# When Risk Persists: Two-Time Longitudinal Assessment of Healthcare Workers’ Exposure Risk in the Context of COVID-19

## TL;DR

Healthcare workers' risk of exposure to COVID-19 increased over time, likely due to declining adherence to infection control practices, especially among nurses.

## Contribution

This study provides longitudinal evidence of evolving occupational exposure risk and adherence to IPC practices among healthcare workers during the pandemic.

## Key findings

- High-risk exposure classification among healthcare workers increased significantly over six months.
- Adherence to key IPC practices, such as PPE removal and surface decontamination, declined over time.
- Nurses consistently showed higher risk compared to physicians despite high PPE usage.

## Abstract

What are the main findings?
Classification of high-risk occupational exposure increased over time, potentially reflecting shifts in self-reported adherence to IPC practices.Adherence to key infection prevention and control practices declined, with nurses showing consistently higher risk.

Classification of high-risk occupational exposure increased over time, potentially reflecting shifts in self-reported adherence to IPC practices.

Adherence to key infection prevention and control practices declined, with nurses showing consistently higher risk.

What are the implications of the main findings?
Occupational risk requires ongoing monitoring rather than single-time assessment.Findings suggest a need for ongoing attention to protective measures, as adherence declines over time.

Occupational risk requires ongoing monitoring rather than single-time assessment.

Findings suggest a need for ongoing attention to protective measures, as adherence declines over time.

Background: Healthcare workers (HCWs) have experienced sustained occupational exposure to SARS-CoV-2 throughout the COVID-19 pandemic. While infection prevention and control (IPC) practices have been widely implemented, limited prospective data exist on how occupational exposure risk and adherence to protective practices evolve over time, particularly beyond the acute phases of the pandemic. This study aimed to prospectively assess occupational and community exposure risk to COVID-19 among HCWs and to evaluate temporal changes in adherence to IPC practices during routine care and aerosol-generating procedures. Methods: A prospective observational study was conducted among HCWs from four public hospitals in the region of Thessaly, Greece. Eligible participants were HCWs who reported contact with suspected or confirmed COVID-19 cases. The data were collected at baseline (January–March 2022) and at a six-month follow-up using the World Health Organization’s “Risk Assessment and Management of Exposure of Health Care Workers in the Context of COVID-19” questionnaire. The instrument captured demographic characteristics, professional roles, occupational and community exposure, and adherence to IPC practices. Results: A total of 203 HCWs participated in the study. The overall proportion of HCWs reporting occupational exposure was 72.9% in both assessments. Among HCWs with occupational exposure (n = 148), the proportion classified as high-risk showed a statistically significant increase from 76% (95% CI: 0.6951–0.8320) at baseline to 88% (95% CI: 0.8258–0.9310) at follow-up (p = 0.010). This shift reflects a substantial effect size, with the odds of high-risk classification being more than double at follow-up (OR = 2.24). Nurses consistently demonstrated higher risk compared with physicians. The overall use of personal protective equipment remained high. However, adherence to several IPC practices declined over time, including removal and replacement of PPE according to protocol and frequent decontamination of high-touch surfaces. Conclusions: Occupational exposure risk among HCWs remained substantial and increased over time despite stable occupational exposure estimates. The observed decline in adherence to key IPC measures highlights the need for continuous monitoring and reinforcement of protective practices in healthcare settings.