Factors associated with the SARS-CoV-2 infection among health professionals from university hospitals

Cunha, Quézia Boeira da; Freitas, Etiane de Oliveira; Pai, Daiane Dal; Santos, José Luís Guedes dos; Lourenção, Luciano Garcia; Silva, Rosângela Marion da; Magnago, Tânia Solange Bosi de Souza; Miranda, Fernanda Moura D’Almeida; Camponogara, Silviamar

doi:10.1590/1518-8345.6482.3918

Quézia Boeira da Cunha

Study concept and design

Obtaining data

Data analysis and interpretation

Statistical analysis

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal de Santa Maria, Hospital Universitário de Santa Maria, Santa Maria, RS, Brazil

https://orcid.org/0000-0001-7014-9343

Etiane de Oliveira Freitas

Study concept and design

Obtaining data

Data analysis and interpretation

Statistical analysis

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil

https://orcid.org/0000-0002-8589-2524

Daiane Dal Pai

Study concept and design

Obtaining data

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil

https://orcid.org/0000-0002-6761-0415

José Luís Guedes dos Santos

Study concept and design

Obtaining data

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal de Santa Catarina, Departamento de Enfermagem, Florianópolis, SC, Brazil

https://orcid.org/0000-0003-3186-8286

Luciano Garcia Lourenção

Obtaining data

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal do Rio Grande, Escola de Enfermagem, Rio Grande, RS, Brazil

https://orcid.org/0000-0002-1240-4702

Rosângela Marion da Silva

Study concept and design

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil

https://orcid.org/0000-0003-3978-9654

Tânia Solange Bosi de Souza Magnago

Study concept and design

Data analysis and interpretation

Statistical analysis

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil

https://orcid.org/0000-0002-5308-1604

Fernanda Moura D’Almeida Miranda

Obtaining data

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brazil

https://orcid.org/0000-0001-7140-9557

Silviamar Camponogara

Study concept and design

Obtaining data

Data analysis and interpretation

Statistical analysis

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil

https://orcid.org/0000-0001-9342-3683

Corresponding author:
Quézia Boeira da Cunha E-mail: quezia.cunha@ufsm.br https://orcid.org/0000-0001-7014-9343

Conflict of interest:

the authors have declared that there is no conflict of interest.

Associate Editor:

Maria Lucia do Carmo Cruz Robazzi

	Quantitative stage (n=559)		Qualitative stage (n=599)
	Care professionals (n=559)		Care professionals (n=546)		Managers, IHICC ^* * IHICC = In-Hospital Infection Control Center; , PE ^† † PE = Permanent Education Service; , WH ^‡ ‡ WH = Workers’ Health Service; (n=53)
Variables	N (%)	Md ^§ § Md = Median; [P25; P75]	N(%)	Md ^§ § Md = Median; [P25; P75]	N(%)	Md ^§ § Md = Median; [P25; P75]
Age		45 [39; 52.25]		45 [39; 45]		45 [39; 54]
Sex
Female	432 (77.3)		424 (77.6)		38 (71.7)
Male	127 (22.7)		122 (22.3)		15 (28.3)
Marital status
With a partner	444 (79.4)		437 (80.0)		41 (77.3)
Without a partner	115 (20.6)		109 (20.0)		12 (22.7)
Children
Yes	407 (72.8)		410 (75.1)		19 (35.8)
No	152 (27.2)		136 (24.9)		34 (64.2)
Profession
Nursing	397 (71)		391 (71.6)		36 (67.9)
Medicine	162 (29)		155 (28.4)		13 (24.5)
Pharmacy	-		-		3 (5.6)
Physiotherapy	-		-		1 (1.8)
Employment contract
SLR ^\|\| \|\| SLR = Single Legal Regime;	127 (22.7)		122 (22.3)		23 (43.4)
CLT ^¶ ¶ CLT = Consolidação das Leis do Trabalho (Consolidation of Labor Laws)	405 (72.5)		399 (73.1)		29 (54.7)
Emergency	27 (4.8)		25 (4.6)		1 (1.8)

	SARS-CoV-2 infection
	Total	Negative test result	Positive test result	p ^* * p = Significance level (p<0.05);
	437 (100)	305 (69.8%)	132 (30.2)
	n (%)	n (%)	n (%)
Sex ^† † Chi-square test;
Female	342 (78.3)	238 (54.5)	104 (23.8)	0.861
Male	95 (21.7)	67 (15.3)	28 (6.4)
Marital status ^† † Chi-square test;
With a partner	347 (79.4)	245 (56.1)	102 (23.3)	0.468
Without a partner	90 (20.6)	60 (13.7)	30 (6.9)
Children ^† † Chi-square test;
Yes	319 (73)	225 (51.5)	94 (21.5)	0.580
No	118 (27)	80 (18.3)	38 (8.7)
Sector ^† † Chi-square test;
COVID area	45 (10.3)	30 (6.9)	15 (3.4)	0.630
Non-COVID area	392 (89.7)	275 (62.9)	117 (26.8)
Function ^† † Chi-square test;
Nurses	326 (74.6)	221 (50.6)	105 (24)	0.118
Physicians	111 (25.4)	84 (19.2)	27 (6.2)
Predominant work shift ^† † Chi-square test;
Day	289 (66.1)	207 (47.4)	82 (18.8)	0.244
Night	148 (33.9)	98 (22.4)	50 (11.4)
Age ^‡ ‡ Mann-Whitney test
Median	43	43	43	0.568
P25; P75	37.5; 51	37.5; 51	37.25; 50
Time of professional experience (in years) ^‡
Median	16	16	15	0.754
P25; P75	10; 24	10; 24	11; 24

	Simple regression
	PRU ^* * PRU = Unadjusted Prevalence Ratio (variables with significance below 0.20 were included in the multiple model);	[CI ^† † CI = Confidence interval (CI=95%); ]	p ^‡ ‡ p = Significance level (p<0.05);
Sex
Female	Ref ^§ § Ref = Reference;
Male	0.969	[0.683; 1.375]	0.861
Marital status
With a partner	Ref ^§ § Ref = Reference;
Without a partner	1.134	[0.812; 1.585]	0.461
Children
Yes	Ref ^§ § Ref = Reference;
No	1.093	[0.800; 1.493]	0.577
Institution
Hospital A	Ref ^§ § Ref = Reference;
Hospital B	1.772	[1.110; 2.828]	0.017
Hospital C	1.533	[1.031; 2.279]	0.035
Hospital D	1.635	[0.998; 2.680]	0.051
Hospital E	1.728	[1.031; 2.897]	0.038
Sector
COVID area	Ref ^§ § Ref = Reference;
Non-COVID area	0.895	[0.577; 1.391]	0.623
Function
Nurses	Ref ^§ § Ref = Reference;
Physicians	0.755	[0.525; 1.087]	0.131
Employment contract
SLR ^\|\| \|\| SLR = Single Legal Regime;	Ref ^§ § Ref = Reference;
CLT ^¶ ¶ CLT = Consolidação das Leis do Trabalho (Consolidation of Labor Laws);	1.393	[0.947; 2.050]	0.092
Emergency	1.576	[0.819; 3.033]	0.173
Type of test
RT-PCR ^ RT-PCR = Reverse Transcriptase Polymerase Chain Reaction;	Ref ^§ § Ref = Reference;
Serology	0.252	[0.098; 0.649]	0.004
Both	0.669	[0.467; 0.957]	0.028
The service treats COVID-19 patients
No	Ref ^§ § Ref = Reference;
Yes	2.592	[1.128; 5.958]	0.025
Guidelines and/or training in the institution about biosafety with a focus on preventing transmission of the new coronavirus
Yes	Ref ^§ § Ref = Reference;
No	1.222	[0.633; 2.360]	0.550
Direct assistance provided to suspected or confirmed COVID-19 patients
No	Ref ^§ § Ref = Reference;
Yes	3.617	[0.955; 13.703]	0.059
Does not know	3.286	[0.561; 19.251]	0.873
Symptoms suggestive of COVID-19
No	Ref ^§ § Ref = Reference;
Yes	6.141	[3.922; 9.615]	<0.001
Social distancing in the private life activities
Always	Ref ^§ § Ref = Reference;
Most of the time	0.330	[0.230; 0.474]	<0.001
Occasionally	0.341	[0.094; 1.229]	0.100
Rarely	0.738	[0.236; 2.310]	0.602
Risk group
Yes	Ref ^§ § Ref = Reference;
No	0.871	[0.641; 1.182]	0.375
	Multiple regression
	PRA ^†† †† PRA = Adjusted Prevalence Ratio = “SARS-CoV-2 Infection” + “Institution” + “Employment contract” + “Direct assistance to suspected or confirmed patient” + “Type of test” + “The service treats COVID-19 patients” + “Symptoms suggestive of COVID-19” + “Social distancing in the private life activities”	[CI ^† † CI = Confidence interval (CI=95%); ]	p ‡ p = Significance level (p<0.05); ‡
Symptoms suggestive of COVID-19
No	Ref ^§ § Ref = Reference;
Yes	5.634	[3.508; 9.050]	<0.0001
Social distancing in the private life activities
Always	Ref ^§ § Ref = Reference;
Most of the time	0.461	[0.328; 0.647]	<0.0001
Occasionally	0.417	[0.131; 1.325]	0.138
Rarely	2.832	[0.834; 9.639]	0.095

Difficulty identified	Use of Personal Protective Equipment
Shortage and low quality of the equipment	We’ve already been told to wear our fabric masks because there are no others. At this moment, the available masks are of awful quality, as an example, the elastic band keeps pulling the ears, leaving them red and in pain. (NT33, Hospital A – Ward)
Prioritization of the COVID areas	I understand that all professionals who are working in patient care (COVID or non-COVID), both in hospitalization as well as in the outpatient service, should receive an N95 mask, which was only provided to professionals in the COVID areas (emergency, ICU^* * ICU = Intensive Care Unit; , OMS^† † OMS = Occupational Medicine Service; or COVID hospitalization). (Ph100, Hospital C – Outpatient service)
Difficulty identified	Work process, organization and routines
Isolation of patients	There’s lack of organization, in my work, on the part of the regulation, in hospitalizing suspected and positive COVID patients with other patients and it also puts us under risk. (NT138, Hospital D – Ward)
Changes in the guidelines	Mismatched information, different from institutional guidance. Frequent changes in guidelines and adequacy of the SOPs^‡ ‡ SOPs = Standard Operating Procedures . Fear of contracting the disease reduces understanding of the guidelines. (Ph44, Hospital C)
Difficulty identified	Distancing in the work environment
Co-living areas	Despite the professionals’ technical qualification, it is necessary to make a weekly call to comply with safety course of action in the co-living areas. These places were the main sources for contamination among employees. (Ph38, Hospital C)
Inadequate physical space	It was very difficult at first and, to this day, we work in a small and overcrowded physical space. (Ph12, Hospital D – Obstetric Center)
Difficulty identified	Work overload
Leaves and insufficient staffing	Our greatest difficulty was the number of employees, due to leaves related to COVID-19. Temporary selection processes were opened and not enough people were hired to meet the need. This generated a tight schedule, work overload, stress and, consequently, problems in interpersonal relationships. (M41, Hospital B)
Difficulty identified	Screening and testing policy
Screening and testing of the professionals	The number of colleagues (from all sectors) who come to work with COVID-19 symptoms is shocking. I suggest a daily interrogation about symptoms before taking over the job. (Ph30, Hospital C – CCRPA)
Screening and testing of patients, family members and companions	The difficulties are in that the patients don’t have COVID symptoms and end up going to non-COVID wards and then they turn out to be positive and this exposes large groups of employees. (M18, Hospital B) As we’re Pediatrics, the family must be included in anamnesis, and there was a failure at this point, many times the family had COVID and this wasn’t taken into account, which exposed the other patients, because the child had no flu-like symptoms at that moment. (M37, Hospital C)

[1] Corresponding author:
Quézia Boeira da Cunha E-mail: quezia.cunha@ufsm.br https://orcid.org/0000-0001-7014-9343

Brasil

Brasil

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