Operational and infection-control lessons learned from protecting frontline healthcare workers during a pandemic: Evidence from tertiary hospital case-control data
Meenakshi Khapre, Mahendra Gehlot, Vartika Saxena, Yogesh Bahurupi, Smita Sinha, Teja Rama Krishna S, Deepjyoti Kalita
A
BSTRACT
Background:
Healthcare workers (HCWs) are at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection because of repeated patient contact and exposure to contaminated clinical environments. Identification of behavioral and operational risk factors is essential for strengthening institutional preparedness and infection-prevention strategies.
Methods:
A nested case–control study was conducted among HCWs at a tertiary-care hospital in North India from December 2020 to May 2021 using World Health Organization (WHO)-adapted protocols. Cases were HCWs with laboratory-confirmed SARS-CoV-2 infection and documented occupational exposure; controls were exposed but remained uninfected. Data on exposure patterns, infection-prevention behaviors, and clinical features were collected. Paired serology was performed. Logistic regression was used to identify independent predictors of infection.
Results:
Of 263 participants, 65 were cases and 198 controls. Demographic factors were not associated with infection. Increased risk was observed with frequent close contact (>50 encounters), prolonged face-to-face exposure (>15 min), and repeated contact with patient materials and surrounding surfaces. Exposure to patient body fluids via contaminated surfaces remained the strongest independent risk factor (adjusted odds ratios (aOR) 6.91;
Conclusion:
SARS-CoV-2 infection among HCWs was primarily driven by modifiable behaviors and environmental exposure. Strengthening hand hygiene, IPC compliance, surface decontamination, and administrative controls can substantially reduce infection risk and improve pandemic preparedness.