Infection prevention and control risk factors in health workers infected with SARS-CoV-2 in Jordan: A case control study

Ala Bin Tarif; Mohannad Ramadan; Mo Yin; Ghazi Sharkas; Sami Sheikh Ali; Mahmoud Gazo; Ali Zeitawy; Lora Alsawalha; Kaiyue Wu; Alvaro Alonso-Garbayo; Bassim Zayed; Lubna Al-Ariqi; Khalid A. Kheirallah; Maha Talaat; Arash Rashidian; Alice Simniceanu; Benedetta Allegranzi; Alessandro Cassini; Saverio Bellizzi

doi:10.1371/journal.pone.0271133

Peer Review History

Original SubmissionFebruary 18, 2022
13 Apr 2022 Decision Letter - Balram Rathish, Editor PONE-D-22-04948Infection prevention and control risk factors in health workers infected with SARS-CoV-2 in Jordan: a case control studyPLOS ONE Dear Dr. Bellizzi, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Please see the reviewer comments attached. In addition to those, please specify the timeframe of your study - this will help understand which variant was dominant at the time. Please also consider including any information on the impact of different VOCs/VOIs in the studied samples. Reviewer #1: Thanks for the authors for the good work, comments as below: 1- In introduction section line -75 & discussion section line-318, It would be great if the COVID-19 epidemiological curve in Jordan during the first 19 months of the pandemic can be demonstrated in a figure that reflect count of confirmed covid-19 cases in community and counts of infected HWs in 8 hospitals in parallel with actions taken at the public & hospital level. See an example below: https://doi.org/10.1001/jama.2020.11160 2- Please indicate what is the status of 8 hospitals in regard to similarities in IPC practices, PPE shortages and designated COVID-19 hospitals. 3- Under study design & participants enrollment: Line -115, please define a suspected/probable COVID-19 patients or indicate the references in reference section. 4- Under identification of cases subsection: RDT abbreviation stands for what- need to write it as is in the first time.? Also, what do you mean by suspected criteria A or B in line 124 (please clarify). 5- Under control section: How did you manage HWs with prior positive PCR or RDT , did you test them before enrollment especially they can carry the virus with no symptoms, how can you handle it. Reviewer #2: This study supports the COVID-19 prevention measures adopted in hospitals located in Jordan as advised by the WHO. The results highlights the importance of personal hygiene in combating viral infections as well as in precautions to pandemic. The study is short but has impact in the current situation. Minor comments - The standard method of hand washing needs to be mentioned with other PPEs. A short summary of the training provided to HWs needs to be mentioned. - Whether the HWs were trained for hand washing steps, especially for this study? - The HWs were wearing gloves as part of their PPEs. How does the investigators implement hand washing in this context? Do they change the gloves very often during their work? - Authors stated that HWs exposed to COVID-19 patients within 1 meter for more than 15 minutes increased 3-fold adds of infection. As SARS-CoV-2 is a respiratory virus, a more detailed clarification with respect to the face mask need to be described. ============================== Please submit your revised manuscript by May 28 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. 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Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ 7. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Please see the reviewer comments attached. In addition to those, please specify the timeframe of your study - this will help understand which variant was dominant at the time. Please also consider including any information on the impact of different VOCs/VOIs in the studied samples. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thanks for the authors for the good work, comments as below: 1- In introduction section line -75 & discussion section line-318, It would be great if the COVID-19 epidemiological curve in Jordan during the first 19 months of the pandemic can be demonstrated in a figure that reflect count of confirmed covid-19 cases in community and counts of infected HWs in 8 hospitals in parallel with actions taken at the public & hospital level. See an example below: https://doi.org/10.1001/jama.2020.11160 2- Please indicate what is the status of 8 hospitals in regard to similarities in IPC practices, PPE shortages and designated COVID-19 hospitals. 3- Under study design & participants enrollment: Line -115, please define a suspected/probable COVID-19 patients or indicate the references in reference section. 4- Under identification of cases subsection: RDT abbreviation stands for what- need to write it as is in the first time.? Also, what do you mean by suspected criteria A or B in line 124 (please clarify). 5- Under control section: How did you manage HWs with prior positive PCR or RDT , did you test them before enrollment especially they can carry the virus with no symptoms, how can you handle it. Reviewer #2: This study supports the COVID-19 prevention measures adopted in hospitals located in Jordan as advised by the WHO. The results highlights the importance of personal hygiene in combating viral infections as well as in precautions to pandemic. The study is short but has impact in the current situation. Minor comments - The standard method of hand washing needs to be mentioned with other PPEs. A short summary of the training provided to HWs needs to be mentioned. - Whether the HWs were trained for hand washing steps, especially for this study? - The HWs were wearing gloves as part of their PPEs. How does the investigators implement hand washing in this context? Do they change the gloves very often during their work? - Authors stated that HWs exposed to COVID-19 patients within 1 meter for more than 15 minutes increased 3-fold adds of infection. As SARS-CoV-2 is a respiratory virus, a more detailed clarification with respect to the face mask need to be described. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Faisal Abdoh Alasmari Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. 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Revision 1
22 Apr 2022 Author Response Dear Editor, Many thanks for taking into consideration our paper entitled: Infection prevention and control risk factors in health workers infected with SARS-CoV-2 in Jordan: a case control study. Please find below our feedback on your recommended amendments: - We have removed the funding section from the manuscript and added it in the online editorial manager system. - The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. - The authors have declared that no competing interests exist - I have linked and validate my personal ORCID - Proprietors of the data are the Jordanian Ministry of Health, which can make such data available upon request. The authors of this study can facilitate access to the dataset through the Jordanian Ministry of Health. The researchers cannot make data available directly on behalf of the Jordanian Ministry of Health. Retrieval of data should be sought via the Jordanian Ministry of Health (iprd@moh.gov.jo) - Reference n 11 was updated with new access link (https://www.who.int/tools/godata) - Reference n 30 was updated with new access link (https://apps.who.int/iris/handle/10665/342620) Reviewer #1: Thanks for the authors for the good work, comments as below: 1- In introduction section line -75 & discussion section line-318, It would be great if the COVID-19 epidemiological curve in Jordan during the first 19 months of the pandemic can be demonstrated in a figure that reflect count of confirmed covid-19 cases in community and counts of infected HWs in 8 hospitals in parallel with actions taken at the public & hospital level. See an example below: https://doi.org/10.1001/jama.2020.11160 - We acknowledge the important contribution that the suggested graph would add’ however, we have no comprehensive time-data around infections in healthcare workers 2- Please indicate what is the status of 8 hospitals in regard to similarities in IPC practices, PPE shortages and designated COVID-19 hospitals. - Thanks for the important input and we added as follows: “At the time of the study, all selected facilities were designated as COVID-19 hospitals, with adequate stock in personal protective equipment, and IPC practices were aligned under the standard protocol devised the Ministry of Health of Jordan with the support of the WHO Jordan Country Office. Specifically, training on the use of personal protective equipment (PPE), including hand washing steps and its complementarity with the use of gloves (remove gloves and proceed to hand washing between patients or between contact with various sites on a single patient), had been ongoing in line with international standards and with practical sessions.” 3- Under study design & participants enrollment: Line -115, please define a suspected/probable COVID-19 patients or indicate the references in reference section. - As suggested, we indicated the appropriate reference 4- Under identification of cases subsection: RDT abbreviation stands for what- need to write it as is in the first time.? Also, what do you mean by suspected criteria A or B in line 124 (please clarify). - We agree on the importance of spelling out and clarified RDT being rapid diagnostic test. We also added the previous reference to clarify that we are referring to the WHO probable and suspected criteria 5- Under control section: How did you manage HWs with prior positive PCR or RDT , did you test them before enrollment especially they can carry the virus with no symptoms, how can you handle it. - We better clarified this aspect and highlighted the fact that controls were tested before enrollment. The sentence now reads: “Enrolment was preceded by testing and having a positive serology test to SARS-CoV-2 and/or prior vaccination was considered as exclusion criteria” Reviewer #2: This study supports the COVID-19 prevention measures adopted in hospitals located in Jordan as advised by the WHO. The results highlights the importance of personal hygiene in combating viral infections as well as in precautions to pandemic. The study is short but has impact in the current situation. Minor comments 1. The standard method of hand washing needs to be mentioned with other PPEs. A short summary of the training provided to HWs needs to be mentioned. - We clarified and added as follows: “At the time of the study, all selected facilities were designated as COVID-19 hospitals, with adequate stock in personal protective equipment, and IPC practices were aligned under the standard protocol devised the Ministry of Health of Jordan with the support of the WHO Jordan Country Office. Specifically, training on the use of personal protective equipment (PPE), including hand washing steps and its complementarity with the use of gloves (remove gloves and proceed to hand washing between patients or between contact with various sites on a single patient), had been ongoing in line with international standards and with practical sessions.” 2. Whether the HWs were trained for hand washing steps, especially for this study? - Please see above 3. The HWs were wearing gloves as part of their PPEs. How does the investigators implement hand washing in this context? Do they change the gloves very often during their work? - Please see above 4. Authors stated that HWs exposed to COVID-19 patients within 1 meter for more than 15 minutes increased 3-fold adds of infection. As SARS-CoV-2 is a respiratory virus, a more detailed clarification with respect to the face mask need to be described. We expanded on this concept and added: “While our findings on physical distancing of at least 1 metre confirms it as a key IPC and public health and social measure to reduce transmission of SARS-CoV-2, the available evidence mostly stems from studies with small sample sizes and other methodological concerns (22,23,24). On the other hand, this confirms the importance of physical distancing as part of a comprehensive strategy of measures to suppress transmission, including mask wearing (use of masks alone not sufficient to provide an adequate level of protection against COVID-19).” Attachments Attachment Submitted filename: rebuttal letter.docx https://doi.org/10.1371/journal.pone.0271133.r002
1 May 2022 Decision Letter - Balram Rathish, Editor PONE-D-22-04948R1Infection prevention and control risk factors in health workers infected with SARS-CoV-2 in Jordan: a case control studyPLOS ONE Dear Dr. Bellizzi, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. As stated in the previous communication, please clarify the study period and any information on VOC/VOIs on the impact of your findings. Please submit your revised manuscript by Jun 15 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Balram Rathish Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: As stated in the previous communication, please clarify the study period and any information on VOC/VOIs on the impact of your findings. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0271133.r003
Revision 2
11 May 2022 Author Response Editor comments: As stated in the previous communication, please clarify the study period and any information on VOC/VOIs on the impact of your findings. Dear Editor, thanks for your inputs and please find below responses to your queries: - We added in the abstract the following statement (lines 40-41): The study lasted approximately two months (from early January to early March 2021). - A very similar statement was added in the Introduction (lines 97-98) - We added the following statement in the Discussion (lines 333-336): Finally, generalization is not possible due to important differences in the pandemic evolving differently across countries, regions, and hospitals. Specifically, during the study period health workers were most likely affected by the original coronavirus strain, which was less contagious than the subsequent VOCs. Attachments Attachment Submitted filename: response to reviewers.docx https://doi.org/10.1371/journal.pone.0271133.r004
24 Jun 2022 Decision Letter - Balram Rathish, Editor Infection prevention and control risk factors in health workers infected with SARS-CoV-2 in Jordan: a case control study PONE-D-22-04948R2 Dear Dr. Bellizzi, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Balram Rathish Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0271133.r005
Formally Accepted
28 Jun 2022 Acceptance Letter - Balram Rathish, Editor PONE-D-22-04948R2 Infection prevention and control risk factors in health workers infected with SARS-CoV-2 in Jordan: a case control study Dear Dr. Bellizzi: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Balram Rathish Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0271133.r006

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