Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings

Ana Beatriz Pizarro, Emma Persad, Solange Durao, Barbara Nussbaumer-Streit, Jean S. Engela-Volker, Damien McElvenny, Sarah Rhodes, Katie Stocking, Tony Fletcher, Craig Martin, Kukuh Noertjojo, Olivia Sampson, Jos H. Verbeek, Karsten Juhl Jørgensen, Matteo Bruschettini*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

Background: Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become more urgent with the spread of more infectious SARS-CoV-2 variants of concern (VoC), and the potential psychological toll imposed by the coronavirus disease 2019 (COVID-19) pandemic. Controlling exposures to occupational hazards is the fundamental method of protecting workers. When it comes to the transmission of viruses, such as SARS-CoV-2, workplaces should first consider control measures that can potentially have the most significant impact. According to the hierarchy of controls, one should first consider elimination (and substitution), then engineering controls, administrative controls, and lastly, personal protective equipment (PPE). Objectives: To assess the benefits and harms of interventions in non-healthcare-related workplaces to reduce the risk of SARS-CoV-2 infection relative to other interventions, or no intervention. Search methods: We searched MEDLINE, Embase, Web of Science, Cochrane COVID-19 Study Register, the Canadian Centre for Occupational Health and Safety (CCOHS), Clinicaltrials.gov, and the International Clinical Trials Registry Platform to 14 September 2021. We will conduct an update of this review in six months. Selection criteria: We included randomised control trials (RCT) and planned to include non-randomised studies of interventions. We included adult workers, both those who come into close contact with clients or customers (e.g. public-facing employees, such as cashiers or taxi drivers), and those who do not, but who could be infected by co-workers. We excluded studies involving healthcare workers. We included any intervention to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace, defining categories of intervention according to the hierarchy of hazard controls, i.e. elimination; engineering controls; administrative controls; personal protective equipment. Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were incidence rate of SARS-CoV-2 infection (or other respiratory viruses), SARS-CoV-2-related mortality, adverse events, and absenteeism from work. Our secondary outcomes were all-cause mortality, quality of life, hospitalisation, and uptake, acceptability, or adherence to strategies. We used the Cochrane RoB 2 tool to assess the risk of bias, and GRADE methods to assess the certainty of evidence for each outcome. Main results: Elimination of exposure interventions. We included one study examining an intervention that focused on elimination of hazards. This study is an open-label, cluster-randomised, non-inferiority trial, conducted in England in 2021. The study compared standard 10-day self-isolation after contact with an infected person to a new strategy of daily rapid antigen testing and staying at work if the test is negative (test-based attendance). The trialists hypothesised that this would lead to a similar rate of infections, but lower COVID-related absence. Staff (N = 11,798) working at 76 schools were assigned to standard isolation, and staff (N = 12,229) at 86 schools to the test-based attendance strategy. The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of symptomatic PCR-positive SARS-COV-2 infection rate ratio ((RR) 1.28, 95% confidence interval (CI) 0.74 to 2.21; 1 study, very low-certainty evidence)). The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of any PCR-positive SARS-COV-2 infection (RR 1.35, 95% CI 0.82 to 2.21; 1 study, very low-certainty evidence). COVID-related absenteeism rates were 3704 absence days in 566,502 days-at-risk (6.5 per 1000 days at risk) in the control group and 2932 per 539,805 days-at-risk (5.4 per 1000 days at risk) in the intervention group (RR 0.83; 95% CI 0.55 to 1.25). The certainty of the evidence was downgraded to low, due to imprecision. Uptake of the intervention was 71 % in the intervention group, but not reported for the control intervention. The trial did not measure other outcomes, SARS-CoV-2-related mortality, adverse events, all-cause mortality, quality of life, and hospitalisation. We found one ongoing RCT about screening in schools, using elimination of hazard strategies. Personal protective equipment. We found one ongoing non-randomised study on the effects of closed face shields to prevent COVID-19 transmission. Other intervention categories. We did not find studies in the other intervention categories. Authors' conclusions: We are uncertain whether a test-based attendance policy affects rates of PCR-postive SARS-CoV-2 infection (any infection; symptomatic infection) compared to standard 10-day self-isolation amongst school and college staff. Test-based attendance policy may result in little to no difference in absence rates compared to standard 10-day self-isolation. As a large part of the population is exposed in the case of a pandemic, an apparently small relative effect that would not be worthwhile from the individual perspective may still affect many people, and thus, become an important absolute effect from the enterprise or societal perspective. The included study did not report on any other primary outcomes of our review, i.e. SARS-CoV-2-related mortality and adverse events. No completed studies were identified on any other interventions specified in this review, but two eligible studies are ongoing. More controlled studies are needed on testing and isolation strategies, and working from home, as these have important implications for work organisations.

Original languageEnglish
Article numberCD015112
JournalThe Cochrane database of systematic reviews
Volume2022
Issue number5
DOIs
Publication statusPublished - 6 May 2022

Bibliographical note

Funding Information:
MB has received research funding from an ALF grant (non-profit – Lund University) for research projects not related to Cochrane.

Funding Information:
We thank Maria Björklund, Information Specialist at Cochrane Sweden, and Yuan Chi, Information Specialist at Cochrane Global Ageing, for designing and running the search strategy; Matthias Bank, Information Specialist at Cochrane Sweden, and Robin Featherstone, Information Specialist at Cochrane Central Editorial Service, for peer-reviewing the search strategy. Many thanks to the Library staff at WorkSafeBC, including Daphne Hamilton-Nagorsen and her team, for running additional literature searches and engaging in full-text article retrieval. We thank Chantelle Garritty for screening studies for inclusion, and Martie Van Tongeren for his contribution to the protocol. We thank the Cochrane Work Review Group editorial staff, Jan Hoving, Co-ordinating Editor, and Julitta Boschman, Managing Editor, for their help in all stages of the current review. The following people conducted the editorial process for this article: Sign-off Editor (final editorial decision): Lisa Bero, Professor of Medicine and Public Health and Chief Scientist, Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus; Managing Editor (selected peer reviewers, collated peer-reviewer comments, provided editorial guidance to authors, edited the article): Colleen Ovelman, Cochrane Central Editorial Service; Editorial Assistant (conducted editorial policy checks and supported editorial team): Leticia Rodrigues, Cochrane Central Editorial Service; Copy Editor (copy editing and production): Victoria Pennick, Cochrane Copy Edit Peer-reviewers (provided comments and recommended an editorial decision): Faruque Ahmed, PhD U.S. Centers for Disease Control and Prevention (CDC) Atlanta, Tomohiro Ishimaru, MD, MPH, PhD Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan (clinical review), Debra Knauft (consumer review), Kerry Dwan and Andrew Back, Cochrane Methods Support Unit (methods review), Robin Featherstone, Information Specialist at Cochrane Central Editorial Service (search review), Robert Walton Senior Fellow in General Practice Cochrane UK (abstract review). Sign-off Editor (final editorial decision): Lisa Bero, Professor of Medicine and Public Health and Chief Scientist, Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus; Managing Editor (selected peer reviewers, collated peer-reviewer comments, provided editorial guidance to authors, edited the article): Colleen Ovelman, Cochrane Central Editorial Service; Editorial Assistant (conducted editorial policy checks and supported editorial team): Leticia Rodrigues, Cochrane Central Editorial Service; Copy Editor (copy editing and production): Victoria Pennick, Cochrane Copy Edit Peer-reviewers (provided comments and recommended an editorial decision): Faruque Ahmed, PhD U.S. Centers for Disease Control and Prevention (CDC) Atlanta, Tomohiro Ishimaru, MD, MPH, PhD Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan (clinical review), Debra Knauft (consumer review), Kerry Dwan and Andrew Back, Cochrane Methods Support Unit (methods review), Robin Featherstone, Information Specialist at Cochrane Central Editorial Service (search review), Robert Walton Senior Fellow in General Practice Cochrane UK (abstract review).

Funding Information:
KS: part of her salary was paid to her institution by funding from the National Core Study 'PROTECT' programme, managed by the Health and Safety Executive on behalf of HM Government (UK). The grant was from 1 October 2020 to 31 March 2022. She is the statistical editor for Cochrane Gynaecology & Fertility.

Publisher Copyright:
Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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