LAUSR

Introduction There is no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia healthcare workers and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. Methods We searched government reports and websites and media reports to create a comprehensive line listing of Australian healthcare worker infections and nosocomial outbreaks between January 25th and July 8th, 2020. A line list of healthcare worker related COVID-19 reported cases was created and enhanced by matching data extracted from media reports of healthcare related COVID-19 relevant outbreaks and reports, using matching criteria. Rates of infections and odds ratios (ORs) for healthcare workers were calculated per state, by comparing overall cases to healthcare worker cases. To investigate the sources of infection amongst healthcare workers, transmission data were collated and graphed to show distribution of sources. Results We identified 36 hospital outbreaks or outbreaks between January 25th and July 8th, 2020. According to our estimates, at least 536 healthcare workers in Australia have been infected with COVID-19, comprising 6.03% of all reported infections. The rate of healthcare worker infection was 72/100,000 and of community infection 34/100,000. healthcare workers were 2.76 times more likely to contract COVID-19 (95% CI 2.53 to 3.01; P<0.001). The timing of hospital outbreaks did not always correspond to community peaks. Where data were available, a total of 131 healthcare workers across 21 outbreaks, led to 1656 healthcare workers being furloughed for quarantine. One hospital was closed and had 1200 workers quarantined in one outbreak. Conclusion The study shows that HCWs were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, healthcare workers are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous workers during an outbreak. The occurrence of hospital outbreaks even when community incidence was low, highlights the high risk setting that hospitals present. Australia faces a resurgence of COVID-19 since late June 2020, with multiple hospital outbreaks. We recommend formal reporting of healthcare worker infections, testing protocols for nosocomial outbreaks, cohorting of workforce to minimize the impact, and improved PPE guidelines to provide precautionary and optimal protection for healthcare workers.