UCLA, UI Health Care, CDC researchers find PPE highly effective at protecting emergency department workers from COVID
Emergency department health care workers’ risk of infection in the early stages of the SARS-CoV-2 (COVID-19) pandemic was largely related to household and other community exposures and not from providing direct patient care while using recommended personal protective equipment (PPE), according to a study published in the journal PLOS ONE.
Proper PPE use, including masks, gloves, and protective gowns, helped keep emergency health care workers shielded from infection while caring for patients. It was when emergency personnel were not working that they were most at risk.
“We did find signals of increased risk among nurses generally and among clinicians who intubated COVID-19-infected patients, but the magnitude of this extra risk was minimal overall compared to that posed by household and community exposures,” said co-principal investigator Dr. David Talan, professor emeritus of emergency medicine and medicine/infectious diseases at the David Geffen School of Medicine at UCLA and Ronald Reagan UCLA Medical Center. “Further, of those staff who tested positive for COVID, 41% never had symptoms, which is important to understand how important universal masking is in hospitals during periods of high COVID-19 activity.”
The findings are part of the COVID-19 Evaluation of Risks in Emergency Departments (Project COVERED) study, conducted by researchers from UCLA, the University of Iowa, and the Centers for Disease Control and Prevention (CDC). Between May and December 2020, prior to the COVID-19 vaccine availability, emergency department staff at 20 medical centers across the country were followed with serial surveys, COVID-19 tests, and serology testing. The study included 1,673 emergency department physicians, advanced practice providers (APPs), nurses, and non-clinical staff who were observed over 20 weeks and 30,000 person-weeks in total. During this surveillance, over 4,400 high-risk aerosolizing intubations were performed.
“At the beginning of the pandemic, the risk of providing emergency patient care was not understood. Emergency care staff were committed to their role in responding to the crisis, but they were understandably anxious.,” said Dr. Nicholas Mohr, lead author and co-principal investigator of the study, and professor of emergency medicine, anesthesia critical care, and epidemiology at University of Iowa Hospitals & Clinics. “Even though emergency care workers felt vulnerable performing procedures and providing clinical care for COVID-19 patients during this time, our findings support that it was really when they were outside the hospital and at home, with their families and friends, and in their community that people were at risk of infection."
Mohr said researchers found 4.5% of emergency personnel became infected with COVID-19, and the most prominent factors associated with those infections were community exposures, hospital case counts, and mask use in public.
“The pandemic has dragged on for a long time, and with each new variant, emergency department health care personnel want to know whether they are safe doing their jobs, and this study shows that they are,” Mohr added. “We found that PPE is effective at preventing COVID-19 transmission during clinical care, so when case counts are high in the community, health care personnel should take precautions outside the hospital as they do when they are working.”
Additional researchers on this study are Anusha Krishnadasan (UCLA); Karisa Harland (UI); Patrick Ten Eyck (UI); William Mower (UCLA); Walter Schrading (University of Alabama and Birmingham); Juan Carlos Montoy (University of California San Francisco); Preeta K. Kutty (CDC); Elisabeth Hesse (CDC); Scott Santibanez (CDC); David Weissman (National Institute for Occupational Safety and Health/CDC); Patricia Slev (ARUP Laboratories).