Use, failure, and non-compliance of respiratory personal protective equipment and risk of upper respiratory tract infections—A longitudinal repeated measurement study during the COVID-19 pandemic among healthcare workers in Denmark

Author:

Biering Karin1ORCID,Kinnerup Martin12,Cramer Christine23ORCID,Dalbøge Annett2,Toft Würtz Else24,Lund Würtz Anne Mette3,Kolstad Henrik Albert2ORCID,Schlünssen Vivi3ORCID,Meulengracht Flachs Esben5,Nielsen Kent J1

Affiliation:

1. Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital , 7400 Herning , Denmark

2. Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital , 8200 Aarhus N , Denmark

3. Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University , 8000 Aarhus C , Denmark

4. Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital , 9000 Aalborg , Denmark

5. Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen , 2400 Copenhagen NV , Denmark

Abstract

Abstract Introduction Upper respiratory tract infections (URTI) are common and a common cause of sick-leave for healthcare workers, and furthermore pose a threat especially for patients susceptible to other diseases. Sufficient use of respiratory protective equipment (RPE) may protect both the workers and the patients. The COVID-19 pandemic provided a unique opportunity to study the association between use of RPE and URTI in a real-life setting. The aim of this study was to examine if failure of RPE or non-compliance with RPE guidelines increases the risk of non-COVID-19 URTI symptoms among healthcare workers. Methods In a longitudinal cohort study, we collected self-reported data daily on work tasks, use of RPE, and URTI symptoms among healthcare workers with patient contact in 2 Danish Regions in 2 time periods during the COVID-19 pandemic. The association between failure of RPE or non-compliance with RPE guidelines and URTI symptoms was analyzed separately by generalized linear models. Persons tested positive for severe acute respiratory syndrome coronavirus 2 were censored from the analyses. The 2 waves of data collection were analyzed separately, as there were differences in recommendations of RPE during the 2 waves. Results We found that for healthcare workers performing work tasks with a risk of transmission of viruses or bacteria, failure of RPE was associated with an increased risk of URTI symptoms, RR: 1.65[0.53–5.14] in wave 1 and RR: 1.30[0.56–3.03] in wave 2. Also non-compliance with RPE guidelines was associated with an increased risk of URTI symptoms compared to the use of RPE in wave 1, RR: 1.28[0.87–1.87] and wave 2, RR: 1.39[1.01–1.91]. Stratifying on high- versus low-risk tasks showed that the risk related to failure and non-compliance was primarily associated with high-risk tasks, although not statistically significant. Discussion The study was conducted during the COVID-19 pandemic and thus may be affected by other preventive measures in society. However, this gave the opportunity to study the use of RPE in a real-life setting, also in departments that did not previously use RPE. The circumstances in the 2 time periods of data collection differed and were analyzed separately and thus the sample size was limited and affected the precision of the estimates. Conclusion Failures of RPE and non-compliance with RPE guidelines may increase the risk of URTI, compared to those who reported use of RPE as recommended. The implications of these findings are that the use of RPE to prevent URTI could be considered, especially while performing high-risk tasks where other prevention strategies are not achievable.

Funder

Danish Working Environment Fund

Publisher

Oxford University Press (OUP)

Reference28 articles.

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2. Cost burden of viral respiratory infections: issues for formulary decision makers;Bertino,2002

3. Use of personal protective equipment among healthcare workers during the first and the second wave of the covid-19 pandemic;Cramer,2023

4. Nurses’ compliance to standard precautions prior to and during covid-19;Dobrina;Int Nurs Rev,2023

5. Barriers to using personal protective equipment by healthcare staff during the covid-19 outbreak in China;Fan;Medicine (Baltimore),2020

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