Abstract
ObjectiveCoronavirus disease (COVID-19) was officially declared a pandemic in March 2020. Many cases of COVID-19 are nosocomial, but to the best of our knowledge, no nosocomial outbreaks on psychiatric departments of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in Europe. The different nature of psychiatry makes outbreak management more difficult. This study determines which psychiatry specific factors contributed to a nosocomial outbreak taking place in a psychiatric department. This will provide possible interventions in future outbreak management.MethodA case series describing a nosocomial outbreak in a psychiatric department of an acute care hospital in the Netherlands between March 13, 2020 and April, 14 2020. The outbreak was analyzed by combining data from standardized interviews, polymerase chain reaction (PCR) tests and whole genome sequencing (WGS).ResultsThe nosocomial outbreak in which 43% of staff of the psychiatric department and 19% of admitted patients were involved, was caused by healthcare worker (HCW)-to-HCW transmissions, as well as patient-to-HCW-to-patient transmission. We identified four aspects associated with the mental health care system which might have made our department more susceptible to an outbreak.ConclusionsInfection control measures designed for hospitals are not directly applicable to psychiatric departments. Psychiatric patients should be considered a high-risk group for infectious diseases and customized measures should be designed and implemented. Extra attention for psychiatric departments is necessary during a pandemic as psychiatric HCWs are less familiar with outbreak management. Clear communication and governance is crucial in correctly implementing these measures.
Highlights
In December 2019, an unknown coronavirus was linked to a surge in patients with fever and pneumonia in China
We identified four aspects associated with the mental health care system which might have made our department more susceptible to an outbreak
Extra attention for psychiatric departments is necessary during a pandemic as psychiatric healthcare workers (HCWs) are less familiar with outbreak management
Summary
In December 2019, an unknown coronavirus was linked to a surge in patients with fever and pneumonia in China. The causative agent was identified as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the resulting disease was named coronavirus disease (COVID-19). On March 11, the World Health Organization (WHO) declared COVID-19 a pandemic. It is Rovers et al Antimicrob Resist Infect Control (2020) 9:190 thought that ongoing surveillance of SARS-CoV-2 is warranted as a re-emergence of the disease could still occur over the following years [1]. Severe and critical infections account for about 14 and 5% of cases, and may be complicated by acute respiratory distress syndrome (ARDS) and multiple organ failure [9]. Since the clinical manifestation of infection ranges from severe to asymptomatic, there have been concerns that transmission might be able to occur due to unquarantined individuals and healthcare workers (HCWs) with no or few symptoms going unnoticed [8]
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