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Wilson NM, Calabria C, Warren A, Finlay A, O'Donovan A, Passerello GL, Ribaric NL, Ward P, Gillespie R, Farrel R, McNarry AF, Pan D. Quantifying hospital environmental ventilation using carbon dioxide monitoring - a multicentre study. Anaesthesia 2024; 79:147-155. [PMID: 38059394 DOI: 10.1111/anae.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol-generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high-risk infective or immunocompromised patients may be isolated to reduce cross-infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two-phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non-dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient-occupied (clinical) and staff break and office (non-clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID-19 are cared for routinely, as well as ICUs and operating theatres where aerosol-generating procedures are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non-clinical areas vs. 7% in clinical areas (p < 0.001). In non-clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation.
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Affiliation(s)
- N M Wilson
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Calabria
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Warren
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Finlay
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A O'Donovan
- Department of Process, Energy and Transport Engineering, MeSSO Research Group, Munster Technological University, Cork, Ireland
| | - G L Passerello
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - N L Ribaric
- Faculty of Medicine, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - P Ward
- Department of Anaesthesia, St John's Hospital, Livingston, UK
| | - R Gillespie
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Farrel
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A F McNarry
- Department of Anaesthesia, Western General Hospital, UK
| | - D Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Sansom SE, Barbian H, Hayden MK, Fukuda C, Moore NM, Thotapalli L, Baied EJ, Kim DY, Snitkin E, Lin MY. Genomic Investigation to Identify Sources of Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare Personnel in an Acute Care Hospital. Open Forum Infect Dis 2022; 9:ofac581. [PMID: 36467294 PMCID: PMC9709631 DOI: 10.1093/ofid/ofac581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background Identifying the source of healthcare personnel (HCP) coronavirus disease 2019 (COVID-19) is important to guide occupational safety efforts. We used a combined whole genome sequencing (WGS) and epidemiologic approach to investigate the source of HCP COVID-19 at a tertiary-care center early in the COVID-19 pandemic. Methods Remnant nasopharyngeal swab samples from HCP and patients with polymerase chain reaction-proven COVID-19 from a period with complete sample retention (14 March 2020 to 10 April 2020) at Rush University Medical Center in Chicago, Illinois, underwent viral RNA extraction and WGS. Genomes with >90% coverage underwent cluster detection using a 2 single-nucleotide variant genetic distance cutoff. Genomic clusters were evaluated for epidemiologic linkages, with strong linkages defined by evidence of time/location overlap. Results We analyzed 1031 sequences, identifying 49 clusters that included ≥1 HCP (265 patients, 115 HCP). Most HCP infections were not healthcare associated (88/115 [76.5%]). We did not identify any strong epidemiologic linkages for patient-to-HCP transmission. Thirteen HCP cases (11.3%) were attributed to a potential patient source (weak evidence involving nonclinical staff that lacked location data to prove or disprove contact with patients in same cluster). Fourteen HCP cases (12.2%) were attributed to HCP source (11 with strong evidence). Conclusions Using genomic and epidemiologic data, we found that most HCP severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were not healthcare associated. We did not find strong evidence of patient-to-HCP transmission of SARS-CoV-2.
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Affiliation(s)
- Sarah E Sansom
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Hannah Barbian
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Mary K Hayden
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Christine Fukuda
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Nicholas M Moore
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Lahari Thotapalli
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Elias J Baied
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Do Young Kim
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan Snitkin
- Department of Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael Y Lin
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
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Zeeb M, Weissberg D, Rampini SK, Müller R, Scheier T, Zingg W, Kouyos RD, Wolfensberger A. Identifying Contact Risks for SARS-CoV-2 Transmission to Healthcare Workers during Outbreak on COVID-19 Ward. Emerg Infect Dis 2022; 28:2134-2137. [PMID: 36001791 PMCID: PMC9514331 DOI: 10.3201/eid2810.220266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We assessed the risk for different exposures to SARS-CoV-2 during a COVID-19 outbreak among healthcare workers on a hospital ward in late 2020. We found working with isolated COVID-19 patients did not increase the risk of COVID-19 among workers, but working shifts with presymptomatic healthcare coworkers did.
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Itoh N, Akazawa N, Ishikane M, Kawabata T, Kawamura D, Chikusa T, Kodama EN, Ohmagari N. Lessons learned from an outbreak of COVID-19 in the head and neck surgery ward of a Japanese cancer center during the sixth wave by Omicron. J Infect Chemother 2022; 28:1610-1615. [PMID: 35995417 PMCID: PMC9389781 DOI: 10.1016/j.jiac.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
Abstract
Introduction We describe a coronavirus disease (COVID-19) outbreak in a cancer center's head and neck surgery ward and the interventions to halt ongoing exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers and patients with cancer. Methods Case definition included all healthcare workers and all patients associated to the ward from January 27 to January 31, 2022 with a positive SARS-COV-2 antigen test. This retrospective descriptive study was conducted between January 27, 2022, and February 14, 2022. Results From January 28, 2022, to February 9, 2022, 84 cases (36 healthcare workers, 48 patients) were screened, and 26 (12 healthcare workers, 14 patients) were identified as SARS-CoV-2-positive. The proportion of healthcare providers who performed aerosol generating procedures on positive patients was 91% for positive cases and 49% for non-cases. Room sharing with patients with COVID-19 was 64% for positive cases and 21% for non-cases (57% vs. 21% with positive tracheostomy patients; 43% vs. 9% with positive cases using a nebulizer; 50% vs. 15% with positive cases requiring sputum suctioning, respectively). Compliance with the universal masking policy for patients was 36% of positive cases and 79% of non-cases. Conclusions This is the first report of a nosocomial outbreak of COVID-19 in a head and neck surgery ward during the Omicron pandemic. Notably, there were a high number of positive cases among healthcare workers who performed aerosol generating procedures for positive patients and patients who shared the room with a patient with COVID-19 with the potential to generate aerosols.
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Affiliation(s)
- Naoya Itoh
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan.
| | - Nana Akazawa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Daichi Kawamura
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Tomoyuki Chikusa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Eiichi N Kodama
- Division of Infectious Diseases, International Research Institute of Disaster Science, Graduate School of Medicine, Tohoku University and Tohoku Medical Megabank Organization, Sendai, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan
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Clustering of Covid-19 Infections among Healthcare Workers: Experience from A Tertiary Care Center in Saudi Arabia. Am J Infect Control 2022; 50:981-987. [PMID: 35714707 PMCID: PMC9192356 DOI: 10.1016/j.ajic.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
Abstract
Introduction Coronavirus infectious disease 2019 (COVID-19) had a significant impact on healthcare workers (HCWs) worldwide. Understanding the dynamics of infection transmission is important to develop strategies to prevent its spread. Methods A retrospective study of a cohort of HCWs with COVID-19 from a single tertiary care hospital during the first wave of the pandemic. Epidemiological investigations and identification of clusters of infection were done prospectively. Results A total of 326 HCWs had COVID-19 based on positive polymerase chain reaction tests for SARS-CoV-2. Ten clusters of infection were identified; nine clusters had HCWs as the index cases while one cluster had a patient as the index case. The largest cluster involved 15 transmissions, and one cluster included a secondary transmission. Sharing accommodation and social gatherings were the commonest epidemiological links. The majority of infected HCWs had mild infections, 23 (6%) required hospital admission and 3 (1%) required intensive care; all fully recovered. Majority of infections (80%) were community-acquired. Living in shared accommodation was associated with COVID-19 (120/690 versus 206/1610, P value = .01) while working in COVID-19 designated wards/units was not associated with COVID-19 (52/297 vs 274/2003, P value = .13). Conclusions Clustering of COVID-19 was common among HCWs and related to shared accommodation and social gatherings, infection was of mild severity, and was not associated with caring for COVID-19 patients.
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Winkler ML, Hooper DC, Shenoy ES. Infection Prevention and Control of Severe Acute Respiratory Syndrome Coronavirus 2 in Health Care Settings. Infect Dis Clin North Am 2022; 36:309-326. [PMID: 35636902 PMCID: PMC8806155 DOI: 10.1016/j.idc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The authors describe infection prevention and control approaches to severe acute respiratory syndrome coronavirus 2 in the health care setting, including a review of the chain of transmission and the hierarchy of controls, which are cornerstones of infection control and prevention. The authors also discuss lessons learned from nosocomial transmission events.
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Affiliation(s)
- Marisa L. Winkler
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA,Corresponding author. Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA, 02114
| | - David C. Hooper
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Erica S. Shenoy
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Pisani M, Anderson L, Hatas G, Safdar N. A systems approach to understanding SARS-CoV-2 transmission among healthcare workers in a cluster. Am J Infect Control 2022; 50:459-461. [PMID: 34883160 PMCID: PMC8645508 DOI: 10.1016/j.ajic.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022]
Abstract
Preventing transmission of COVID-19 between healthcare workers is essential to optimize patient, employee, and organizational outcomes. We used a systems engineering approach to analyze contact tracing interviews from a cluster of COVID-19 at our healthcare institution and identified modifiable and non-modifiable causes of transmission. Similar work system analyses may be useful to institutions in identifying multiple factors contributing to infection clusters among healthcare workers, and in developing layered infection prevention methods to further reduce transmission.
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Kanji JN, Chan YLE, Boychuk LR, Boyington C, Turay S, Kobelsky M, Doroshuk C, Choo P, Jacka S, Roberts E, Leighton K, Smith SW, Sikora C, Black R. SARS-CoV-2 outbreak in a Canadian suburban tertiary hospital necessitating full facility closure: a descriptive observational study. CMAJ Open 2022; 10:E137-E145. [PMID: 35193878 PMCID: PMC9259436 DOI: 10.9778/cmajo.20210064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND SARS-CoV-2 can cause outbreaks in community- and hospital-based settings. The aim of this study was to provide a detailed epidemiologic account of a hospital-wide SARS-CoV-2 outbreak and provide a description of case evaluations, transmission networks and the interventions implemented to stem the outbreak. METHODS We conducted a retrospective descriptive study of a hospital-wide SARS-CoV-2 outbreak at the Misericordia Community Hospital (Edmonton) from June 21 to Aug. 14, 2020. We reviewed hospital chart, public health and occupational health records to determine demographics, case type (community- or hospital-acquired), need for critical care and outcome for each case linked to the outbreak (patients, hospital staff, and community and patient visitors). We developed detailed transmission networks using epidemiologic data to determine what variables may have contributed to transmission. RESULTS Fifty-eight cases of SARS-CoV-2 infection were linked to this hospital outbreak (31 patients, 25 staff members and 2 visitors; 66% female, age range 19-97 years). One patient required critical care, and 11 deaths were recorded (all among inpatients). Most cases were hospital-acquired (91%), and 28% were asymptomatic at the time of diagnosis. The outbreak was composed of 2 clusters driven by protective equipment breaches, premature removal of precautions, transmission in small staff quarters and infection of a staff member after exposure to a wandering patient with dementia and asymptomatic, undetected SARS-CoV-2 infection. INTERPRETATION A detailed epidemiologic review of this hospital-wide outbreak shows that a SARS-CoV-2 outbreak can involve complex transmission chains and clusters. Multipronged bundled approaches, aggressive contact tracing, and patient and staff prevalence screening are important to help bring such outbreaks under control, along with ongoing vigilance in detecting delayed cases.
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Affiliation(s)
- Jamil N Kanji
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta.
| | - Y L Elaine Chan
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Lesia R Boychuk
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Curtiss Boyington
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Sebora Turay
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Melissa Kobelsky
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Carolyn Doroshuk
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Philana Choo
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Susan Jacka
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Erin Roberts
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Karen Leighton
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Christopher Sikora
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
| | - Robert Black
- Division of Infectious Diseases, Department of Medicine (Kanji, Boychuk, Boyington, Smith), University of Alberta; Covenant Health (Kanji, Boychuk, Boyington, Turay, Kobelsky, Doroshuk, Choo, Jacka, Roberts, Leighton, Black); Canadian Public Health Service, Public Health Agency of Canada (Chan); Division of Preventive Medicine, Faculty of Medicine and Dentistry (Sikora), University of Alberta; Medical Officer of Health (Edmonton Zone), (Sikora) Alberta Health Services; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry (Black), University of Alberta, Edmonton, Alta. Note: Dr. J.N. Kanji is now with the Division of Infectious Diseases, Department of Medicine and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta
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Rebmann T, Alvino RT, Mazzara RL, Sandcork J. Infection preventionists' experiences during the first nine months of the COVID-19 pandemic: Findings from focus groups conducted with Association of Professionals in Infection Control & Epidemiology (APIC) members. Am J Infect Control 2021; 49:1093-1098. [PMID: 34454681 PMCID: PMC8387098 DOI: 10.1016/j.ajic.2021.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION A novel human Coronavirus (SARS CoV-2) was identified in January, 2020 and developed into a pandemic by March, 2020. This rapid, enormous, and unanticipated event had major implications for healthcare. Infection preventionists (IP) have a critical role in worker and patient safety. IPs' lessons learned can guide future pandemic response. METHODS Seven focus groups were conducted with APIC members in September and October, 2020 via Zoom to elicit IPs' experiences during the COVID-19 pandemic. Sessions were recorded then transcribed verbatim. Major themes were identified through content analysis. RESULTS In total, 73 IPs participated (average of 10 IPs per focus group) and represented all geographical areas and work settings. Participating IPs described multiple challenges they have faced during the COVID-19 pandemic, including rapidly changing and conflicting guidance, a lack of infection prevention recommendations for nonacute care settings, insufficient personal protective equipment, healthcare personnel complacency with personal protective equipment and infection prevention protocols, and increases in healthcare associated infections and workload. CONCLUSIONS The identified gaps in pandemic response need to be addressed in order to minimize healthcare associated infections and occupational illness. In addition, the educational topics identified by the participating IPs should be developed into new educational programs and resources.
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Chow K, Aslam A, McClure T, Singh J, Burns J, McMillen T, Jani K, Lucca A, Bubb T, Robilotti EV, Babady NE, Kamboj M. Risk of Healthcare-Associated Transmission of SARS-CoV-2 in Hospitalized Cancer Patients. Clin Infect Dis 2021; 74:1579-1585. [PMID: 34329418 PMCID: PMC8385815 DOI: 10.1093/cid/ciab670] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is limited information on the risk of hospital-acquired coronavirus disease 2019 (COVID-19) among high-risk hospitalized patients after exposure to an infected patient or healthcare worker (HCW) in a nonoutbreak setting. Methods This study was conducted at a tertiary care cancer center in New York City from 10 March 2020 until 28 February 2021. In early April 2020, the study institution implemented universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing at admission and retesting every 3 days through the hospital stay. Contact tracing records were reviewed for all exposures to SARS-CoV-2 positive patients and HCWs. Results From 10 March 2020 to 28 February 2021, 11 348 unique patients who were SARS-CoV-2 polymerase chain reaction (PCR) negative at the time of admission underwent 31 662 postadmission tests during their hospitalization, and 112 tested positive (0.98%). Among these, 49 patients housed in semiprivate rooms during admission resulted in 74 close contacts and 14 secondary infections within 14 days, for an overall attack rate of 18.9%. Among those exposed to a roommate undergoing an aerosol-generating procedure (AGP), the attack rate was 35.7%. Whole genome sequencing (WGS) corroborated transmission in 6/8 evaluated pairs. In addition, three transmission events occurred in 214 patients with significant exposure to 105 COVID-19 positive healthcare workers (1.4%). Conclusions The overall risk of hospital-acquired COVID-19 is low for hospitalized cancer patients, even during periods of high community prevalence. However, shared occupancy with an unrecognized case is associated with a high secondary attack rate in exposed roommates.
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Affiliation(s)
- Karin Chow
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anoshe Aslam
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tara McClure
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Singh
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jacquelyn Burns
- Hospital Administration, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tracy McMillen
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Krupa Jani
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anabella Lucca
- Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Employee Health and Wellness Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tania Bubb
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth V Robilotti
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N Esther Babady
- Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mini Kamboj
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Gordon CL, Trubiano JA, Holmes NE, Chua KYL, Feldman J, Young G, Sherry NL, Grayson ML, Kwong JC. Staff to staff transmission as a driver of healthcare worker infections with COVID-19. Infect Dis Health 2021; 26:276-283. [PMID: 34344634 PMCID: PMC8285261 DOI: 10.1016/j.idh.2021.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/03/2022]
Abstract
Background High rates of healthcare worker (HCW) infections due to COVID-19 have been attributed to several factors, including inadequate personal protective equipment (PPE), exposure to a high density of patients with COVID-19, and poor building ventilation. We investigated an increase in the number of staff COVID-19 infections at our hospital to determine the factors contributing to infection and to implement the interventions required to prevent subsequent infections. Methods We conducted a single-centre retrospective cohort study of staff working at a tertiary referral hospital who tested positive for SARS-CoV-2 between 25 January 2020 and 25 November 2020. The primary outcome was the source of COVID-19 infection. Results Of 45 staff who returned a positive test result for SARS-CoV-2, 19 were determined to be acquired at our hospital. Fifteen (15/19; 79% [95% CI: 54–94%]) of these were identified through contact tracing and testing following exposures to other infected staff and were presumed to be staff-to-staff transmission, including an outbreak in 10 healthcare workers (HCWs) linked to a single ward that cared for COVID-19 patients. The staff tearoom was identified as the likely location for transmission, with subsequent reduction in HCW infections and resolution of the outbreak following implementation of enhanced control measures in tearoom facilities. No HCW contacts (0/204; 0% [95% CI: 0–2%]) developed COVID-19 infection following exposure to unrecognised patients with COVID-19. Conclusion Unrecognised infections among staff may be a significant driver of HCW infections in healthcare settings. Control measures should be implemented to prevent acquisition from other staff as well as patient-staff transmission.
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Affiliation(s)
- Claire L Gordon
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, 3084, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, 3084, Australia; Department of Medicine, The University of Melbourne at Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, 3084, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, 3050, Australia
| | - Kyra Y L Chua
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Jeff Feldman
- Arden Street Labs, Melbourne, Victoria, 3000, Australia
| | - Greg Young
- Business Intelligence Unit, Austin Health, Victoria, 3084, Australia
| | - Norelle L Sherry
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, 3084, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - M Lindsay Grayson
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, 3084, Australia; Department of Medicine, The University of Melbourne at Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Jason C Kwong
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, 3084, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia.
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