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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations Medical system and its affiliated organizations in Seattle, WA, between March 12 and April 23, 2020. During that period, 185 5.3% employees tested positive. Prevalence i.e., proportion of SARSCoV2 in frontline healthcare employees those with faceto-face contact with patients was 5.2%
and prevalence in non-frontline staff was 5.5%. Some staff who were asymptomatic also underwent screening as part of outbreak investigations, and 9
of 151 6% tested positive. When findings from symptomatic and asymptomatic staff were combined, SARSCoV2 prevalence was 5.3% in frontline healthcare employees and 5.3% among all employees. Of the 174
employees who tested positive and were followed, six 3.2% reported COVIDrelated hospitalization, and one employee was admitted to the ICU. No deaths were reported. The study authors suspected that community transmission likely played a major role in infection among healthcare employees early in the local epidemic and that similar percentages of infections in frontline and non-frontline healthcare employees support the PPE protocols implemented for frontline workers at the institution.
In addition, positive cases were likely underestimated due to the focus on testing symptomatic employees.
Vahidy et al., 2020 studied asymptomatic infection rates among staff from a medical center consisting of seven hospitals in Texas and members of the surrounding community in March through April of 2020. Healthcare jobs with possible exposure to COVID19
patients were classified into five categories, with varying levels of patient exposure: 1 Nursing e.g., nurses/
nurses aids, emergency medical technicians, 2 clinicians e.g., physicians, nurse practitioners, 3
allied healthcare workers e.g., therapists, social workers, 4 support staff e.g., security, housekeeping, and 5 administrative or research staff e.g., managers, research assistants. A total of 2,872 asymptomatic individuals, including 2,787 healthcare personnel and 85 community residents, were tested for SARSCoV2 infection.
Among the healthcare personnel tested, the prevalence of SARSCoV2
infection was 5.4% among the 1,992
patient-facing staff treating COVID19
patients and 0.6% among the 625
patient-facing staff not treating COVID
19 patients. No cases were seen among the 170 nonclinical healthcare staff that did not interact with patients or in the 85 community residents Vahidy et al., 2020. The nonclinical healthcare staff worked in buildings with separate
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heating, ventilation, and air conditioning systems, and with lower population density because of remote work when compared to clinical healthcare staff. In the different healthcare categories that cared for COVID19 patients, prevalence of infection ranged from 3.6% to 6.5%, with no significant differences in the different categories of healthcare workers. Therefore, the study indicates that healthcare workers providing both direct and indirect care to COVID19
patients are at risk.
Nagler et al., June 28, 2020, reported the results of SARSCoV2 testing in employees from the New York Langone Health system, an academic medical center encompassing four hospital campuses and over 250 ambulatory sites, with approximately 43,000
employees. Between March 25 and May 18, 2020, the health system tested employees who were symptomatic 4,150, were asymptomatic but exposed to COVID19 4,362, and asymptomatic employees who were returning to work after their services had been suspended during the peak of the epidemic 6,234.
Among symptomatic employees, the COVID19 positivity rate across the duration of the study was 33%. Among asymptomatic employees with selfreported exposure, the COVID19
positivity rate was 8%. In asymptomatic employees returning to work, COVID19
positivity rate was 3%. In all groups, the positivity rate in the first week of testing was substantially higher than in the last week of testing, which occurred more than a month after the first week. The study authors noted a temporal correlation of COVID19 case declines in healthcare employees and the community, despite continued workplace exposure, and suggested that infections in healthcare employees may reflect importance of community transmission and efficacy of stringent infection control and PPE standards that remained largely unchanged since the start of the pandemic in March 2020.
OSHA finds that the study demonstrates the potential for COVID19 to be introduced into the workplace from uncontrolled community spread and that the effective use of infection control practices and PPE most likely prevented transmission to healthcare employees.
Misra-Hebert et al., September 1, 2020 conducted a retrospective cohort study to obtain data on rates of COVID
19 and risk factors for severe disease in healthcare employees and nonhealthcare employees neither category defined who were tested for SARS
CoV2, and listed in a registry at the Cleveland Clinic Health System, between March 8 and June 9, 2020. The
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data was drawn from healthcare employees from different segments of the country. Ninety percent of the healthcare employees and 75% of nonhealthcare employees were from Ohio, and the remainder were from Florida.
Although more healthcare employees than non-healthcare employees reported exposures to COVID19 72% vs. 17%, similar, and not significantly different, proportions of employees tested positive for COVID19 in each group: 9% 551/
6145 of healthcare employees and 6.5%
4353/66,764 of non-healthcare employees. OSHA finds it difficult to draw conclusions regarding this finding because the nature of the exposure e.g., whether it was at close contact was not explained. In fact, patient-facing healthcare employees those having direct contact with patients were 1.6
times more likely than non-patientfacing healthcare employees to test positive. The study authors suggested that the finding represents an increased risk of infection with work exposure, however they were not able to confirm if the exposure occurred 14 days prior to testing or if PPE was worn during the exposure. Positive cases peaked in early-to-mid April for both healthcare employees and non-healthcare employees 16% and 12%, respectively, as estimated from figure 2 of the study, and then decreased concurrently with the implementation of preventive measures, such as masking and physical distancing, over the course of the study.
Of those who tested positive, 6.9% of healthcare employees and 27.7% of non-healthcare employees were hospitalized, and 1.8% and 10.8%
respectively, were admitted to the intensive care unit. The study noted that the lower rates of hospitalization for the healthcare employee group could be explained on the basis that the healthcare employee population was younger and had fewer co-morbidities.
Serology Testing in Employees in Hospitals.
Although most of the studies described in this section relied on polymerase chain reaction PCR tests to detect cases of COVID19, a number of studies conducted serology testing to determine how many individuals had been infected by the SARSCoV2 virus in the past. Serology tests determine if antibodies that respond to the SARS
CoV2 virus are present in samples of blood serum. Seroprevalence is the percentage of individuals in a population who have antibodies. Terms such as seropositive or seroconversion are often used to describe persons who have tested positive for the SARSCoV
2 antibody. Most of the serology tests
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