TABLE 1 : Enrolled Participants by Hospital , Clinical Role , and Risk Stratification J . W . Ruby Memorial Hospital High Risk Low Risk Other Total United Hospital Center High Risk Low Risk Other Total Berkeley Medical Center High Risk Low Risk Other Total Camden Clark Medical Center High Risk Low Risk Other Total
While PPE and hand hygiene as a broad strategy is the backbone of infection prevention , what specific PPE and for which workers and its real-world effectiveness were highly elusive when this study was completed . There was a heightened sense of urgency regarding proper PPE selection given the supply chain issues , and , as such , the “ most conservative ” approach of maximal PPE for every worker was not operationally feasible . Additionally , it was unknown whether COVID-19 viral transmission primarily occurred through droplet or airborne mechanisms . The creation of new levels of isolation , such as “ enhanced droplet ,” where HCW would wear a surgical mask , eye protection and a gown and gloves were implemented , however , questions remained . For example , it was unclear how soon after an aerosol generating procedure a HCW could safely go into a room without a respirator , or whether interventions such as high flow nasal cannula were considered an aerosol generating procedure .
105 physicians , 308 nurses , 2 respiratory therapists 20 physicians , 54 nurses 10 EVS workers 499 HCW
60 physicians , 121 nurses , 27 respiratory therapists 10 nurses 6 EVS workers 224 HCW
4 physicians , 86 nurses , 18 respiratory therapists 74 nurses 11 EVS workers 193 HCW
14 physicians , 66 nurses , 24 respiratory therapists 8 physicians , 10 nurses 4 EVS workers 126 HCW
EVS : Environmental service workers ; HCW : Healthcare workers
West Virginia ( WV ), a rural state , did not experience the predicted early surge of SARS-CoV-2.9 The first confirmed case was diagnosed in WV on March 16 , 2020 , and at WVUH on March 22 , 2020 . 9 At the time of study completion in early June 2020 , WV ’ s SARS-CoV-2 test by polymerase chain reaction ( PCR ) cumulative percent positivity was 2.332 positives of 133,142 tests ( 1.75 %). 10 While preparing for WVUH ’ s first phased reopening , which began on May 25 , 2020 , concern was raised regarding the potential for increased employee exposure to persons with SARS- CoV-2 . The reopening was a challenging task where infection risks were weighed against providing care for the maximal number of patients . Vaccines were not available during this phased reopening until December 2020 . 11 Several multidisciplinary committees were established to weigh these risks . Given the slow surge in WV , and the phased reopening before vaccine availability , we aimed to elucidate whether our PPE policies were effective in
preventing HCW seroconversion during the original variant of COVID-19 .
METHODS
A multicenter , cross-sectional study of randomly selected HCW was conducted at four WVU Medicine hospitals located in COVID-19 hotspots : J . W . Ruby Memorial Hospital , United Hospital Center , Camden Clark Medical Center , and Berkeley Medical Center . At the time of the study , there were 121 cumulative SARS-CoV-2 PCR positive patients across the four participating hospitals . This study was granted approval under expedited status by the local institutional review board .
Medical personnel , such as physicians , nurses , respiratory therapists , and environmental service ( EVS ) workers aged 18 years and older and employed at any of the four designated hospitals during the study period were eligible to participate . A total of 2,400 randomly selected physicians , nurses , respiratory therapists , and EVS workers were invited to participate by email . Participants were classified as high risk or low risk for exposure to COVID-19 based on work location . The high-risk group included those working in intensive care units , designated COVID-19 units or other stepdown units with confirmed COVID-19 positive patients , operating rooms , and emergency departments . The low-risk group was comprised of those working on floor units without confirmed cases of COVID-19 , pediatric units without patients with COVID-19 , ambulatory settings , and remote locations . In those locations , given the limited in-person services and use of telemedicine , there were no known cases of COVID-19 . Environmental service workers were not risk-stratified due to having multiple work locations within the hospitals both within low and high-risk settings . Due to social distancing , participants viewed video informed consent prior to enrolling in the study . A confidential online questionnaire was used to obtain information about demographics , chronic medical conditions , symptoms , and exposures .
The PPE policies implemented ranged depending on risk of exposure . HCW were required to wear a surgical mask at a minimum in all patient care areas . When going
West Virginia Medical Journal • March 2024 • 15