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Okpani, Arnold Ikedichi

University of British Columbia

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posed a major challenge to the resilience of health systems worldwide. Central to the pandemic response was the safety of the healthcare workforce which was the focus of several mitigation strategies. The overarching aim of this dissertation was to assess SARS-CoV-2 infection risk and mitigation among healthcare workers (HCWs) in a Canadian health region by: 1) examining the influence of occupational and community-acquired risk factors on SARS-CoV-2 infection, and HCW perception of the adequacy of controls; 2) synthesizing evidence on the effectiveness of vaccine mandates in healthcare contexts; and 3) evaluating the impact of the healthcare vaccine mandate in risk mitigation among HCWs. Methods: A matched case-control study with an embedded mixed method design was conducted using primary data of active duty HCWs who tested for SARS-CoV-2 up to 15 months into the pandemic. A systematic review was conducted on the impact of healthcare vaccine mandates globally. Secondary data on vaccination and testing in the regional HCW cohort was utilized for a cohort study on the impact of the vaccine mandate on vaccine uptake and infection risk. Results: The case-control study found that while some occupational factors were associated with infection risk, community exposure was more predictive of infection. HCWs were overall satisfied with the mitigation strategies, with some concerns expressed on prioritization of personal protective equipment allocation and mental stress. The systematic review found that the healthcare vaccine mandates were broadly effective for increasing vaccine uptake, but impact on infection risk was less understood and concerns on inequity were highlighted. The cohort study indicated that the vaccine mandate in the region was associated with significant increase in coverage and infection risk reduction. Conclusion: A universal precautions approach can mitigate occupationally induced infection risk while ensuring that HCWs in perceived low risk settings are not neglected during public health emergencies. Application of mitigation strategies should be based not just on their short-term impact, but with consideration of the broader benefit to the health system. Creating and effectively utilizing trust-building opportunities will yield dividends during future public health emergencies.

Text

2024-10-21

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/89450

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/