cord-028273-22swinc6	2020	The Coordinating Center of the "COVID-19 Lombardy ICU-Network", therefore, promoted an exploratory survey to assess the incidence of episodes of discrimination experienced by specialists and trainees in Anesthesiology and in Intensive Care Medicine. Overall, 159 HCWs (25%) reported at least 1 episode of discrimination involving themselves, their colleagues or family members. Sadly, the "not in my backyard" principle seems to apply to HCWs, who are celebrated as long as they stay confined in hospitals, and this discrimination is also being extended to their families. Healthcare systems administrators and policy-makers should employ every means to minimize the risk of infection among HCWs by providing adequate PPE and training. There is a good chance that as long as we are presented as heroes continuously facing death, we will suffer discrimination; such portrayal erroneously belabours the risk of being infected by HCWs, making it seem a very probable option.
cord-252250-hhdawwjf	2020	title: Ethical dilemmas faced by health care workers during COVID-19 pandemic: Issues, implications and suggestions In this regard, we point out a few moral and ethical dilemmas that can be faced by health care workers (HCW) while attending the call of duty: J o u r n a l P r e -p r o o f 2. 4. Setting up of a COVID support cell in every institution would serve as a one stop resource for mental and physical health care needs of HCW''s. We hope that the measures outlined above would assist institutions and team leaders in providing the best possible working conditions for their staff and health care workers. Mental Health Needs of Health Care Workers Providing Frontline COVID-19 Care Managing mental health challenges faced by healthcare workers during covid-19 pandemic
cord-253833-0lajhqn5	2020	[7] [8] [9] 11 A recent prospective study in the United Kingdom and US suggested a ve-fold increased risk for HCW caring for patients with COVID-19 compared to HCW not caring for patients with COVID-19, even with the use of PPE 12 while another study of HCW in a large healthcare system showed a decrease in positive tests for SARS-CoV-2 associated with a universal masking recommendation. In this study, we aimed to assess whether HCW are at higher risk for COVID-19 infection, COVID-19 related hospitalization, and intensive care unit (ICU) admission compared to non-HCW using advanced statistical methodology to account for various confounders. [7] [8] [9] [10] 12 The fact that HCW identi ed as patient-facing had a signi cantly higher odds for SARS-CoV-2 test positivity suggests an increased risk of COVID-19 infection with work exposure.
cord-256705-gexh2wtd	2020	In view of this, a cross-sectional survey of front-line healthcare workers (HCWs) at two large acute NHS hospital trusts in England was undertaken to assess their confidence and perceived level of preparedness for the virus. As such we carried out an online cross sectional questionnaire based survey of front line HCW at two large acute NHS hospital Trusts in England to ascertain how prepared they felt to manage COVID-19. We designed an online cross-sectional questionnaire-based survey using Online Surveys (formerly BOS) to ascertain how confident and prepared front line HCW felt in managing potential COVID-19 cases. At the time the survey went live work in both hospital Trusts had already begun to prepare front line HCW for COVID-19. As the threat of COVID-19 grows, we wanted to assess how confident our front line HCW felt to manage possible cases.
cord-261173-lnjh56ts	2020	In this study, we aimed to assess whether HCW are at higher risk for COVID-19 infection, COVID-19-related hospitalization, and intensive care unit (ICU) admission compared to non-HCW using advanced statistical methodology to account for various confounders. 23 For the outcomes of hospital and intensive care unit (ICU) admission of COVID-19 testpositive patients, the propensity score covariates are those that were found associated with COVID-19 hospitalization outcome in our previous work including age, race, ethnicity, gender, smoking history, body mass index, median income, population per housing unit, presenting symptoms (including fever, fatigue, shortness of breath, diarrhea, vomiting), comorbidities (including asthma, hypertension, diabetes, immunosuppressive disease), medications (including immunosuppressive treatment, nonsteroidal anti-inflammatory drugs [NSAIDs]), and laboratory values (including pre-testing platelets, aspartate aminotransferase, blood urea nitrogen, chloride, and potassium). [7] [8] [9] [10] 12 The fact that HCW identified as patient facing had a significantly higher odds for SARS-CoV-2 test positivity suggests an increased risk of COVID-19 infection with work exposure.
cord-262653-v1to1mrp	2020	Subsequent investigation over a 14 day period revealed symptoms in 23 staff members and five linked cases in patients on the same ward. Staff members and patients can act as Trojan horses carrying infection into and around the hospital, setting up unexpected transmission events. An in house real time PCR assay for COVID-19 was carried out on dry throat swabs taken from symptomatic patients and staff members working on the ward. HCW cases were defined as (A) a member of staff from the affected ward and (B) compatible symptoms for COVID-19 (C) onset of infection during the outbreak period. Four of the five staff members with very early onset of infection were working with the index case during the likely infectious period ( Figure 3 ). In this case infection was most likely introduced by an asymptomatic or minimally symptomatic HCW and then transferred via a longstanding patient from ITU to a previously negative medical ward.
cord-264522-u61m4x9l	2016	In the 2008–2009 influenza season, Flushing Hospital Medical Center (FHMC; New York) adopted a "push/pull" point-of-dispensing (POD) vaccination model that was derived from emergency preparedness planning for mass vaccination and/or prophylaxis to respond to an infectious disease outbreak, whether occurring naturally or due to bioterrorism. In the 2008-2009 influenza season, Flushing Hospital Medi cal Center (FHMC; New York) adopted a "push/pull" point-ofdispensing (POD) vaccination model that was derived from emergency preparedness planning for mass vaccination and/or prophylaxis to respond to an infectious disease outbreak, whether occurring naturally or due to bioterrorism. Conclusions: This model provides a novel approach for institutions to improve their HCW influenza vaccination rates within a limited period through exercising emergency preparedness plans for infectious disease outbreaks. Conclusions: This model provides a novel approach for institutions to improve their HCW influenza vaccination rates within a limited period through exercising emergency preparedness plans for infectious disease outbreaks.
cord-266261-6h7c26xg	2020	key: cord-266261-6h7c26xg authors: Bharati, Joyita; Ramachandran, Raja; Kumar, Vivek; Kohli, Harbir Singh title: COVID‐19 pandemic in limited‐resource countries: Strategies for challenges in a dialysis unit cord_uid: 6h7c26xg The rapid surge of novel coronavirus disease 2019 (COVID-19) pandemic has brought unique challenges. In the absence of universal testing, apprehensions related to inadvertent exposure to COVID-19 positive patient was increasing among health-care workers (HCW) and patients, which was crucial to be addressed to maintain functionality of the unit. A risk stratification algorithm after inadvertent exposure to COVID-19 positive patient was adapted from the U.S. Centers for Disease Control and Prevention (CDC) to educate HCW. 1,2 A flow-chart simplified the interpretation of CDC tables for risk stratification which were found intricate by HCW. Protocol for hemodialysis unit during COVID-19 pandemic. guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease The authors declare no conflicts of interest.
cord-282280-5pggpbrq	2020	The following concepts are used: (1) predisposing factors, including baseline characteristics of studied populations; (2) information factors, including information retrieved via media, social contacts and HCW; (3) awareness, of the infectious agent being present or a vaccine being available; (4) knowledge (either examined or self-evaluated), about the consequences of the infection, or about the efficacy and duration of protection of vaccination; (5a) perceived risk of the infection, which is divided into perceived severity of the disease and perceived susceptibility to get infected; (5b) perceived risk of vaccination, including vaccine-specific considerations such as fear of side-effects and trust in the effectiveness of the vaccine; (6) attitude, defined as a person''s disposition to respond favourably or unfavourably to vaccinations [14] , often reflected by a person''s general believes about vaccinations; (7) social influence, which can be social norms imposed by family, friends or religion, but also recommendations from a healthcare professional or tour guide; (8) self-efficacy, defined as beliefs in one''s own capacity to perform certain behaviour [15] ; (9) intention to behaviour, expressed by people before they perform the behaviour; (10) barriers and facilitators, that withhold individuals from or enable them to certain behaviour, such as time, costs, or accessibility.
cord-282675-s4zmffj3	2020	title: Assessment of mental health outcomes and associated factors among workers in community-based HIV care centers in the early stage of the COVID-19 outbreak in Mali Mental health in ARCAD Santé PLUS''s CHW in Mali seemed to be associated with uncertainty about COVID-19 at the beginning of the outbreak, as suggested by the relationship between the (un)availability of face masks and insomnia, depression, and anxiety. The relationship discovered between the density of nurses in HIV care services and workers'' psychological outcomes not only highlights areas for improvement in the management of mental health among ARCAD Santé PLUS''s HCW during the current COVID-19 outbreak, but also provides insight into how these workers'' performance in HIV-related care could be improved in the short and long terms.
cord-284640-tl9nmvog	2020	PURPOSE: To survey healthcare workers (HCW) on availability and use of personal protective equipment (PPE) caring for COVID-19 patients in the intensive care unit (ICU). While pain, heat stress and fluid loss with using Powered Air-Purifying Respirators (PAPR) were predicted by experimental data (14) , there are no real-life reports of this issue when using PPE that is available to HCWs. The objective of this study was to describe the current reported practices, availability, training, confidence in the use and adverse effects due to extended use of PPE by HCWs from around the world caring for COVID-19 patients who require ICU management. This survey provides a snapshot of the reported availability, perceived adequacy of training and provided protection, adverse effects and usage of PPE among HCW managing COVID-19 patients in critical care environments from across the globe.
cord-286932-2gjnpqqa	2020	title: Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review We included studies that assessed postoperative patient outcomes or protection measures for surgical personnel during epidemics. CONCLUSIONS: This review highlights postoperative patient outcomes during worldwide epidemics including the COVID-19 pandemic and identifies specific safety measures to minimize infection of healthcare workers. Studies reporting outcomes of patients undergoing surgery during an epidemic-caused hospital lockdown and studies investigating the impact of lockdown on surgical HCW and surgical practice were included. 23,29,35 Fourteen studies described modifying the roles of HCW during epidemics, including formation of an "Emergency Incident Command Team" to identify and separate infected patients from other patients, allowing only essential personnel to be present during procedures, and assigning staff to conduct patient screening full-time. 21 No infections or adverse outcomes were reported for HCW during the SARS epidemics (0/128) from the included studies.
cord-291810-eq7pjltx	2020	To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active circulation) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active circulation) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Furthermore, in hospital B in Breda, which has offered low-threshold testing for employees with respiratory complaints since 2 March 2020, several healthcare workers (HCW) had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A focus on HCW would simplify sampling, at such short notice, of adequate numbers of people with mild respiratory symptoms (coughing and/or sore throat and/or common cold) and without a known epidemiological link for SARS-CoV-2 exposure (travel to high-risk areas, close contact with confirmed case).
cord-296306-xcomjvaa	2020	Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Table 3 outlines the total number of SARS-CoV-2 tests performed in each screening group (HCW asymptomatic, HCW symptomatic, and HCW symptomatic household contact) categorised according to the ward with the highest anticipated risk of exposure to high; ''amber'', medium; ''green'', low; . Three subgroups of SARS-CoV-2 positive asymptomatic HCW Each individual in the HCW asymptomatic screening group was contacted by telephone to establish a clinical history, and COVID-19 probability criteria ( Table 1) were retrospectively applied to categorise any symptoms in the month prior to testing ( Figure 2 ). 12/30 (40%) individuals from the HCW asymptomatic screening group reported symptoms > 7 days prior to testing, and the majority experiencing symptoms consistent with a high probability of COVID-19 had appropriately self-isolated during that period.
cord-297879-6xb25uhx	2020	A follow-up survey one month after the baseline (April-May 2020) measured SARS-CoV-2 infection by real time reverse-transcriptase polymerase chain reaction (rRT-PCR) and IgM, IgA, IgG and subclasses to the receptor-binding domain of the SARS-CoV-2 spike protein by Luminex. We found that 9.3% (95% CI: 7.1-12.0) of the participants were seropositive and the cumulative prevalence of SARS-CoV-2 infection (considering a past or current positive result to either antibody testing or rRT-PCR) was 11.2% (95% CI: 8.8-14.1). We measured IgM, IgG, and IgA isotypes and subclasses, and assessed the factors associated with new infections as well as levels and kinetics of antibodies. Levels (median fluorescence intensity, MFI) of IgM, IgG, and IgA against receptor-binding domain (RBD) of the SARS-CoV-2 spike glycoprotein stratified by asymptomatic participants and participants who reported COVID-19 compatible symptoms at recruitment (month 0, M0), month 1 (M1) or at both visits (M0&M1).
cord-301299-flb5wwzg	2020	AIM: The aim of this study was to describe the epidemiological and clinical characteristics of COVID-19 among healthcare workers (HCWs) between February 24(th) to April 30(th), 2020 in a hospital in Madrid, Spain. Therefore, we designed a retrospective cohort study whose aim was to describe the epidemiological and clinical characteristics of SARS-CoV-2 infection among HCWs in a hospital in Madrid, Spain. During the study period, HCWs experiencing symptoms consistent with probable COVID-19 were instructed to present at the Occupational Health outpatient clinic, where they were managed according to the hospital protocol: a nasopharyngeal swab was collected and analysed with polymerase chain reaction (PCR) for SARS-CoV-2. A case of COVID-19 was defined as any HCW presenting to the Occupational Health outpatient clinic with symptoms consistent with COVID-19 and with positive SARS-CoV-2 PCR.
cord-306247-259zacce	2020	We addressed our preparation to face COVID-19 pandemic in a Hematological and Stem Cell Transplant Unit in Brazil during the first two months of COVID-19 pandemic and described COVID-19 cases in patients and health care workers (HCW). Despite a decrease in the number of procedures, the Transplant Program performed 8 autologous and 4 allogeneic SCT during the period, and 49 onco-hematological patients were admitted to continuing their treatments. Although we observed a high frequency of COVID-19 among patients and HCW, showing that SARS-CoV-2 is disseminated in Brazil, hematological patients were safely treated during pandemic times. 8 In this manuscript, we address our preparation to face the COVID-19 pandemic during the first two months and describe COVID-19 documented cases in patients and health care workers (HCW): from diagnosis to outcomes. This is a case series study from hematological patients treated from March 12 th to May 21 th in Complexo Hospitalar de Niterói, a quaternary level hospital, reference for stem cell transplantation (SCT), and solid organ transplant in Rio de Janeiro, Brazil.
cord-310508-zgqbfmzl	2020	This report to World Health Organization (WHO), raised global public health concern because this is the third coronavirus âȂŞassociated acute respiratory illness outbreak. Clinical care of patients with suspected 2019-nCoV should focus on early recognition, immediate isolation (separation), implementation of appropriate infection prevention and control (IPC) measures and provision optimized supportive care. Both the health care worker (HCW) and the suspected case of acute respiratory illness (ALI) should wear a medical mask and the patient should better be directed to a separate area, an isolation room if available. At the time being, emergency preparedness and response for providing appropriate care to the patients suspected to coronavirus-associated acute respiratory illness (abovementioned plans) should be developed and implemented in the emergency departments, as the frontline of treating human infections of 2019-nCov in the hospitals. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance
cord-311151-mrsjhjh4	2020	Methods: Using previously published information on elective ambulatory or outpatient surgical procedures and publicly available data on COVID19 infections in the US and on the Diamond Princess cruise ship, we calculated a transmission rate and generated a mathematical model to predict a lower bound for the number of healthcare-acquired COVID19 infections that could be prevented by canceling or postponing elective outpatient surgeries in Washington state. 11 Given the current status of the COVID19 outbreak, the US Surgeon General, 12 Centers for Disease Control and Prevention (CDC), 13 American College of Surgeons (ACS), 14 American Society of Anesthesiologists (ASA), and Anesthesia Patient Safety Foundation (APSF) 15 have recommended considering rescheduling or postponing some elective surgeries with the goal of conserving limited resources, such as ventilators and ICU beds, and mitigating the risk of "exposing other inpatients, outpatients, and health care providers to the risk of contracting COVID-19" from asymptomatic but infectious patients.
cord-311539-pbzb0jjt	2006	BACKGROUND: The World Health Organization (WHO) has recommended that a severe acute respiratory syndrome (SARS) alert should be raised when two or more healthcare workers (HCW) in the same health care unit fulfil the SARS clinical criteria, with onset of illness in the same 10-day period. To detect the possible re-emergence of severe acute respiratory syndrome (SARS), the World Health Organization (WHO) has recommended the implementation of an alert system based on the surveillance of healthcare workers (HCW): an alert should be raised when two or more HCW in the same health care unit fulfil the clinical criteria for SARS, with onset of illness in the same 10-day period [1] . To try to determine the minimum number of pneumonia alert cases that should define a SARS alert cluster in Italy, we analyzed sickness absences longer than 7 days, which occurred among HCW employed in three Italian hospitals in 2003.
cord-316266-6m9g3bdr	2020	CONCLUSIONS: Although limited, current evidence suggests that viral carriage on the outer surface of surgical masks worn by HCW treating patients with clinical respiratory illness is low and there was not strong evidence to support the assumption that mask use may increase the risk of viral transmission. During the current novel coronavirus disease 2019 (SARS-CoV-2, COVID-19) pandemic, the Ministry of Health (MOH) and District Health Boards (DHB) have not recommended routine use of surgical masks for healthcare workers (HCW) in emergency departments (ED) in New Zealand (NZ). Articles were included if they were clinical studies that reported virus detection on masks worn by HCW. Systematic review evidence from a previous coronavirus pandemic suggests that general use of masks may be protective for HCW in this setting, 20 21 with a Number Needed to Treat (NNT) of six to prevent one HCW infection (meta-analysis of case control studies).
cord-322451-cwpz4akv	2004	To examine the professional moral duty of health care workers (HCWs) in the outbreak of severe acute respiratory syndrome (SARS) in 2003. In a number of countries in order to encourage HCW, the government and the public started to give the title of ''hero'' to nurses and doctors who are working in the frontline of SARS outbreak. While the ethical ideal of self-less sacrifice of life for curing disease is promoted in the public image and media, discussions with HCW in several countries suggests that being a hero is not what modern medical practice is for some HCWs. Most HCWs in Taiwan are working in the commercial hospital, where the hirer pushes them to focus their effort of work on business competition rather than the basic role of helpers to human''s health. Nurses'' professional care obligation and their attitudes towards SARS infection control measures in Taiwan during and after the 2003 epidemic
cord-325778-y5miy24f	2020	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 25(th) and July 8(th), 2020. Many studies have also shown that hospitals not only present a high exposure setting for respiratory infections in HCW 17, 18 but that presenteeism is a key risk factor in disease transmission and extension of an outbreak 19 . Analysis of the infection status of the health care workers in Wuhan during the COVID-19 outbreak: A cross-sectional study COVID-19 and the Risk to Health Care Workers: A Case Report COVID-19: the case for health-care worker screening to prevent hospital transmission
cord-329350-qrxl5o1e	2020	We have had to care for high numbers of severely ill patients with limited resources, i.e. ventilators and specialists in respiratory failure management, often with a lack of health-care workers (HCW): a terrible situation. 1. Education first: it is difficult to organize continuing HCW education in an emergency setting, but it is necessary to implement courses on infection control and prevention (ICP) and on COVID-19 management. HCW need to be rapidly updated on necessary competencies required to manage highly infectious patients with respiratory failure. C. COVID-19 management: "fast and dirty" courses on should be organized on general principles of respiratory insufficiency, blood gas analysis, oxygen therapy, venous thromboembolism prevention, antivirals and anti-inflammatory drugs use (7) . while waiting for possible new waves, we are working on education on PPE, HH, and ventilation, and programming how to dedicate general ward and ICU to manage new COVID-19 patients.
cord-332083-135iic7m	2020	INTRODUCTION: The purpose of this study was to rapidly quantify the safety measures regarding donning and doffing personal protective equipment, complaints of discomfort caused by wearing personal protective equipment, and the psychological perceptions of health care workers in hospitals in Wuhan, China, responding to the outbreak. Detailed donning and doffing procedures are described in the Supplementary Figure The purpose of this study was to rapidly quantify the safety measures of donning and doffing PPE, complaints of discomfort caused by wearing PPE, and the psychological perceptions of HCWs in hospitals in Wuhan, China, responding to the COVID-19 outbreak. Because our participants were all HCWs in Wuhan hospitals, we divided their demographic information as follows: the demographic variables included sex (male or female); age (20-30 years, 30-40 years, 40-50 years, and >50 years); occupation (physician, nurse, pharmacist, medical technician, or other); workplace (a designated hospital for patients critically ill with severe COVID-19; an undesignated hospital for patients uninfected with COVID-19; and Fangcang Hospital for patients with mild symptoms of COVID-19); and department (general isolation ward, intensive care unit [ICU], emergency department for patients with fevers, and other).
cord-333460-4ui8i9u5	2020	title: The Psychological Health Status of Healthcare Workers During the COVID-19 Outbreak: A Cross-Sectional Survey Study in Guangdong, China Similar to SARS and MERS, front-line healthcare workers (HCW) may be in direct contact with and have to care for patients and suspected cases of COVID-19; they are therefore at a particularly high risk of infection. The aim of our study was to assess the psychological status of HCW in Guangdong Province, China, and to identify coping strategies during the outbreak of COVID-19. However, surprisingly, the mean scores of the SAS (42.9) and SDS (47.8) of HCW indicated that they were in the normal range for both anxiety and depression, which seemed to differ from the results of previous studies on SARS and MERS (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) .
cord-335638-p84nmtfp	2007	This study aimed to estimate the resource needs that a hospital might face in the fi rst few hours of management of a single patient who sought treatment with possible avian or pandemic infl uenza (API) or similar highly virulent respiratory infection. The study outcome measures were the following: 1) number of close contacts associated with the API patient during the initial 6 hours of patient management, including how many of these were HCW close contacts; 2) the total number of exposures experienced by close contacts; 3) overall quantity and type of PPE items (gowns, gloves, N95 masks, eyewear) actually used during the simulation by HCW close contacts and ancillary HCWs; 4) overall "opportunities for PPE item use" for HCW close contacts and ancillary HCWs (i.e., actual use plus missed opportunities for appropriate PPE use); and 5) stratifi cation of HCW close contacts into medium-or low-risk groups for the purpose of recommending antiviral postexposure prophylaxis.
cord-336837-rerp1g1w	2020	These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent ''hubs'' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely. Testing for SARS-CoV-2 RNA was performed with real-time RT-PCR using throat and nose swab samples of HCWs from Cambridge University Hospitals NHS Foundation Trust (CUHNFT) and their symptomatic household contacts. In the HCW symptomatic and HCW symptomatic household contact screening arms combined (reflecting all individuals with self-reported symptoms at the time of testing), 13/771 (1.7%) tests were positive, which was significantly lower than 30/221 (13%) in the original study period (Fisher''s exact test p<0.0001). In particular, during the last 2 weeks of the study period (11th to 24th May 2020), we identified only four positive SARS-CoV-2 samples from 2016 tests performed, two from the HCW asymptomatic and two from the HCW symptomatic/symptomatic household contact arms.
cord-351022-8y43jhmu	2020	title: A dynamic response to exposures of healthcare workers to newly diagnosed COVID-19 patients or hospital personnel, in order to minimize cross transmission and need for suspension from work during the outbreak Jerusalem and its surroundings is the area with the highest prevalence of COVID-19 patients in Israel (2) .Health care workers (HCWs) are at increased risk of exposure to infected persons (3) , and concern aroused early in the course of the epidemic that a substantial number of HCWs might need to be suspended from work. After two weeks (on March 20), during which over 250 HCWs were sustained from work, the need A c c e p t e d M a n u s c r i p t 8 for home isolation was redefined according to the following principles: 1) if the index case was symptomatic at the time of exposure (e.g., fever or chills, respiratory symptoms, loss of smell or taste), all close contacts were sent to home isolation for 14 days following exposure date.
cord-353988-xoxmugi8	2007	Material and methods: All HCW (73) from Hospital São João''s ENT Unit who had been in contact with two in-patients with active TB underwent TB screening. Material and methods: All HCW (73) from Hospital São João''s ENT Unit who had been in contact with two in-patients with active TB underwent TB screening. Microbiology diagnosis was obtained in 7 cases by sputum smear, n=2; culture exam in bronchial lavage, n=4 and histological exam of pleural tissue, n=1. The HCW with suspected TB were evaluated via chest X-ray, mycobacteriological sputum smear, bronchofibroscopy with bronchial lavage, diagnostic thoracocentesis and pleural biopsy. Um dos 9 casos de tuberculose apresentava derrame pleural esquerdo, que foi estudado, tendo para esse efeito sido realizada toracocentese diagnóstica (ADA: 119 U/L; exame directo e cul-in 6 patients, pulmonary nodules in 2 and pleural effusion in 1 (Fig. 3) . Risk of Mycobacterium tuberculosis infection and disease among health care workers