Assessment Of Risk Factors For Coronavirus Disease 2019 Among Hospital Healthcare Workers, Sierra Leone

Abstract

Background: Healthcare workers (HCWs) are at increased risk of COVID-19 infection due to their role in caring for patients. Despite reports of HCW infections in Sierra Leone, little information exists on the extent and risk factors for infection in healthcare settings. This study aims at investigating the extent and risk factors for COVID-19 infection among healthcare workers exposed to COVID-19 patients at three regional hospitals in Sierra Leone. Methods: A case-ascertained prospective study was conducted in Bo, Kenema, and Port Loko Regional Hospitals from May to July 2020. HCWs exposed to confirmed COVID-19 patients were recruited and followed. A semi-structured questionnaire was used to collect data on demographics, infection prevention and control (IPC) practice, clinical presentation, exposures and contact information. Infection status was determined by laboratory detection of SARS-CoV-2 RNA by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) on nasopharyngeal swab samples. Risk factors were assessed by comparing COVID-19 infected and non-infected participants using binary logistic regression model. Results: Out of 152 participants, 58.6% (89/152) were from Bo Government Hospital, 20.4% (31/152) from Port Loko Government Hospital, and 21.0% (32/152) from Kenema Government Hospital. The median age was 34.0 years (range: 20 – 63 years). About 74.3% (113/152) were females. Overall, the secondary infection rate (SIR) was 28.9% (44/152). SIR was highest among cleaners (55.6% [10/18]). About 68.2% (30/44) of infected HCWs were asymptomatic. Among symptomatic cases, the most common symptoms were headache 27.3% (12/44), fever 18.2% (8/44), and cough 15.9% (7/44). Contact with surfaces around patient (RR 3.3; 95% CI: 1.14 – 9.30; p=0.028), exposure at the triage/isolation or outpatient unit (RR 8.3; 95% CI: 2.49 – 28.27; p=0.001) and cleaning of patient room (RR 4.1; 95% CI: 1.12 – 14.96; p=0.034) were associated with increased risk of COVID-19 infection. Good hand hygiene practice (RR 0.04; 95% CI: 0.01 – 0.23) was associated with a decreased risk of infection. Conclusion: The infection rate for COVID-19 among HCWs was high. Contact with patient’s environment, cleaning of patient room, and exposure at the triage or outpatient units were risk factors for infection. This study emphasized the need for strict adherence to infection control measures by HCWs. Keywords: Risk factors, COVID-19, SARS-CoV-2, Healthcare workers, Hospital, Sierra Leone