.4% (n=123) were found to have high risk exposure to COVID-19 confirmed cases (close contact of duration above 15 minutes without wearing PPE appropriate to the setting).

(Table/Fig 4), (Table/Fig 5) gives details of the distribution of HCWs according to the type of patient’s material that they had direct contact with and the type of surfaces around the patient that they had direct contact with. Details regarding symptom development in the period since patient admission and pre-existing co-morbidities of the healthcare workers were also assessed as part of the WHO questionnaire (Table/Fig 6).

Secondary infection rate: Out of the 433 HCWs who were exposed to COVID-19 patients, 9 tested positive for COVID-19. The secondary infection rate was 2.07% (CI-0.7-3.4%).

All 9 of the positive HCWs were females with a mean age 31 years (SD of 10.72 years). All were exposed while providing care in a ward setting, to COVID-19 cases whose status was unknown at the time of exposure. On evaluating the details, it was found that all 9 had high risk exposure to the COVID-19 case, and in 7 (77.7%) of them, HCW was exposed to multiple COVID-19 patients. A total of 6 of the healthcare workers (66.6%) were not using PPE appropriate for the setting at the time of exposure (10). Three HCWs were using PPE appropriate to the setting but reported breach of PPE (2 reported that they were wearing N95 masks in ward, but had removed the mask while attending phone calls, 1 reported that her mask was wet).

A total of 8 positive HCW contacts i.e., 88.89% were symptomatic - fever reported by 3, sore throat by 2, cough by 2, nasal symptoms by 2 and abdominal symptoms by 1. Except 1 (11.1%) who had history of bronchial asthma, no other positive HCW contacts gave history of co-morbidities. None had ICU admission.

On exploring the secondary infection rate according to the department of work [Table/Fig 7], it was seen that 2 among the 20 HCW contacts (Secondary infection rate of 10 %) in the Department of Paediatrics and 7 among the 205 HCWs (secondary infection rate of 3.4 %) in the Department of Obstetrics and Gynaecology became COVID-19 positive.

On assessing the category of staff, secondary infection rate was highest among technicians, security staff etc (Table/Fig 8).

Discussion

In the present study, 433 healthcare workers were found to be exposed to COVID-19 confirmed patients in the institution during the study period. They were exposed while providing care in a non-COVID setting, where patient status was unknown at the time of exposure or had history of use of breach of PPE or was not using PPE appropriate for the setting (10). This may be explained by the fact that, as recommended in the WHO assessment protocol (2), the study was conducted within the early phases of the epidemic, before widespread transmission or nosocomial outbreaks occurred, when stringent infection prevention and control measures were yet to be instigated.

On assessing the details of adherence to infection prevention and control measures by healthcare workers routinely, invariably all the healthcare staff reported that they adhered to all the routine infection prevention control measures. This data may be biased, especially in the current COVID-19 scenario, healthcare workers may not be ready to commit to the fact that they do not adhere to COVID-19 practice routinely.

Out of the 433 healthcare workers who were exposed, 9 were found to be COVID positive. Those COVID positive healthcare workers, who had another implicated source of COVID-19 infection like a positive family member, a colleague, or a source from a different setting, were excluded from the study.

In the present study, the most exposed category of healthcare workers was nursing staff 176 (40.6%). Nursing staff being exposed the most may be explained by the longer duration that they involved in direct patient care, bedside tasks, drug administration etc as well as being the first line of response in case of any patient complaints (5). Whereas the secondary infection rate among nursing staff in the present study was only 0.57%. Contrasting finding was seen in the study by Alajmi J et al., (6), where the highest number of infected healthcare workers were nurses and midwives (33.2%), and Gómez-Ochoa SA et al., (5) also reported upto 48% of infection among nursing staff.

The current study revealed that the exposure of healthcare workers occurred in a non-COVID setting (21.1% in non-COVID ICU and 78.9% in non-COVID wards). Alajmi J et al., also reported a very similar picture where 95% of the infected healthcare workers reported acquiring the virus while working in a non-COVID-designated setting (6). This may be possibly because of unknown status of the infected, lower adherence to prescribed personal protective equipment, lesser observance of infection prevention and control measures in non-COVID settings as compared to COVID setting, especially in the initial phase of the pandemic (6).

In the present study, secondary infection rate among healthcare worker contacts was 2.07 % (0.7-3.4%). Similar to these findings, Huang YT et al., reported secondary attack rate in a hospital setting as 1.56% with CI of 0.73-2.93% (12). Most of the available literature explores the prevalence of SARS-CoV-2 among health care workers, and Indian studies have reported up to 11% prevalence among healthcare workers (Table/Fig 9) (6),(8),(9),(12),(13).

The mean age of the infected healthcare workers in the current study was 31 years (SD of 10.72 years) and all were females. Similarly studies by Mandana G et al., (4) Jeremias A et al., (14) and Sabetian G et al., (9) reported a higher female proportion of 78.6%, 70% and 53.5% respectively, but a higher mean age of 38.37 years, 42.8 years and 35 years respectively. It could be due to the socio-demographic difference in the sample.

The current study showed that 8 (88.89%) of the infected health care workers were symptomatic and the most common symptom was fever. These findings are in line with the findings of Mahajan NN et al., (8) who reported that 85% of the infected health care workers were symptomatic and Nguyen LH et al., (13) who reported that 93.5% as symptomatic. Also fever was documented as the most prevalent symptom in studies by Jeremias A et al., (14) and Ran L et al., (15).

In the present study, all the positive health care workers had high risk exposure and 7 (77.7%) had multiple exposure, i.e., either was exposed multiple times or to multiple confirmed cases. These figures were higher than the findings of Mansoor S et al., who reported 40% multiple exposure and 20% of the high risk exposure health care workers tested positive in his study (16). This difference could be explained by the fact that there was a positive cluster of mothers and babies in the Obstetrics and Gynaecology (OBG) Department and Neonatal unit during the period that this study was conducted, as opposed to scattered cases in other departments. (Table/Fig 7) 205 HCWs in the department of OBG were exposed and 7 were positive, and in the department of Paediatrics 20 of the healthcare workers were exposed and 2 were positive. Hence the healthcare workers in these departments were exposed to multiple cases and since the infection status of the patients were unknown at the time of exposure, the staff were exposed multiple times to the same case while providing care. There could have been asymptomatic or pre-symptomatic transmission of SARS-CoV-2 virus through respiratory droplets (17).

Limitation(s)

Some healthcare workers included in the study might have contracted the infection from an unknown asymptomatic source outside the institution and not necessarily from a patient within the institution. Not being able to exclude them was a drawback of the study.

Conclusion

The present study concluded that the secondary infection rate among healthcare workers from COVID-19 patients was 2.07%. High risk exposure and exposure in non-COVID setting and not using PPE appropriate for the setting was seen among the infected. More seroepidemiological studies and studies including more than one centre are recommended to validate the results of this study.

References

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DOI and Others

DOI: 10.7860/JCDR/2022/53122.16537

Date of Submission: Nov 02, 2021
Date of Peer Review: Jan 11, 2022
Date of Acceptance: Mar 24, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 07, 2022
• Manual Googling: Mar 23, 2022
• iThenticate Software: May 20, 2022 (19%)

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