Containment of a Large SARS-CoV-2 Outbreak Among Healthcare Workers in a Pediatric Intensive Care Unit

Abstract

Objective: Healthcare workers (HCWs) are particularly exposed SARS-CoV-2 because they are critical in preventing viral transmission and treating COVID-19 patients. Within HCWs, personnel of intensive care units (ICUs) are at the forefront of treating patients with a severe course of COVID-19 infection and therefore represent an extremely vulnerable group. Thus, our objective is to contribute to establish means of infection control protecting HCWs in the frontline of the current pandemic. Design: An outbreak of SARS-CoV-2 was detected and contained in a pediatric ICU (PICU). The first positive case was identified with a point-of-care diagnostic system on site. Real-time PCR-based testing systems from self-collected nasopharyngeal samples swabs were used to test for viral RNA of SARS-CoV-2 in the follow-up. Setting: PICU within a tertiary university hospital in Germany. Participants: Healthcare workers of the PICU. Interventions: Positive HCWs were sent into quarantine. Containment measures were implemented including wearing of surgical-masks, physical distancing and systematic testing. Results: Among 432 HCWs, 91 (25%) were tested. Forty-five percent reported symptoms corresponding to characteristics of COVID-19. Of those, only 19,5% (8 HCWs) were tested positive for SARS-CoV-2. No infection occurred outside the PICU. After the implementation of containment measures, viral transmission was stopped. Conclusions: In the present study, a large outbreak within a team of healthcare workers of a PICU, affecting almost one fifth of the entire personnel is documented, along with detailed insights about how the outbreak was contained and how operability of the unit was maintained.

COVID-19 Prevention and Control Measures in Workplace Settings: A Rapid Review and Meta-Analysis

“…Following duplicate removal, title and abstract screening, and full-text screening, 61 met all inclusion criteria and were included in the review (Figure 1). Included studies (k = 61) varied in study design, comprising 6 cross-sectional studies [21][22][23][24][25][26], 7 case-control series [27,28], 22 prospective cohort studies , 1 longitudinal cohort study [51], 7 retrospective cohort studies [52][53][54][55][56][57][58], 7 prospective observational studies (i.e., observing the number of new cases in a facility after the implementation of IPC measures) [59][60][61][62][63][64][65], 1 retrospective observational study [66], 3 outbreak investigation reports [67][68][69], 1 post hoc analysis [70], 1 sequential follow-up study [71], 1 short-term prospective survey [72], 2 surveillance studies [73,74], and 7 mathematical modelling studies [75][76][77][78][79][80][81]. All studies were conducted before COVID-19 vaccinations became available in December 2020.…”

“…Fifteen studies were performed in the United States (USA) [28,36,38,41,45,49,51,52,55,69,72,[78][79][80][81]. Other included studies were performed in India [32], France [72], Canada [29,63], Italy [22,42,44,57,60,62,74], the United King-dom (UK) [35,40,50,53,58,65,75,76], Belgium [21,39], Korea [30,31,54,56], Taiwan [73], Germany [33,37,59,67,68,71] China [48], Finland [25], Spain [26], Japan …”

“…Fifteen studies used multiple IPC measures at once, as displayed in Table 5. The most widely used intervention component was PPE (universal masking, full PPE in high-risk healthcare settings) [22,34,44,[46][47][48]62,68,71]. Kong and Yan added a unique component to their intervention: inventory monitoring protocols to ensure adequate PPE supply at all times [48].…”

“…Kong and Yan added a unique component to their intervention: inventory monitoring protocols to ensure adequate PPE supply at all times [48]. Other widely used measures in combined interventions were universal, asymptomatic testing [29,42,48,56,62,71], symptomatic testing [29,46,47,67,68], and social distancing [22,47,48,67,68]. Five studies conducted employee education and/or training [22,34,44,48,67].…”

Reliable detection of SARS-CoV-2 with patient-collected swabs and saline gargles: A three-headed comparison on multiple molecular platforms

“…Unsupervised home self-collection has been performed by both HCWs and the public at large, ( McCulloch et al, 2020 ) with HCW volunteers largely agreeing to perform self-collected NP swabs for diagnosis or research purposes ( Demmer et al, 2020 ), and a majority of community dwellers agreeing to self-collecting a throat swab sample at home ( Hall et al, 2020 ). Self-collected swabs have a role in outbreak investigation and management ( Knoll et al, 2020 ), and in target populations that require serial testing ( O’Shea et al, 2020 ). Locally, regular interval asymptomatic voluntary testing by self-collected OP/N swabs has been implemented among HCWs in long term care facilities, and are being offered to asymptomatic inter-provincial trucking professionals, allowing them to conveniently deposit their specimens at defined locations.…”