Introduction
Healthcare workers (HCWs) have been at the forefront of the COVID-19 pandemic and have faced prolonged occupational exposure to SARS-CoV-2. Despite widespread implementation of infection prevention and control (IPC) measures, the persistence of the pandemic and its transition into more routine phases have raised concerns about sustained exposure risks and behavioral fatigue. Understanding how occupational and community exposure risks evolve over time, along with adherence to IPC practices, is essential for protecting HCWs and maintaining healthcare system resilience. This study addresses an important gap by prospectively examining exposure risks and IPC adherence among HCWs beyond the acute pandemic phase.
Study Design and Setting
This prospective observational study was conducted across four public hospitals in the Thessaly region of Greece, providing a representative snapshot of HCWs operating in diverse clinical environments. Data collection occurred at two time points—baseline (January–March 2022) and a six-month follow-up—allowing for temporal comparisons. By focusing on HCWs who reported contact with suspected or confirmed COVID-19 cases, the study targeted individuals with meaningful exposure risk, thereby strengthening the relevance of its findings to real-world clinical practice.
Assessment of Occupational and Community Exposure
Exposure risk was systematically evaluated using the World Health Organization’s standardized risk assessment questionnaire for HCWs. This instrument captured both occupational exposure, such as patient contact during routine care or aerosol-generating procedures, and community exposure outside the workplace. The consistent finding that nearly three-quarters of participants reported occupational exposure at both time points underscores the sustained nature of risk for HCWs, even as pandemic dynamics evolved.
Temporal Changes in Risk Classification
Among HCWs with occupational exposure, a significant increase in high-risk classification was observed over time, rising from 76% at baseline to 88% at follow-up. This shift indicates that although the proportion of exposed HCWs remained stable, the intensity or quality of exposure worsened. The more than twofold increase in odds of being classified as high-risk highlights a substantial effect size and suggests growing vulnerability, potentially linked to cumulative exposure, changes in work practices, or declining vigilance.
Professional Role and Differential Risk
The study revealed notable differences in exposure risk by professional role, with nurses consistently demonstrating higher risk compared with physicians. This disparity likely reflects the nature of nursing duties, which involve more frequent and prolonged patient contact, including close bedside care. These findings emphasize the need for role-specific risk mitigation strategies and targeted support for professional groups disproportionately affected by occupational exposure.
Adherence to Infection Prevention and Control Practices
While overall use of personal protective equipment (PPE) remained high throughout the study period, adherence to several critical IPC practices declined over time. Specifically, proper removal and replacement of PPE and routine decontamination of high-touch surfaces were less consistently followed at follow-up. This decline may reflect pandemic fatigue or normalization of risk, underscoring the importance of continuous training, monitoring, and reinforcement of IPC measures to sustain protective behaviors among HCWs.
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