An overview of the establishment of a national contact tracing programme: a quality improvement approach in a time of pandemic

Abstract

Background: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, the Irish health system needed a contact tracing and management intervention at a national level to undertake high volume, low complexity contact tracing. This paper describes the establishment and first year of a national Contact Management Programme (CMP) in Ireland, its core components, outcomes on key measures (coverage, timeliness, and training) and learnings from the process. Methods: CMP is centred on four steps, 1) case: rapid notification to a person of a result and provision of advice, 2) contacts: rapid identification of contacts, 3) control: rapid public health management of contacts, which includes testing and 4) active follow-up of close contacts with additional testing and public health advice reminder SMS and calls. The outcome measures used in this study are: 1) The proportion of all Irish cases contact traced through the CMP (Coverage), 2) the time taken to complete the 3 types of CMP calls (timeliness), 3) number of contact tracers trained and their feedback (training). Results: 246,666 positive cases were recorded using the CMP between 17th March 2020 and 30th April 2021, with contact tracing successfully completed for 237,759 cases, representing 99% and 96%, respectively, of the 248,529 cases notified in Ireland up to the 30th of April 2021. The average time taken for contact tracing to be completed was 29.4 hours (95% CI 28.9, 29.9) and the median was 16.8 hours (approximate 95% CI 15.9, 17.7). Conclusion: Using the Quality Improvement (QI) approach, the Health Service Executive (HSE) successfully established and scaled up a Contact Management Programme that rapidly notified results to people and traced their close contacts. CMP contributed to the success of the Irish health service in managing the pandemic. CMP slowed COVID-19 transmission and lessened the impact on health services capacity.