Nosocomial Outbreak of COVID-19 in a Hematologic Ward

Abstract

Background Coronavirus disease 2019 (COVID-19) outbreaks occur in hospitals in many parts of the world. In hospital settings, the possibility of airborne transmission needs to be investigated thoroughly. Materials and Methods There was a nosocomial outbreak of COVID-19 in a hematologic ward in a tertiary hospital, Seoul, Korea. We found 11 patients and guardians with COVID-19 through vigorous contact tracing and closed-circuit television monitoring. We found one patient who probably had acquired COVID-19 through airborne-transmission. We performed airflow investigation with simulation software, whole-genome sequencing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results Of the nine individuals with COVID-19 who had been in the hematologic ward, six stayed in one multi-patient room (Room 36), and other three stayed in different rooms (Room 1, 34, 35). Guardian in room 35 was close contact to cases in room 36, and patient in room 34 used the shared bathroom for teeth brushing 40 minutes after index used. Airflow simulation revealed that air was spread from the bathroom to the adjacent room 1 while patient in room 1 did not used the shared bathroom. Airflow was associated with poor ventilation in shared bathroom due to dysfunctioning air-exhaust, grill on the door of shared bathroom and the unintended negative pressure of adjacent room. Conclusion Transmission of SARS-CoV-2 in the hematologic ward occurred rapidly in the multi-patient room and shared bathroom settings. In addition, there was a case of possible airborne transmission due to unexpected airflow.

New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses

“…[43][44][45] Large clusters of SARS-CoV-2, influenza, RSV, parainfluenza, and human metapneumovirus in acute care hospitals have been well reported, [26][27][28][29][30] most attributed to staff with communityacquired infections who transmitted to peers and patients [46][47][48] or to patients with missed diagnoses or infections incubating at the time of admission who subsequently infected staff and/or other patients. [49][50][51][52][53][54] Cases have also been attributed to visitors. 55…”

“…Some multi-room clusters have been reported, but all have also involved infected staff members making it difficult to differentiate room-to-room transmission via the air versus transmission via infected staff intermediaries. [49][50][51][52][53][54] The number of air exchanges per hour if anything appears to be more important than a given room's pressure differential relative to the corridor and other rooms. Notwithstanding the fact that SARS-CoV-2 and other respiratory viruses are carried by aerosols, it does not appear to be necessary to place every patient with SARS-CoV-2 in an airborne infection isolation room with negative pressure relative to the hallway.…”

“…Some multi-room clusters have been reported, but all have also involved infected staff members making it difficult to differentiate room-to-room transmission via the air versus transmission via infected staff intermediaries. 49 50 51 52 53 54…”

What does family involvement in care provision look like across hospital settings in Bangladesh, Indonesia, and South Korea?

“…Early in the pandemic (March 2020), the incidence of patients with COVID-19 exceeded the availability of single isolation rooms in many UK hospitals [3]. Studies exploring these HAI COVID cases have focused on the role of the healthcare worker (HCW) [4,5], but in some situations, the source of the infection has been linked back to the patients' family members and/or privately hired carers [6,7]. Previously the role of family carers in the clinical setting was linked to the spread of Middle East Respiratory Syndrome (MERS) during an outbreak in 2015 [7][8][9][10].…”

“…Studies exploring these HAI COVID cases have focused on the role of the healthcare worker (HCW) [4,5], but in some situations, the source of the infection has been linked back to the patients' family members and/or privately hired carers [6,7]. Previously the role of family carers in the clinical setting was linked to the spread of Middle East Respiratory Syndrome (MERS) during an outbreak in 2015 [7][8][9][10]. A recent COVID-19 outbreak report noted the role of multiple occupancy room settings, where patients' caregivers stay next to the patient, as potentially facilitating the spread of the virus [6,7,9].…”