COVID-19 and healthcare workers: a rapid systematic review into risks and preventive measures

J Valérie Gross, Judith Mohren, Thomas C Erren, J Valérie Gross, Judith Mohren, Thomas C Erren

Abstract

Objective: The COVID-19 pandemic is demanding for occupational medicine and for public health. As healthcare workers (HCWs) fight impacts of SARS-CoV-2 on front lines, we must create safe work environments through comprehensive risk assessments, evaluation and effective implementation of counter-measures. We ask: 'What does current literature report on health risks at workplaces regarding COVID-19?' and 'What do current studies report on the effectiveness of enacted preventative recommendations?'

Methods: As a snapshot of early HCW research, on 26 April 2020, we conducted a rapid systematic literature search in three databases (PubMed, Web of Science and PsycInfo) for COVID-19-related health outcomes and preventive measures in healthcare-associated workplaces.

Results: 27 studies were identified as relevant for exploring the risk of infection, 11 studies evaluated preventive measures. The studies described that SARS-CoV-2 impacts significantly on HCW's health and well-being, not only through infections (n=6), but also from a mental health perspective (n=16). 4 studies reported indirect risks such as skin injuries, one study described headaches to result from the use of personal protective equipment. Few studies provided information on the effectiveness of prevention strategies. Overall, most studies on health risks as well as on the effectiveness of preventive measures were of a moderate-to-low quality; this was mainly due to limitations in study design, imprecise exposure and outcome assessments.

Conclusions: Due to widespread exposure of HCW to SARS-CoV-2, workplaces in healthcare must be as safe as possible. Information from HCW can provide valuable insights into how infections spread, into direct and indirect health effects and into how effectively counter-measures mitigate adverse health outcomes. However, available research disallows to judge which counter-measure(s) of a current 'mix' should be prioritised for HCW. To arrive at evidence-based cost-effective prevention strategies, more well-conceived studies on the effectiveness of counter-measures are needed.

Keywords: epidemiology; occupational & industrial medicine; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of the included studies.

References

    1. Godderis L, Luyten J. Challenges and opportunities for occupational health and safety after the COVID-19 lockdowns. Occup Environ Med 2020;77:511–2. 10.1136/oemed-2020-106645
    1. The Lancet COVID-19: protecting health-care workers. The Lancet 2020;395:922 10.1016/S0140-6736(20)30644-9
    1. CDC COVID-19 Response Team Characteristics of Health Care Personnel with COVID-19 - United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep 2020;69:477–81. 10.15585/mmwr.mm6915e6
    1. Chu J, Yang N, Wei Y, et al. . Clinical characteristics of 54 medical staff with COVID-19: a retrospective study in a single center in Wuhan, China. J Med Virol 2020;92:807–13. 10.1002/jmv.25793
    1. Li W, Zhang J, Xiao S. Characteristics of health worker fatality in China during the outbreak of COVID-19 infection. J Infect 2020;81 10.1016/j.jinf.2020.03.030
    1. McMichael TM, Currie DW, Clark S, et al. . Epidemiology of Covid-19 in a long-term care facility in King County, Washington. N Engl J Med 2020;382:2005–11. 10.1056/NEJMoa2005412
    1. Ran L, Chen X, Wang Y, et al. . Risk factors of healthcare workers with coronavirus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China. Clin Infect Dis 2020;71:2218–21. 10.1093/cid/ciaa287
    1. Zhan M, Qin Y, Xue X, et al. . Death from Covid-19 of 23 health care workers in China. N Engl J Med 2020;382:2267–8. 10.1056/NEJMc2005696
    1. Cao J, Wei J, Zhu H, et al. . A study of basic needs and psychological wellbeing of medical workers in the fever clinic of a tertiary General Hospital in Beijing during the COVID-19 outbreak. Psychother Psychosom 2020;89:252–4. 10.1159/000507453
    1. Chen Y, Zhou H, Zhou Y, et al. . Prevalence of self-reported depression and anxiety among pediatric medical staff members during the COVID-19 outbreak in Guiyang, China. Psychiatry Res 2020;288:113005. 10.1016/j.psychres.2020.113005
    1. Chew NWS, Lee GKH, Tan BYQ, et al. . A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun 2020;88:559–65. 10.1016/j.bbi.2020.04.049
    1. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res 2020;288:112954. 10.1016/j.psychres.2020.112954
    1. Kang L, Ma S, Chen M, et al. . Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: a cross-sectional study. Brain Behav Immun 2020;87:11–17. 10.1016/j.bbi.2020.03.028
    1. Lai J, Ma S, Wang Y, et al. . Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976. 10.1001/jamanetworkopen.2020.3976
    1. Li Z, Ge J, Yang M, et al. . Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain Behav Immun 2020;88:916–9. 10.1016/j.bbi.2020.03.007
    1. ZaH L, Jiang R, et al. . Mental health status of doctors and nurses during COVID-19 epidemic in China, 2020.
    1. Lu W, Wang H, Lin Y, et al. . Psychological status of medical workforce during the COVID-19 pandemic: a cross-sectional study. Psychiatry Res 2020;288:112936. 10.1016/j.psychres.2020.112936
    1. Mo Y, Deng L, Zhang L, et al. . Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag 2020;28:1002–9. 10.1111/jonm.13014
    1. Sun N, Wei L, Shi S, et al. . A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control 2020;48:592–8. 10.1016/j.ajic.2020.03.018
    1. BYQ T, Chew NWS, GKH L. Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Ann Intern Med 2020. 10.7326/M20-1083
    1. Wu W, Zhang Y, Wang P, et al. . Psychological stress of medical staffs during outbreak of COVID-19 and adjustment strategy. J Med Virol 2020;92:1962–70. 10.1002/jmv.25914
    1. Xiao H, Zhang Y, Kong D, et al. . The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 2020;26:e923549. 10.12659/MSM.923549
    1. Xu J, Xu Q-H, Wang C-M, et al. . Psychological status of surgical staff during the COVID-19 outbreak. Psychiatry Res 2020;288:112955. 10.1016/j.psychres.2020.112955
    1. Zhang W-R, Wang K, Yin L, et al. . Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom 2020;89:242–50. 10.1159/000507639
    1. Gheisari M, Araghi F, Moravvej H, et al. . Skin reactions to non-glove personal protective equipment: an emerging issue in the COVID-19 pandemic. J Eur Acad Dermatol Venereol 2020;34:e297–8. 10.1111/jdv.16492
    1. Jiang Q, Song S, Zhou J, et al. . The prevalence, characteristics, and prevention status of skin injury caused by personal protective equipment among medical staff in fighting COVID-19: a multicenter, cross-sectional study. Advances in Wound Care 2020;9:357–64. 10.1089/wound.2020.1212
    1. Lan J, Song Z, Miao X, et al. . Skin damage among health care workers managing coronavirus disease-2019. J Am Acad Dermatol 2020;82:1215–6. 10.1016/j.jaad.2020.03.014
    1. Lin P, Zhu S, Huang Y, et al. . Adverse skin reactions among healthcare workers during the coronavirus disease 2019 outbreak: a survey in Wuhan and its surrounding regions. Br J Dermatol 2020;183:190–2. 10.1111/bjd.19089
    1. Ong JJY, Bharatendu C, Goh Y, et al. . Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache 2020;60:864–77. 10.1111/head.13811
    1. Huang Z, Zhao S, Li Z, et al. . The battle against coronavirus disease 2019 (COVID-19): emergency management and infection control in a radiology department. J Am Coll Radiol 2020;17:710–6. 10.1016/j.jacr.2020.03.011
    1. Wee LE, Fua T-P, Chua YY, et al. . Containing COVID-19 in the emergency department: the role of improved case detection and segregation of suspect cases. Acad Emerg Med 2020;27:379–87. 10.1111/acem.13984
    1. Ng K, Poon BH, Kiat Puar TH, et al. . COVID-19 and the risk to health care workers: a case report. Ann Intern Med 2020;172:766–7. 10.7326/L20-0175
    1. Malik T. COVID-19 and the efficacy of different types of respiratory protective equipment used by health care providers in a health care setting. Cureus 2020;12 10.7759/cureus.7621
    1. Chen R, Zhang Y, Huang L, et al. . Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing cesarean delivery: a case series of 17 patients. Can J Anaesth 2020;67:655–63. 10.1007/s12630-020-01630-7
    1. Huang L, Lin G, Tang L, et al. . Special attention to nurses' protection during the COVID-19 epidemic. Crit Care 2020;24:120. 10.1186/s13054-020-2841-7
    1. Htun HL, Lim DW, Kyaw WM, et al. . Responding to the COVID-19 outbreak in Singapore: staff protection and staff temperature and sickness surveillance systems. Clin Infect Dis 2020;71:1947–52. 10.1093/cid/ciaa468
    1. Zhu W, Huang X, Zhao H, et al. . A COVID-19 patient who underwent endonasal endoscopic pituitary adenoma resection: a case report. Neurosurgery 2020;87:E140–6. 10.1093/neuros/nyaa147
    1. Kabesch M, Roth S, Brandstetter S, et al. . Successful containment of Covid‐19 outbreak in a large maternity and perinatal center while continuing clinical service. Pediatr Allergy Immunol 2020;31:560–4. 10.1111/pai.13265
    1. Chen Q, Liang M, Li Y, et al. . Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry 2020;7:e15–16. 10.1016/S2215-0366(20)30078-X
    1. He X, Lau EHY, Wu P, et al. . Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020;26:672–5. 10.1038/s41591-020-0869-5
    1. Reusken CB, Buiting A, Bleeker-Rovers C, et al. . Rapid assessment of regional SARS-CoV-2 community transmission through a convenience sample of healthcare workers, the Netherlands, March 2020. Euro Surveill 2020;25. 10.2807/1560-7917.ES.2020.25.12.2000334
    1. Wilson AN, Ravaldi C, Scoullar MJL, et al. . Caring for the carers: ensuring the provision of quality maternity care during a global pandemic. Women Birth 2020. 10.1016/j.wombi.2020.03.011. [Epub ahead of print: 08 Apr 2020].
    1. Rana W, Mukhtar S, Mukhtar S. Mental health of medical workers in Pakistan during the pandemic COVID-19 outbreak. Asian J Psychiatr 2020;51:102080. 10.1016/j.ajp.2020.102080
    1. Pappa S, Ntella V, Giannakas T, et al. . Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun 2020;88:S0889-1591(20)30845-X. 10.1016/j.bbi.2020.05.026
    1. Lancaster EM, Sosa JA, Sammann A, et al. . Rapid response of an academic surgical department to the COVID-19 pandemic: implications for patients, surgeons, and the community. J Am Coll Surg 2020;230:1064–73. 10.1016/j.jamcollsurg.2020.04.007
    1. Cook TM. Personal protective equipment during the COVID-19 pandemic - a narrative review. Anaesthesia 2020;75 10.1111/anae.15071
    1. Delgado D, Wyss Quintana F, Perez G, et al. . Personal safety during the COVID-19 pandemic: realities and perspectives of healthcare workers in Latin America. Int J Environ Res Public Health 2020;17. 10.3390/ijerph17082798. [Epub ahead of print: 18 Apr 2020].
    1. Coffey S, Moynagh A, Green B, et al. . Changes to management of a non-pandemic illness during the COVID-19 pandemic: case study of invasive management of acute coronary syndrome. N Z Med J 2020;133:101–6.
    1. Bhadelia N. Coronavirus: hospitals must learn from past pandemics. Nature 2020;578:193. 10.1038/d41586-020-00354-4
    1. Xu C, Jin J, Song J, et al. . Application of refined management in prevention and control of the coronavirus disease 2019 epidemic in non-isolated areas of a general Hospital. Int J Nurs Sci 2020;7:143–7. 10.1016/j.ijnss.2020.04.003
    1. Houghton C, Meskell P, Delaney H, et al. . Barriers and facilitators to healthcare workers' adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst Rev 2020;4:Cd013582. 10.1002/14651858.CD013582
    1. Herron JBT, Kuht JA, Hussain AZ, et al. . Do theatre staff use face masks in accordance with the manufacturers' guidelines of use? J Infect Prev 2019;20:99–106. 10.1177/1757177418815551
    1. Wennmann DO, Dlugos CP, Hofschröer A, et al. . [Handling of COVID-19 in the emergency department : Field report of the emergency ward of the University Hospital Münster]. Med Klin Intensivmed Notfmed 2020;115:380-387. 10.1007/s00063-020-00693-0
    1. Zhang M, Zhou M, Tang F, Wang Y, et al. . Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect 2020;105:183-187. 10.1016/j.jhin.2020.04.012
    1. Erren TC, Lewis P, Shaw DM. The COVID-19 Pandemic: Ethical and Scientific Imperatives for "Natural" Experiments. Circulation 2020;142:309–11. 10.1161/CIRCULATIONAHA.120.048671
    1. Glasziou PP, Sanders S, Hoffmann T. Waste in covid-19 research. BMJ 2020;369:m1847. 10.1136/bmj.m1847

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir