Quantification of occupational and community risk factors for SARS-CoV-2 seropositivity among healthcare workers in a large U.S. healthcare system

Baker, Julia M.; Nelson, Kristin N.; Overton, Elizabeth; Lopman, Benjamin A.; Lash, Timothy L.; Photakis, Mark; Jacob, Jesse T.; Roback, John; Fridkin, Scott K.; Steinberg, James P.

BACKGROUND: Quantifying occupational risk factors for SARS-CoV-2 infection among healthcare workers can inform efforts to improve healthcare worker and patient safety and reduce transmission. This study aimed to quantify demographic, occupational, and community risk factors for SARS-CoV-2 seropositivity among healthcare workers in a large metropolitan healthcare system. METHODS: We analyzed data from a cross-sectional survey conducted from April through June of 2020 linking risk factors for occupational and community exposure to COVID-19 with SARS-CoV-2 seropositivity. A multivariable logistic regression model was fit to quantify risk factors for infection. Participants were employees and medical staff members who elected to participate in SARS-CoV-2 serology testing offered to all healthcare workers as part of a quality initiative, and who completed a survey on exposure to COVID-19 and use of personal protective equipment. Exposures of interest included known demographic risk factors for COVID-19, residential zip code incidence of COVID-19, occupational exposure to PCR test-positive healthcare workers or patients, and use of personal protective equipment. The primary outcome of interest was SARS-CoV-2 seropositivity. RESULTS: SARS-CoV-2 seropositivity was estimated to be 5.7% (95% CI: 5.2%−6.1%) among 10,275 healthcare workers. Community contact with a person known or suspected to have COVID-19 (aOR=1.9, 95% CI:1.4–2.5) and zip code level COVID-19 incidence (aOR: 1.4, 95% CI: 1.0–2.0) increased the odds of infection. Black individuals were at high risk (aOR=2.0, 95% CI:1.6–2.4). Overall, occupational risk factors accounted for 27% (95% CI: 25%−30%) of the risk among healthcare workers and included contact with a PCR test-positive healthcare worker (aOR=1.2, 95% CI:1.0–1.6). CONCLUSIONS: Community risk factors, including contact with a COVID-19 positive individual and residential COVID-19 incidence, are more strongly associated with SARS-CoV-2 seropositivity among healthcare workers than exposure in the workplace.