Abstract
To describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled-nursing facility (SNF), and the strategies that controlled transmission. This cohort study was conducted during March 22-May 4, 2020, among all staff and residents at a 780-bed SNF in San Francisco, California. Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPSs) in units with confirmed cases. Cases were confirmed by real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2, and whole-genome sequencing (WGS) was used to characterize viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact with a confirmed case; restricting movement between units; implementing surgical face masking facility-wide; and the use of recommended PPE (ie, isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases. Of 725 staff and residents tested through targeted testing and serial PPSs, 21 (3%) were SARS-CoV-2 positive: 16 (76%) staff and 5 (24%) residents. Fifteen cases (71%) were linked to a single unit. Targeted testing identified 17 cases (81%), and PPSs identified 4 cases (19%). Most cases (71%) were identified before IPC interventions could be implemented. WGS was performed on SARS-CoV-2 isolates from 4 staff and 4 residents: 5 were of Santa Clara County lineage and the 3 others were distinct lineages. Early implementation of targeted testing, serial PPSs, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.
Highlights
Implementation of targeted testing, serial point prevalence surveys (PPSs), and multimodal Infection prevention and control (IPC) interventions limited SARS-CoV-2 transmission within the skilled-nursing facility (SNF)
Given the substantial morbidity and mortality during novel coronavirus disease 2019 (COVID-19) outbreaks in SNFs nationwide, SNFs are a high priority for outbreak prevention and control.[3,4,5,6]
With continued community-based SARS-CoV-2 transmission nationwide,[8] staff pose an ongoing risk of introducing the virus to SNFs.[9]
Summary
Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were collected through serial point prevalence surveys (PPSs) in units with confirmed cases. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact with a confirmed case; restricting movement between units; implementing surgical face masking facility-wide; and the use of recommended PPE (ie, isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases. This investigation was a public health response; data collection was determined to be non–human-subjects research by the CDC. Symptomatic close contacts were prioritized for immediate testing by their private provider or the facility
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