• Julia M Baker, Kristin N Nelson, Elizabeth Overton, Benjamin A Lopman, Timothy L Lash, Mark Photakis, Jesse T Jacob, John D Roback, Scott K Fridkin, and James P Steinberg.
• Rollins School of Public Health, Emory University, Atlanta, Georgia (J.M.B., K.N.N., B.A.L., T.L.L.).
• Ann. Intern. Med. 2021 May 1; 174 (5): 649654649-654.

BackgroundIdentifying occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs) can improve HCW and patient safety.ObjectiveTo quantify demographic, occupational, and community risk factors for SARS-CoV-2 seropositivity among HCWs in a large health care system.DesignA logistic regression model was fitted to data from a cross-sectional survey conducted in April to June 2020, linking risk factors for occupational and community exposure to coronavirus disease 2019 (COVID-19) with SARS-CoV-2 seropositivity.SettingA large academic health care system in the Atlanta, Georgia, metropolitan area.ParticipantsEmployees and medical staff members elected to participate in SARS-CoV-2 serology testing offered to all HCWs as part of a quality initiative and completed a survey on exposure to COVID-19 and use of personal protective equipment.MeasurementsDemographic risk factors for COVID-19, residential ZIP code incidence of COVID-19, occupational exposure to HCWs or patients who tested positive on polymerase chain reaction test, and use of personal protective equipment as potential risk factors for infection. The outcome was SARS-CoV-2 seropositivity.ResultsAdjusted SARS-CoV-2 seropositivity was estimated to be 3.8% (95% CI, 3.4% to 4.3%) (positive, n = 582) among the 10 275 HCWs (35% of the Emory Healthcare workforce) who participated in the survey. Community contact with a person known or suspected to have COVID-19 (adjusted odds ratio [aOR], 1.9 [CI, 1.4 to 2.6]; 77 positive persons [10.3%]) and community COVID-19 incidence (aOR, 1.5 [CI, 1.0 to 2.2]) increased the odds of infection. Black individuals were at high risk (aOR, 2.1 [CI, 1.7 to 2.6]; 238 positive persons [8.3%]).LimitationsParticipation rates were modest and key workplace exposures, including job and infection prevention practices, changed rapidly in the early phases of the pandemic.ConclusionDemographic and community risk factors, including contact with a COVID-19-positive person and Black race, are more strongly associated with SARS-CoV-2 seropositivity among HCWs than is exposure in the workplace.Primary Funding SourceEmory COVID-19 Response Collaborative.

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