Multipronged infection control strategy to achieve zero nosocomial coronavirus disease 2019 (COVID-19) cases among Hong Kong healthcare workers in the first 300 days of the pandemic

Abstract

Background: Nosocomial outbreaks leading to healthcare workers (HCWs) infection and death have been increasingly reported during the coronavirus disease 2019 (COVID-19) pandemic. An effective intervention is urgently needed to reduce nosocomial acquisition. Methods: We summarized our experience of multi-pronged infection control (IC) strategy in the first 300 days (December 31, 2019 to October 25, 2020) of COVID-19 era under the governance of Hospital Authority in Hong Kong. Results: Of 5,296 COVID-19 patients, 4,808 (90.8%) were diagnosed in the first (142 cases), second (896 cases), and third wave (3,770 cases) of COVID-19 in Hong Kong. Except for one patient who died before admission, all COVID-19 patients were admitted to public healthcare system which culminated to 78,834 COVID-19 patient-days. The median length of stay was 13 days (ranged, 1-128). Of 81,955 HCWs, thirty-eight (0.05%) HCWs [13 professional (2 doctors, 11 nurses) and 25 non-professional staff], had COVID-19. Except for 5 of 38 (13.2%) infected by HCW-to-HCW transmission in the non-clinical settings, no HCW had documented transmission from COVID-19 patients in the hospitals. The incidence of COVID-19 among HCWs was significantly lower than that of our general population (0.46 per 1,000 HCWs vs 0.71 per 1,000 population, p=0.008). The incidence of COVID-19 among professional staff was significantly lower than that of non-professional staff (0.30 vs 0.66 per 1,000 FTE, p=0.022). Conclusion: Hospital-based approach spared our healthcare service from being overloaded. No nosocomial COVID-19 in HCWs was found in the first 300 days of COVID-19 era in Hong Kong with our multi-pronged IC strategy.

To prevent SARS‐CoV‐2 transmission in designated quarantine hotel for travelers: Is the ventilation system a concern?

“…A portable high‐efficiency particulate air (HEPA) filter is placed outside the door during the collection of specimens. Residents tested positive for SARS‐CoV‐2 will be admitted to airborne infection isolation unit in public hospitals or community isolation and treatment facilities to minimize the risk of COVID‐19 outbreak 6,7 …”

Overcoming Current and Preventing Future Nosocomial Outbreaks during the COVID-19 Pandemic: Lessons Learned at Three Hospitals in Japan

“…This includes epidemiological analysis, zoning and cohorting, precise PPE management, and environmental disinfection. Our findings highlighted that immediate practical guidance and intensified training on-site by experts with experience were effective to make all staff familiar with strict IPC measures in hospitals less experienced in NIs, as the Hong Kong study stressed [ 45 ]. Moreover, its study suggested that the on-site simulation drill in normal times was useful [ 45 ].…”

“…Our findings highlighted that immediate practical guidance and intensified training on-site by experts with experience were effective to make all staff familiar with strict IPC measures in hospitals less experienced in NIs, as the Hong Kong study stressed [ 45 ]. Moreover, its study suggested that the on-site simulation drill in normal times was useful [ 45 ]. In Japan, at present, the cluster teams of MOHLW and the infectious disease specialists of DMATs affiliated with each prefecture play an important role in COVID-19 control and training HCWs to deal with on-site outbreaks.…”

“…In Hospital C, it was pointed out that staff may have brought the virus in from outside. In fact, several studies suggested that HCWs can be infected in the community and possibly amplify SARS-CoV-2 outbreaks in the health facilities [ 3 , 45 ]. The Osaka study implied that the risk of bringing the virus in from outside by staff tends to increase as CAI via unknown routes increase, and it takes around 10–20 days until SARS-CoV-2 can be recognized [ 3 ].…”

“…According to a previous survey in Japan, 52% of the staff infected were nurses [ 40 ]. In the three hospitals in our study, when an infection is found in a ward, the nurses in close contact with the relevant people are isolated immediately, which means that ward duties must be performed on a limited shift, increasing the workload per person [ 18 , 30 , 43 , 45 , 46 , 48 , 49 ]. In addition, when shift changes required support from other departments, the work was unfamiliar as were the new members, which increased stress [ 31 , 49 ].…”