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Protecting Healthcare Personnel : Addressing Research Gaps , Strengthening Policies and Practice
By Kelly M . Pyrek
Healthcare personnel ( HCP ) on the frontlines are modern-day warriors against illness and infection , and as Bielicki , et al . ( 2020 ) remind us during the pandemic , “ The risk profile for SARS-CoV-2 exposure and infection among healthcare workers differs substantially from other groups . In designated COVID-19 wards or hospitals , healthcare workers are at high risk of infection . Potential exposure to SARS-CoV-2 is inherent to their work and is prevented only by excellent adherence to all IP & C measures , including the use of appropriate PPE .
• There is uncertainty about what is optimal PPE , but it is clear that standardized and
rigorous application of PPE and other IPC measures can dramatically reduce nosocomial transmissions .”
Risk stratification continues to be essential as the pandemic waxes and wanes , and as Bielicki , et al . ( 2020 ) explain , “ Defining the risk of a healthcare worker being infected with SARS-CoV-2 can be the first step toward selecting the most appropriate monitoring and evaluation approach . Risk categories for in-hospital exposures are frequently based on the type of contact that has taken place and whether PPE was used consistently and appropriately . Additional specifications are sometimes included in risk assessment algorithms — e . g ., presence during aerosol-generating procedures or exact
The torrent of information coming out of the literature has clinicians scrambling for evidence-based information on the inventions that will keep healthcare workers – and therefore patients – safe .
distancing from patients with COVID-19 ( usually closer or further than 2 meters ). Focusing on adherence to PPE implies that the optimal PPE for all potential contact situations is known and available . However , the effect of optimal PPE and other IP & C measures is being debated because robust evidence to match PPE and IP & C interventions to the risk profile of a given exposure is scarce . Exposures to SARS-CoV-2 via community cases and infected colleagues can be frequent depending on the phase of the outbreak . Risk assessment of healthcare worker exposure is going to be most useful in epidemic phases with low rates of community transmission . In all other situations , all healthcare workers should be considered at moderate to high risk of contracting SARS-CoV-2 , especially when extended IP & C measures , including some use of PPE , cannot be implemented for all patient contacts and staff interactions . Data showing that viral shedding and potential
PPE , especially respiratory protection , is critical to occupational health . Here , SARS-CoV-2 invades lung cells . Courtesy of Camille Here / UNC School of Medicine
SARS-CoV-2 transmission could occur two to three days before symptom onset highlight the importance of wearing adequate PPE in hospitals during phases of high SARS-CoV-2 incidence . Therefore , risk-appropriate PPE and optimal adherence to IP & C measures will reduce the risk of healthcare worker infection to that encountered in the community .”
As we have seen , the torrent of information coming out of the literature has clinicians scrambling for evidence-based information on the inventions that will keep healthcare workers – and therefore patients – safe . But consensus is achieved at a slower rate than patient care is demanded and delivered , thus exposing gaps in knowledge and implementation .
The whitepaper , COVID-19 Research Agenda for Healthcare Epidemiology , produced in January by the Society for Healthcare Epidemiology of America ( SHEA ), established those knowledge gaps and challenges in healthcare epidemiology research related to COVID-19 , with a focus on core principles of healthcare epidemiology . Included in the document is a section addressing healthcare personnel safety and occupational health .
The SHEA whitepaper ( 2021 ) acknowledges that , “ Research is needed to identify strategies to protect HCP from acquiring SARS- CoV-2 at work and support HCP from physical , psychological , social , and organizational challenges related to the pandemic ” and identifies three research domains representing priority areas with unanswered questions concerning HCP and occupational safety :
● Define risks that increase HCP exposure to and acquisition of SARS-CoV-2 and interventions that can mitigate these risks .
● Determine optimized strategies to protect HCP emotional and psychological health .
● Determine impact of social and organizational strategies to maintain the health and wellness of HCP .
As the SHEA whitepaper ( 2021 ) explains , “ Understanding the factors that increase HCP risk of acquiring COVID-19 is essential to develop an evidence-based infection prevention program . These factors may include attributes of the patients under the HCP ’ s care ( e . g ., clinical symptoms , comorbid conditions ); aspects of the care delivered ( e . g ., procedures performed , duration of contact , number of patients under their care during a shift , pre-operative screening ); HCP practices ( e . g ., PPE utilized , years of experience ); and worksite ( e . g ., leadership support , control over practice ). In addition , understanding individual HCP factors that increase the likelihood of an infected HCP developing more severe disease and adverse outcomes will help determine which