Publications // Studies
03.05.2020

Lack of hand hygiene and working long hours

The number of staff suffering from a COVID-19 infection during their nursing or medical work is on the rise. Almost 10,000 cases (situation report dated 05/03/2020) were recently recorded by the Robert Koch Institute with a high estimated number of unreported cases. A current retrospective cohort study at the University Hospital in Wuhan with 3,300 beds provides information about the specific risks for health workers.

The most important risk factors of COVID-19 infection in staff:

• Working in a high risk department

• Working shifts of more than 10 hours

• Lack of hand hygiene compliance before and after contact with patients

• Insufficient personal protective equipment

The development of the pneumonia pandemic COVID-19, caused by SARS-Cov-2, remains a cause for concern. More and more healthcare workers are among those infected. Communicable respiratory diseases are considered to be a particular risk for nurses and physicians. During the SARS outbreak in 2002, approximately 1,725 healthcare workers were infected with Severe Acute Respiratory Syndrome (SARS) while caring for patients who had contracted SARS.

For this reason, greater importance should be placed on the protection of health workers. In order to better understand how staff can be protected, a research team at a 3,300-bed clinic responsible for the medical treatment of COVID-19 patients carried out a retrospective cohort study of 72 health workers. All study participants were suffering from an infection of the respiratory tract or showed typical symptoms.

Participants from different departments were divided into two groups for the study based on their risk exposure:

  • High-risk department

This included staff working in the intensive care unit, the infection ward or the surgical ward or performing activities that generated respiratory aerosols.

  • General groups

This included staff from all other departments where a low risk of infection was assumed.

A follow-up observation confirmed COVID-19 infection in 39% of the participants. Staff were asked to fill out an online questionnaire, which contained detailed information on socio-demographic characteristics, symptoms and course of illness, contact history, occupation, working hours, hand hygiene and the wearing of personal protective equipment (PPE). A total of 72 questionnaires were valid and were included in order to analyze the risk factors. Of these 72 individuals, 39 were assigned to the general low-risk department and 33 to the high-risk department.

Staff from the high-risk department had a risk of developing COVID-19 that was 2.13 times higher compared to the general department group. The higher the number of daily working hours, the higher the risk was that staff would fall ill with COVID-19. This scenario applied to the high-risk department in particular. The researchers assumed that all of the staff there would have been infected if they had had to work 15 hours a day.

According to the authors, the four most important risk factors of COVID-19 infection in staff are working in a high-risk department, working shifts of more than 10 hours, a lack of hand hygiene compliance before and after contact with patients and inadequate personal protective equipment.


Sources:
Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. Risk factors of healthcare workers with corona virus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China. Clin Infect Dis. 2020 Mar 17 [Epub ahead of print]. https://doi.org/10.1093/cid/ciaa287 Last accessed 5/3/2020

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