Outbreak of coronavirus disease 2019 (COVID-19) among operating room staff of a tertiary referral center: An epidemiologic and environmental investigation.

April N Mcdougal,Brenda J Tyler,Hollie R Davis,Mary Ann Demaet,Janak Patel,Dana Elhassani,Shirley Shores,Natalie Williams-Bouyer,Jessica A Plante,Richard Pyles,Kenneth S Plante,Scott C Weaver

doi:10.1017/ice.2021.116

Abstract

Investigate an outbreak of coronavirus disease 2019 (COVID-19) among operating room staff utilizing contact tracing, mass testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2), and environmental sampling. Outbreak investigation. University-affiliated tertiary-care referral center. Operating room staff with positive SARS-CoV-2 molecular testing. Epidemiologic and environmental investigations were conducted including contact tracing, environmental surveys, and sampling and review of the operating room schedule for staff-to-staff, staff-to-patient, and patient-to-staff SARS-CoV-2 transmission. In total, 24 healthcare personnel (HCP) tested positive for SARS-CoV-2, including nurses (29%), surgical technologists (25%), and surgical residents (16%). Moreover, 19 HCP (79%) reported having used a communal area, most commonly break rooms (75%). Overall, 20 HCP (83%) reported symptomatic disease. In total, 72 environmental samples were collected from communal areas for SARS-CoV-2 genomic testing; none was positive. Furthermore, 236 surgical cases were reviewed for transmission: 213 (90%) had negative preoperative SARS-CoV-2 testing, 21 (9%) had a positive test on or before the date of surgery, and 2 (<1%) did not have a preoperative test performed. In addition, 40 patients underwent postoperative testing (mean, 13 days to postoperative testing), and 2 returned positive results. Neither of these 2 cases was linked to our outbreak. Complacency in infection control practices among staff during peak community transmission of SARS-CoV-2 is believed to have driven staff-to-staff transmission. Prompt identification of the outbreak led to rapid interventions, ultimately allowing for uninterrupted surgical service.

Highlights

Because all SARS-CoV-2–positive healthcare personnel (HCP) worked in the operating room (OR) and because there had been recent changes to the patient preoperative SARS-CoV-2 testing algorithm (Fig. 1), we sought to investigate potential staff-to-patient and patient-to-staff transmission
We reviewed all surgical cases performed during the 7 days preceding the cluster of positive HCP were reviewed for date of surgery, surgery type, surgical service, surgical team including all staff present for the operation, operating room number, preoperative SARS-CoV-2 status including date of positive testing and postoperative SARS-CoV-2 status
Infection Control & Hospital Epidemiology have detectable virus within 7 days of exposure to SARS-CoV-2, we reviewed the cases of patients who had surgery during this period.[1]

Summary

Introduction

Because all SARS-CoV-2–positive HCP worked in the OR and because there had been recent changes to the patient preoperative SARS-CoV-2 testing algorithm (Fig. 1), we sought to investigate potential staff-to-patient and patient-to-staff transmission.

Methods

Results

Conclusion