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Healthcare personnel (HCP) were unlikely to be infected with monkeypox from an infected patient, according to research from the Colorado Department of Public Health and Environment.

Among 313 healthcare workers exposed to 55 patients with confirmed monkeypox, none contracted the virus over 21 days of follow-up, even though many did not wear personal protective equipment (PPE) recommended by the CDC, reported Kristen E. Marshall, PhD, and colleagues.

Even so, "these results underscore the importance of public health outreach to better understand the circumstances of HCP exposures so that prevention, infection prevention education, and training of HCP can be improved, especially in primary care and urgent care settings," they wrote in an early release of the .

During the study period from May 1 to July 31, only 23% of the 313 healthcare workers reported wearing all the recommended PPE. High- or intermediate-risk exposures were determined in 87 (28%) cases, making them eligible for postexposure prophylaxis with the Jynneos vaccine; only 37 received the vaccine.

The CDC currently recommends PPE that includes a gown, gloves, eye protection, and an N95 or better respirator when exposed to monkeypox.

In this study, N95 respirators were worn by 38% of HCP, 64% wore gloves, 40% wore gowns, and 31% wore eye protection.

Marshall and colleagues found that use of PPE varied according to task.

Of seven workers exposed to monkeypox during an aerosol-generating procedure, three wore an N95 mask. In 273 who were exposed to patients with a monkeypox-related rash or lesion, 161 had direct contact with patient skin or lesions. Of these workers, 30 did not wear gloves, and 125 did. Protection was unknown in six cases.

In 26 reports of handling monkeypox-infected patient linens, 23 wore gloves, and three did not.

Following exposure, seven workers reported monkeypox-related symptoms, including three with rash or lesions and four with other non-specific symptoms. Two with rash were tested for orthopoxvirus, and both were negative. The other case with rash was determined to be the result of a medication reaction.

"These data suggest that opportunities exist to improve awareness and training among frontline HCP who are most likely to see patients with monkeypox, so that they can take steps to protect themselves from exposure," they noted. "The need for increased awareness and preparation was most apparent in primary care and urgent care settings where adherence to recommended PPE use was lowest."

What's more, as sexually transmitted infection clinics became referral centers in Colorado, it's important that nonclinical staff also follow CDC guidelines, since "more clinical providers and nursing staff members [were] typically wearing recommended PPE than nonclinical staff members," they pointed out.

"Infection prevention training is important in all healthcare settings, and these findings can guide future updates to PPE recommendations and risk classification in healthcare settings," Marshall and colleagues said.

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