A two-ward acute care hospital outbreak of SARS-CoV-2 delta variant including a point-source outbreak associated with the use of a mobile vital signs cart and sub-optimal doffing of personal protective equipment

Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case–control study

“…A recently published systematic review identified that infectious SARS-CoV-2 is indeed present on fomites in multiple settings, especially high frequency touched surfaces. Infectious SARS-CoV-2 on fomites was significantly more likely when the RT-PCR Ct values for clinical specimens and fomite samples was < 30 and most frequently detected within the first week of symptom onset in immunocompetent individuals [ 43 , 44 ]. Other studies have corroborated the finding of infectious virus being very strongly correlated with low Ct values, irrespective of the variant [ 45 , 46 ].…”

“…We cannot exclude mixed modes of transmission, but the relative protection provided for nosocomial acquisition by patients within single rooms argues against long range airborne transmission. We cannot exclude poor hand hygiene and suboptimal PPE practices by HCWs which have been implicated previously as associated with nosocomial transmission of SARS-CoV-2 by HCWs, even with the use of full PPE [ 44 , 47 ].…”

Risk factors for nosocomial COVID-19 in a French university hospital

“…and Shimizu et al . experienced outbreaks of several variants, which were resolved by strict adherence to hygiene measures [45] , [46] . Despite the high rate of vaccination in our country, nosocomial outbreaks of SARS-CoV-2 still occur.…”

Robust epidemiological investigations in hospital-based COVID-19 outbreaks cannot be overlooked–even in the era of whole-genome sequencing

“…A lack of direct contact was highlighted as indicative of airborne transmission. However, indirect contact transmission via fomites was not considered which we believe may be plausible in this setting [ 4 , 5 ] and no data is presented to exclude this possibility. Patient 0 was bed bound, presumably requiring increased level of care, in close proximity and possibly for prolonged periods of time, which may present an increased risk for staff exposure (direct and indirect) and environmental contamination.…”

“…Furthermore, on the point of PPE, adherence to existing recommendations was not evaluated or summarized beyond mention that “routine mask wearing around the desk was identified, retrospectively, as suboptimal.” Inappropriate PPE doffing, which is a recognized risk factor for transmission of highly communicable viruses [ 7 ], was not accurately assessed or audited. A recent study [ 4 ] found a highly significant association with sub-optimal adherence to doffing, hand hygiene and order of doffing in a hospital ward COVID-19 outbreak and the authors provide no data on this crucial component of safe care delivery.…”