Quantification of Occupational and Community Risk Factors for SARS-CoV-2 Seropositivity Among Health Care Workers in a Large U.S. Health Care System

Abstract

BACKGROUND\nIdentifying occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs) can improve HCW and patient safety.\n\n\nOBJECTIVE\nTo quantify demographic, occupational, and community risk factors for SARS-CoV-2 seropositivity among HCWs in a large health care system.\n\n\nDESIGN\nA logistic regression model was fitted to data from a cross-sectional survey conducted in April to June 2020, linking risk factors for occupational and community exposure to coronavirus disease 2019 (COVID-19) with SARS-CoV-2 seropositivity.\n\n\nSETTING\nA large academic health care system in the Atlanta, Georgia, metropolitan area.\n\n\nPARTICIPANTS\nEmployees and medical staff members elected to participate in SARS-CoV-2 serology testing offered to all HCWs as part of a quality initiative and completed a survey on exposure to COVID-19 and use of personal protective equipment.\n\n\nMEASUREMENTS\nDemographic risk factors for COVID-19, residential ZIP code incidence of COVID-19, occupational exposure to HCWs or patients who tested positive on polymerase chain reaction test, and use of personal protective equipment as potential risk factors for infection. The outcome was SARS-CoV-2 seropositivity.\n\n\nRESULTS\nAdjusted SARS-CoV-2 seropositivity was estimated to be 3.8% (95% CI, 3.4%-4.3%) (positive, n\xa0= 582) among the 10\xa0275 HCWs (35% of the Emory Healthcare workforce) who participated in the survey. Community contact with a person known or suspected to have COVID-19 (adjusted odds ratio [aOR], 1.9 [CI, 1.4 to 2.6]; 77 positive persons [10.3%]) and community COVID-19 incidence (aOR, 1.5 [CI, 1.0 to 2.2]) increased the odds of infection. Black individuals were at high risk (aOR, 2.1 [CI, 1.7 to 2.6]; 238 positive persons [8.3%]).\n\n\nLIMITATIONS\nParticipation rates were modest and key workplace exposures, including job and infection prevention practices, changed rapidly in the early phases of the pandemic.\n\n\nCONCLUSION\nDemographic and community risk factors, including contact with a COVID-19-positive person and Black race, are more strongly associated with SARS-CoV-2 seropositivity among HCWs than is exposure in the workplace.\n\n\nPRIMARY FUNDING SOURCE\nEmory COVID-19 Response Collaborative.