Long Workdays Tied to Higher COVID-19 Risk in Healthcare Workers

By Will Boggs MD

March 30, 2020

NEW YORK (Reuters Health) - Long workdays, especially in high-risk departments, are associated with significantly higher risk of acquiring COVID-19 in healthcare workers, according to a study from Wuhan, China.

Poor hand hygiene and inadequate use of personal protective equipment also contributed significantly to their risk, researchers reported in Clinical Infectious Diseases.

"We would like to raise" awareness about protecting medical staff with this paper, Dr. Xiaodong Tan of Wuhan University told Reuters Health by email. "Behaviors like washing hands and wearing personal protective equipment seem little actions, but have proved effective in previous studies."

An estimated 1,716 Chinese healthcare workers had been infected by COVID-19 through mid-February, 2020, Dr. Tan and his colleagues note.

The team sought to determine risk factors and behaviors associated with the development of COVID-19 in their retrospective study of 72 healthcare workers, 39 of whom worked in low-risk clinical departments and 33 of whom worked in high-risk departments such as respiratory, infectious diseases, intensive care unit and surgery.

The risk of infection increased significantly and progressively with the number of hours worked daily. According to the authors' analysis, all of the staff working in high-risk departments would be infected if they worked 15 hours per day.

Healthcare workers with a diagnosed family member had a 2.76-fold higher risk of COVID-19 (versus those without a diagnosed family member), whereas having a diagnosed patient or a suspected patient was associated with a significantly reduced risk of COVID-19.

The risk of COVID-19 was 2.64-fold higher with unqualified handwashing, 3.10-fold higher with suboptimal hand hygiene before patient contact, 2.43-fold higher with suboptimal hand hygiene after patient contact and 2.82-fold higher with improper personal protective equipment. All these risk increases were statistically significant.

Healthcare workers in high-risk departments had a 2.13-fold higher risk of developing COVID-19 than those working in low-risk departments, also a significant finding. This risk was further compounded by male sex and suboptimal hand hygiene after patient contact.

"As can been seen in this study, keeping hands clean before and after contacting patients is important to reduce the risk," Dr. Tan said, as is correct use of "adequate personal protective equipment (like face masks, protective clothing, gloves, goggles)," he added.

"Another way is to limit the duty hours (to) 10 hours per day both for clinicians and nurses, for high-risk departments and general departments," he said.

"Governments should also attach great importance to this issue, assisting with more medical supplies and technical support," Dr. Tan said.

SOURCE: https://bit.ly/3dtI23R Clinical Infectious Diseases, online March 17, 2020.