Nurse infection risk by facility level of isolation wards during the COVID-19 pandemic: A comparative analysis in a South Korean public hospital (2022-2023).

BACKGROUND

During the COVID-19 pandemic, hospitals in South Korea operated various types of negative pressure isolation units (NPIUs), ranging from makeshift conversions to purpose-built wards. While vaccination and personal protective equipment were essential in reducing occupational exposure, the impact of physical infrastructure on the safety of health care workers remains underexplored. This study examined whether nurses' infection risk varied by the level of isolation ward infrastructure.

METHODS

Infection data were collected from a public hospital between February 2022 and June 2023. Four ward types were evaluated: general wards and 3 government-classified NPIUs, each differing in infection control infrastructure. Infection rates per 1,000 nurse-days were calculated. Differences across ward types were analyzed using negative binomial regression, post-hoc comparisons, and permutation tests accounting for temporal overlap.

RESULTS

A facility-level gradient in infection risk was observed. The highest rate occurred in a minimally converted unit (21.62), followed by a partially remodeled unit (5.14). A purpose-built NPIU maintained a low infection rate (1.30), comparable to that of the general ward (0.97).

CONCLUSIONS

The risk of nurse infection was associated with the level of integrated infection control infrastructure. Purpose-built systems substantially reduced occupational exposure.