Breeher, Laura

Objective: To evaluate the effectiveness of a standardized hazardous medication surveillance program and identify occupational factors associated with adverse health outcomes among healthcare workers (HCWs). Methods: We analyzed data from 2,625 HCWs enrolled in a multi-site surveillance program (2020–2022). Participants completed a standardized questionnaire and underwent complete blood count testing. Exposure was categorized by weekly time handling hazardous medications. Associations were evaluated using univariate and multivariable analyses. Results: Higher exposure (>8 hours/week) was associated with increased symptom reporting, hazardous medication spills, and adverse reproductive outcomes. Female sex, older age, and spill exposure independently predicted symptom reporting and reproductive outcomes. No significant association was observed between exposure intensity and abnormal blood counts. Conclusion: Questionnaire-based surveillance effectively identified exposure-related health risks, whereas routine complete blood count testing showed limited utility.

Abstract Healthcare personnel (HCP) are at risk for occupational exposure to tuberculosis. Current guidelines for managing exposed HCP are broad and resource intensive. Based on review of our internal data, we propose a risk-based stratification approach to streamline exposure follow-up testing and optimize resource utilization.

Abstract Objective To share findings of a quality improvement initiative to capture employment status in the electronic medical record (EMR) to mitigate the potential impact of work loss on the health of patients by utilizing the results to identify eligible individuals for resources to assist return-to-work efforts. Materials and Methods Patients self-identified employment status through a structured new social determinants of health (SDOH) question within the EMR. An electronic outreach campaign was developed to provide information via the patient portal detailing services within healthcare and the community that could benefit the patients. Results Over the course of 12 months, 2059 patients were identified from the employment SDOH question. Resources to support stay at work and return to work efforts were provided to patients through an automated electronic portal campaign with 87% of patients reading the message and 7% engaging with a healthcare return to work case manager. Discussion Loss of employment has detrimental impacts on individual and population health. Most EMRs do not capture information on employment status. Adding this simple question identified individuals with potential gaps in SDOH, and in this case allowed specific resources to be shared with patients with an illness or injury that was acutely impacting work. Conclusion Medical center decision makers and EMR programmers should consider adding employment status as a social determinant of health.

Background The Minnesota Retaining Employment and Talent After Injury and Illness Network (MN RETAIN) is a randomized controlled study designed to evaluate early interventions promoting workforce retention among workers in Minnesota. The study compares a cohort receiving increased support for stay at work and return to work (SAW/RTW) services from healthcare organizations and resources through workforce development to a control cohort provided solely a list of SAW/RTW resources within the state they can access on their own. Objective This manuscript aims to describe the design of the MN RETAIN Phase 2 study and experience to date including enrollment. Target enrollment for Phase 2 of MN RETAIN is 3200 workers with approximately half receiving SAW/RTW services from a Return-to-Work Case Manager (RWTCM) who is embedded within the healthcare team. MN RETAIN is structured to be accessible to all workers within the state, with a focus on equity and reaching historically underserved populations. Methods Phase 2 of the RETAIN model expanded the focus from the southeast region of MN to state-wide coverage. Enrollment and services were designed to acquire a large enough cohort to reach adequate statistical power to detect differences in disability costs and rates of SAW/RTW in participating study subjects. Impact analysis of RETAIN will be performed by the federal evaluator at a future date. Results Characteristics of enrolled participants to date are summarized as well as considerations for sustainability of the program upon study completion. Conclusions To date, the study has reached diverse workers from throughout the state of MN to provide assistance with SAW/RTW.

Abstract Background Uncertainty exists regarding the effectiveness of COVID-19 vaccine to prevent postacute sequelae of COVID-19 (PASC) following a breakthrough infection. While most studies based on symptom surveys found an association between preinfection vaccination status and PASC symptoms, studies of medically attended PASC are less common and have reported conflicting findings. Methods In this retrospective cohort of patients with an initial SARS-CoV-2 infection who were continually empaneled for primary care in a large US health system, the electronic health record was queried for preinfection vaccination status, demographics, comorbidity index, and diagnosed conditions. Multivariable logistic regression was used to model the outcome of a medically attended PASC diagnosis within 6 months of SARS-CoV-2 infection. Likelihood ratio tests were used to assess the interaction between vaccination status and prevalent variant at the time of infection and between vaccination status and hospitalization for SARS-CoV-2 infection. Results During the observation period, 6.9% of patients experienced medically attended and diagnosed PASC. A diagnosis of PASC was associated with older age, female sex, hospitalization for the initial infection, and an increased severity-weighted comorbidity index and was inversely associated with infection during the Omicron period. No difference in the development of diagnosed PASC was observed between unvaccinated patients and those vaccinated with either 2 doses of an mRNA vaccine or >2 doses. Conclusions We found no association between vaccination status at the time of infection and development of medically diagnosed PASC. Vaccine remains an important measure to prevent SARS-CoV-2 infection and severity. Further research is needed to identify effective measures to prevent and treat PASC.

The COVID-19 pandemic disrupted the workforce, resulting in a shift to a largely remote working population. As a result of this shift, Employee Occupational Health Services (EOHS) was required to develop a solution to evaluate new employees and provide occupational medical clearance without the physical presence of the candidate. An online candidate portal was created where individuals could complete evaluation paperwork and screenings asynchronously. The evaluation forms and screenings were then reviewed by occupational health nursing staff, and testing was conducted in the candidate’s home location. The virtual evaluation solution expedited the assessment process, added convenience for candidates and reduced the amount of time needed from EOHS staff. It is imperative that EOHS departments adjust to the changing workforce by offering virtual evaluation solutions that provide candidates with a seamless and efficient solution to complete required paperwork, testing and immunisations.

The objective of this observational study is to determine whether vaccination for SARS-CoV-2 alters the clinical presentation of post-COVID conditions (PCC). Self-reported data provided by patients requesting care for PCC at the Mayo Clinic were analyzed to assess for a relationship between vaccination status prior to COVID infection and PCC symptoms. In all, 477 subjects were included in this study. In total, 245 (51.4%) were vaccinated. Vaccinated subjects with PCC reported less abdominal pain, anosmia, parosmia, chest pain/tightness, dizziness, numbness/tingling, dyspnea, spells/tremors, and weakness. For hospitalized patients who developed PCC, vaccinated patients reported less chest pain, cough, dizziness, and dyspnea. After applying Bonferroni correction for multiple comparisons, decreased abdominal pain remained significant. We conclude that vaccination against SARS-CoV-2 may reduce the symptoms of PCC, leading to improved morbidity and function. Further studies on the impact of vaccination on PCC and recovery are needed.

Abstract Background The protective efficacy of prior coronavirus disease 2019 (COVID-19) with or without vaccination remains unknown. This study sought to understand if 2 or more messenger RNA (mRNA) vaccine doses provide additional protection in patients with prior infection, or if infection alone provides comparable protection. Methods We conducted a retrospective cohort study of the risk of COVID-19 from 16 December 2020 through 15 March 2022, among vaccinated and unvaccinated patients of all ages with and without prior infection. A Simon-Makuch hazard plot illustrated the incidence of COVID-19 between groups. Multivariable Cox proportional hazards regression was used to examine the association of demographics, prior infection, and vaccination status with new infection. Results Among 101 941 individuals with at least 1 COVID-19 polymerase chain reaction test prior to 15 March 2022, 72 361 (71.0%) received mRNA vaccination and 5957 (5.8%) were previously infected. The cumulative incidence of COVID-19 was substantially higher throughout the study period for those previously uninfected and unvaccinated, and lowest for those previously infected and vaccinated. After accounting for age, sex, and the interaction between vaccination and prior infection, a reduction in reinfection risk was noted during the Omicron and pre-Omicron phases of 26% (95% confidence interval [CI], 8%–41%; P = .0065) to 36% (95% CI, 10%–54%; P = .0108), respectively, among previously infected and vaccinated individuals, compared to previously infected subjects without vaccination. Conclusions Vaccination was associated with lower risk of COVID-19, including in those with prior infection. Vaccination should be encouraged for all including those with prior infection, especially as new variants emerge and variant-specific booster vaccines become available.

Abstract COVID-19 vaccines are effective, but breakthrough infections have been increasingly reported. We conducted a test-negative case-control study to assess the durability of protection against symptomatic infection after vaccination with mRNA-1273. We fit conditional logistic regression (CLR) models stratified on residential county and calendar date of SARS-CoV-2 PCR testing to assess the association between the time elapsed since vaccination and the odds of symptomatic infection, adjusted for several covariates. There were 2,364 symptomatic individuals who had a positive SARS-CoV-2 PCR test after full vaccination with mRNA-1273 (“cases”) and 12,949 symptomatic individuals who contributed 15,087 negative tests after full vaccination (“controls”). The odds of symptomatic infection were significantly higher 250 days after full vaccination compared to the date of full vaccination (Odds Ratio [OR]: 2.47, 95% confidence interval [CI]: 1.19–5.13). The odds of non-COVID-19 associated hospitalization and non-COVID-19 pneumonia (negative control outcomes) remained relatively stable over the same time interval (Day 250 ORNon-COVID Hospitalization: 0.68, 95% CI: 0.47–1.0; Day 250 ORNon-COVID Pneumonia: 1.11, 95% CI: 0.24–5.2). The odds of symptomatic infection remained significantly lower almost 300 days after the first mRNA-1273 dose as compared to 4 days after the first dose, when immune protection approximates the unvaccinated state (OR: 0.26, 95% CI: 0.17–0.39). Low rates of COVID-19 associated hospitalization or death in this cohort precluded analyses of these severe outcomes. In summary, mRNA-1273 robustly protected against symptomatic SARS-CoV-2 infection at least 8 months after full vaccination, but the degree of protection waned over this time period.

Abstract We report the utility of rapid antigen tests (RAgT) in a cohort of US healthcare personnel with coronavirus disease 2019 (COVID-19) infection who met symptom criteria to return to work at day 5 or later of isolation. In total, 11.9% of initial RAgT were negative. RAgT can be helpful to guide return to work decisions.