A cluster-control approach to a coronavirus disease 2019 (COVID-19) outbreak on a stroke ward with infection control considerations for dementia and vascular units

Abstract

Objective: We sought to contain a healthcare-associated coronavirus disease 2019 (COVID-19) outbreak, to evaluate contributory factors, and to prevent future outbreaks. Design: Quasi-experimental cluster-control outbreak evaluation. Methods: All patients and staff on the outbreak ward (case cluster), and randomly selected patients and staff on COVID-19 wards (positive control cluster) and a non-COVID-19 wards (negative control cluster) underwent reverse-transcriptase polymerase chain reaction (RT-PCR) testing. Hand hygiene and personal protective equipment (PPE) compliance, detection of environmental SARS-COV-2 RNA, patient behavior, and SARS-CoV-2 IgG antibody prevalence were assessed. Results: In total, 145 staff and 26 patients were exposed, resulting in 24 secondary cases. Also, 4 of 14 (29%) staff and 7 of 10 (70%) patients were asymptomatic or presymptomatic. There was no difference in mean cycle threshold between asymptomatic or presymptomatic versus symptomatic individuals. None of 32 randomly selected staff from the control wards tested positive. Environmental RNA detection levels were higher on the COVID-19 ward than on the negative control ward (OR, 19.98; 95% CI, 2.63–906.38; P < .001). RNA levels on the COVID-19 ward (where there were no outbreaks) and the outbreak ward were similar (OR, 2.38; P = .18). Mean monthly hand hygiene compliance, based on 20,146 observations (over preceding year), was lower on the outbreak ward (P < .006). Compared to both control wards, the proportion of staff with detectable antibodies was higher on the outbreak ward (OR, 3.78; 95% CI, 1.01–14.25; P = .008). Conclusion: Staff seroconversion was more likely during a short-term outbreak than from sustained duty on a COVID-19 ward. Environmental contamination and PPE use were similar on the outbreak and control wards. Patient noncompliance, decreased hand hygiene, and asymptomatic or presymptomatic transmission were more frequent on the outbreak ward.

Infection control operations of a large hospital in Taiwan to prevent nosocomial outbreaks during COVID-19 pandemic

“…Wearing surgical masks and hand hygiene may decrease in transmission between patients and HCWs and among HCWs. Decreased hand hygiene compliance was more frequent on the outbreak ward in a quasi-experimental cluster-control outbreak evaluation in New York city hospital [ 13 ]. Universal masking of HCWs and patients in hospital was associated with a significantly lower rate of SARS-CoV-2 positivity among HCWs [ 14 ].…”

Unexpected details regarding nosocomial transmission revealed by whole-genome sequencing of severe acute respiratory coronavirus virus 2 (SARS-CoV-2)

“…Asymptomatic transmission has been suggested a key factor in hospital outbreaks. 7,8 Interpreting symptoms in elderly patients with COVID-19 may be difficult 6,31 and asymptomatic cases are more common among patients aged >80 years. 32 The asymptomatic cases identified in our study support the insufficiency of a strictly symptom-based testing strategy.…”

“…(Received 17 May 2021; accepted 24 July 2021; electronically published 20 August 2021) Advanced age and multiple comorbidities are risk factors for severe outcomes from coronavirus disease 2019 (COVID-19) [1][2][3] ; hence, outbreaks in geriatric facilities could be devastating. With multiple outbreak reports from healthcare settings [4][5][6][7][8][9][10] and healthcareassociated COVID-19 infections (HCAI) documented in 5%-59% of hospitalized patients, 2,3,[11][12][13] the need for effective infection prevention and control (IPC) is evident. Long-lasting, close interactions with infected individuals [14][15][16] and cluster infections are important drivers of the pandemic.…”

Infection control measures promoted by the public health center for “housing for the elderly” facilities during norovirus cluster outbreaks

“…Patients with dementia or memory impairment cannot comply with mask-wearing or movement restrictions 16 ) , which increases their risk of infection. Dementia can increase the risk of outbreaks and death from a range of infectious diseases in hospitals, clinics, and aged care facilities 17 , 18 , 19 ) .…”