Nosocomial Coronavirus Disease 2019 Research Articles

Identification of key potential risk areas and key potential failure modes in hemodialysis rooms by the FMEA method following routine prevention and control of the COVID-19 pandemic.

Hemodialysis is an important part of nosocomial infection prevention and control (IPC). This study aimed to identify the key potential risk areas and failure modes in hemodialysis rooms in hospitals and put forward a series of improvement measures to prevent and control the spread of the coronavirus disease 2019 (COVID-19). Hemodialysis patients are highly susceptible to COVID-19 and usually have a high incidence of severe illness and mortality after infection with COVID-19. Therefore, IPC in hemodialysis patients is of crucial strategic significance. Based on 30 domain experts' interviews and careful analysis of prevention and control documents, we constructed a comprehensive failure system for a model that identifies the potential risks for nosocomial COVID-19 infection in the hemodialysis room. Subsequently, a thorough risk assessment of the potential failure factors identified in our model was conducted. The failure key factors corresponding to the human element in medical waste (garbage) disposal (C2) are verified to be the highest risk factors. They are as follows: The cleaning staff did not dispose of different types of medical waste (garbage) (C21), did not wear masks according to the regulations (C22), and lacked knowledge and norms of nosocomial IPC (C23). This study provides valuable insights for hospital decision-makers on the potential failure factors related to COVID-19 infections in hemodialysis rooms. By working with hospital infection specialists, the suggested improvement measures can help reduce the risk of virus exposure among hospital medical staff, patients, and cleaning staff.

The impact of implementing barrier curtain placement in reducing nosocomial COVID-19 clusters at a tertiary care facility

Abstract Objective: This study aimed to asses the impact of a physical barrier-based infection prevention and control (IPC) intervention in patient wards at a tertiary care center on patient-to-patient coronavirus disease-2019 (COVID-19) transmission and cluster formation. Materials and Methods: A quasi-experimental study was conducted at a 1300-bedded South Indian tertiary care center. Barrier curtains were deployed between ward beds, accompanied by a social interaction protocol, at eight locations, each containing eleven 4-bedded cubicles accommodating 44 patient beds. A surveillance team daily audited adherence to mask usage, barrier curtains, and the social interaction protocol using a predefined checklist. An effective implementation hybrid design was employed to evaluate clinical impact (cluster formation) and implementation effectiveness (adherence to interventions) between the pre-implementation and post-implementation phases. Results: During the pre-implementation and post-implementation periods, 2398 and 1024 positive COVID-19 cases were recorded in the selected areas, respectively, with an average monthly positivity rate of 40%. The number of clusters decreased from three clusters with an average of 11.3 positive cases per cluster in the pre-implementation period to no clusters in the post-implementation period. Implementation effectiveness showed compliance rates of 90% for barrier curtain placement and 100% for the social interaction protocol. Conclusion: This study confirms that physical barriers, specifically curtains, are effective measures against nosocomial COVID-19 transmission. It underscores the importance of adopting context-specific, cost-effective strategies, especially in low-to-middle-income countries, and provides a strong rationale for further research and implementation of such interventions.

A severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nosocomial cluster with inter-facility spread: Lessons learned.

Despite infection control guidance, sporadic nosocomial coronavirus disease 2019 (COVID-19) outbreaks occur. We describe a complex severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cluster with interfacility spread during the SARS-CoV-2 δ (delta) pandemic surge in the Midwest. This study was conducted in (1) a hematology-oncology ward in a regional academic medical center and (2) a geographically distant acute rehabilitation hospital. We conducted contact tracing for each COVID-19 case to identify healthcare exposures within 14 days prior to diagnosis. Liberal testing was performed for asymptomatic carriage for patients and staff. Whole-genome sequencing was conducted for all available clinical isolates from patients and healthcare workers (HCWs) to identify transmission clusters. In the immunosuppressed ward, 19 cases (4 patients, 15 HCWs) shared a genetically related SARS-CoV-2 isolate. Of these 4 patients, 3 died in the hospital or within 1 week of discharge. The suspected index case was a patient with new dyspnea, diagnosed during preprocedure screening. In the rehabilitation hospital, 20 cases (5 patients and 15 HCWs) positive for COVID-19, of whom 2 patients and 3 HCWs had an isolate genetically related to the above cluster. The suspected index case was a patient from the immune suppressed ward whose positive status was not detected at admission to the rehabilitation facility. Our response to this cluster included the following interventions in both settings: restricting visitors, restricting learners, restricting overflow admissions, enforcing strict compliance with escalated PPE, access to on-site free and frequent testing for staff, and testing all patients prior to hospital discharge and transfer to other facilities. Stringent infection control measures can prevent nosocomial COVID-19 transmission in healthcare facilities with high-risk patients during pandemic surges. These interventions were successful in ending these outbreaks.

Nosocomial Coronavirus Disease 2019 during 2020-2021: Role of Architecture and Ventilation.

Nosocomial coronavirus disease 2019 (COVID-19) is a major airborne health threat for inpatients. Architecture and ventilation are key elements to prevent nosocomial COVID-19 (NC), but real-life data are challenging to collect. We aimed to retrospectively assess the impact of the type of ventilation and the ratio of single/double rooms on the risk of NC (acquisition of COVID-19 at least 48 h after admission). This study was conducted in a tertiary hospital composed of two main structures (one historical and one modern), which were the sites of acquisition of NC: historical (H) (natural ventilation, 53% single rooms) or modern (M) hospital (double-flow mechanical ventilation, 91% single rooms). During the study period (1 October 2020 to 31 May 2021), 1020 patients presented with COVID-19, with 150 (14.7%) of them being NC (median delay of acquisition, 12 days). As compared with non-nosocomial cases, the patients with NC were older (79 years vs. 72 years; p < 0.001) and exhibited higher mortality risk (32.7% vs. 14.1%; p < 0.001). Among the 150 NC cases, 99.3% were diagnosed in H, mainly in four medical departments. A total of 73 cases were diagnosed in single rooms versus 77 in double rooms, including 26 secondary cases. Measured air changes per hour were lower in H than in M. We hypothesized that in H, SARS-CoV-2 transmission was favored by short-range transmission within a high ratio of double rooms, but also during clusters, via far-afield transmission through virus-laden aerosols favored by low air changes per hour. A better knowledge of the mechanism of airborne risk in healthcare establishments should lead to the implementation of corrective measures when necessary. People's health is improved using not only personal but also collective protective equipment, i.e., ventilation and architecture, thereby reinforcing the need to change institutional and professional practices.

Descriptive study of COVID-19 vaccinations and infections within an NHS workforce.

Healthcare workers were a priority group for coronavirus disease 2019 (COVID-19) vaccination during the pandemic. Occupational exposure may account for some of the increased risk faced. Describe COVID-19 vaccine uptake and infection rates in staff across a large NHS board in Scotland to better understand occupational risk during the pandemic. Descriptive cross-sectional study. Demographic data were extracted on 5 August 2021 from 26 058 members of staff. COVID-19 vaccination status and positive polymerase chain reaction (PCR) results were extracted on two separate dates to describe the timeline of staff infections between March 2020 and January 2022. There was high uptake of all three vaccine doses across all demographic groups in hospital staff. PCR positivity decreased with increasing age and Scottish Index of Multiple Deprivation score. Staff and nosocomial COVID-19 infections followed peaks in community infection rates. NHS Lothian is a typical NHS workforce with good vaccine uptake. Beyond very early cases, there seems to be minimal evidence of occupational acquisition of COVID-19. The large number of nosocomial infections at the start of the pandemic may, in fact, reflect lack of community testing at this time. Despite protection from high vaccine coverage, job type and good Infection Prevention and Control practices, it seems that staff remain at high risk of catching the highly transmissible omicron variant from the community rather than work.

Designed for a pandemic: Mitigating the risk of SARS-CoV-2 transmission through hospital design and infrastructure

BackgroundTo describe the new Royal Adelaide Hospital (RAH) design and infrastructure features that helped mitigate the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission within the hospital during the pre-vaccination and pre-antiviral period. MethodThe RAH infrastructure, design and initial pandemic response was assessed. A retrospective review of all confirmed or suspected coronavirus disease 2019 (COVID-19) patients admitted from 1 February 2020 to 30 May 2020 was also performed to assess risk of transmission. Outbreak response reports were reviewed to identify episodes of nosocomial COVID-19. ResultsKey infrastructure features include single-bed overnight rooms with dedicated bathrooms, creation of pandemic areas accessible only to pandemic staff, and sophisticated air-handling units with improved ventilation. A total of 264 COVID-19 related admission occurred, with 113 confirmed cases and 1579 total cumulative bed days. Despite a limited understanding of SARS-CoV-2 transmission, no vaccination or anti-viral therapy, global shortages of particulate filter respirators and restricted testing during this period, only one probable nosocomial COVID-19 case occurred in a healthcare worker, with no nosocomial cases involving patients. ConclusionsThe RAH design and pandemic features complimented existing infection control interventions and was important in limiting nosocomial spread of SARS-CoV-2.

Nosocomial SARS-COVID-19 Outbreak During the Third Wave of COVID-19 in an Oncology Facility at a Tertiary Care Hospital in Kashmir, India.

Coronavirus disease 2019 (COVID-19) emerged as a life-threatening respiratory condition, especially in immunocompromised patients, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially detected in China in December 2019, the first case in India was diagnosed on January30, 2020. Here we report a nosocomial COVID-19 outbreak among cancer patients and healthcare workers(HCWs) in a medical oncology unit of a tertiary care hospital from our region. This was a descriptive study of the nosocomial COVID-19 outbreak and was conducted in the month of January 2022 at the medical oncology unit of a tertiary care hospital in Srinagar, Jammu and Kashmir (J&K), India.The study included 25 COVID-19 cases, including patients and HC/non-HCWs (NHCWs). The confirmation of diagnosis was done through real-time polymerase chain reaction (RT-PCR) using nasopharyngeal/oropharyngeal swabs as the test sample. Twenty-five COVID-19 cases, including 14 admitted patients, nine HCWs, and two NHCWs were confirmed by COVID-19 RT-PCR in a span of 11 days. The first case was a positive HCW. The patients were admitted for management of various hematological as well as solid organ malignancies. Of the 14 patients, eight were in the pediatric age group with a mean age of 6.9 years, and six were adults with a mean age of 55.2 years. Thirteen patients were on different chemotherapy protocols, and one was undergoing an autologous stem cell transplant. Of the 14 patients, four were asymptomatic for COVID-19 symptoms, eight had mild disease, and two had severe disease with respiratory failure. Two patients with severe diseases needed COVID-19-designated high-dependency unit (HDU) admission. There was one COVID-19-related death. Among the healthcare workers, the mean age was 33.8 years, of which six were males and three were females. All the HCWs and NHCWs had mild disease, and all of them recovered completely. Nosocomial COVID-19 illness is a new entity and is preventable. COVID-19 illness will remain in society after the pandemic is over, like the influenza B viral illness, and there can be seasonal flares in the future. Proper measures should be taken to prevent its clustering in hospital settings.

Clinical Outcome and Prognosis of a Nosocomial Outbreak of COVID-19.

Nosocomial coronavirus disease 2019 (COVID-19) outbreaks have been reported despite widespread quarantine methods to prevent COVID-19 in society and hospitals. Our study was performed to investigate the clinical outcome and prognosis of a nosocomial outbreak of COVID-19. We retrospectively analyzed the medical records of patients diagnosed with nosocomial COVID-19 of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) at a university teaching hospital between 1 November 2021 and 31 April 2022. Nosocomial COVID-19 was defined as a positive SARS-CoV-2 polymerase chain reaction (PCR) test result 4 or more days after admission in asymptomatic patients who had a negative SARS-CoV-2 PCR test on admission. In this study, 167 patients were diagnosed with nosocomial COVID-19 (1.14%) among a total of 14,667 patients admitted to hospital during the study period. A total of 153 patients (91.6%) survived, but 14 patients (8.4%) died. The median time between admission and COVID-19 diagnosis was 11 days, and the median duration of hospital stay was 24 days. After adjusting for other factors, no vaccination (adjusted HR = 5.944, 95% CI = 1.626-21.733, p = 0.007) and chronic kidney disease (adjusted HR = 6.963, 95% CI = 1.182-41.014, p = 0.032) were found to increase mortality risk. Despite strict quarantine, a significant number of nosocomial COVID-19 cases with a relatively high mortality rate were reported. As unvaccinated status or chronic kidney disease were associated with poor outcomes of nosocomial COVID-19, more active preventive strategies and treatments for patients with these risk factors are needed.

Nosocomial Omicron Outbreak in a Medical Ward During the Coronavirus Disease 2019 Pandemic.

The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is 2 to 3 times more contagious than the Delta variant and poses a new challenge in containing transmission in community and health care settings. Transmission in hospitals can cause nosocomial outbreak infections and affect patients and health care workers. This study describes a coronavirus disease 2019 (COVID-19) outbreak in a medical ward. The purpose of the investigation was to determine the transmission source of the outbreak, as well as the measures implemented to prevent and control it. A cluster of SARS-CoV-2 infections that affected health care workers, inpatients, and caregivers was thoroughly researched in a medical ward. There were several strict outbreak measures implemented in our hospital, and these measures controlled the nosocomial COVID-19 outbreak in this study. Seven cases of SARS-CoV-2 infection were diagnosed within 2 days in the medical ward. The infection control team declared a nosocomial outbreak of the COVID-19 Omicron variant. Several strict outbreak measures were implemented as follows: 1. The medical ward was closed and cleaning and disinfection were performed. 2. All patients and caregivers with negative test results were transferred to a spare COVID-19 isolation ward. 3. Relatives' visits were not allowed, and no new patient was admitted during the outbreak period. 4. Health care workers were retrained on wearing personal protective equipment and enhanced techniques and practices of hand hygiene, social distancing, and self-monitoring of fever and respiratory symptoms. This outbreak occurred in a non-COVID-19 ward during the COVID-19 Omicron variant phase of the pandemic. Our strict outbreak measures halted and contained the nosocomial COVID-19 outbreak in 10 days. Future studies are needed to establish a standard policy of COVID-19 outbreak measure implementation.

Risk Predictors for Mortality in Inpatients with Cancer and Coronavirus Disease 2019 during the Omicron Wave

Abstract Background: Patients with cancer are a high-risk population in the coronavirus disease 2019 (COVID-19) pandemic. We analyzed the characteristics and risk factors for mortality in hospitalized patients with cancer and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the Omicron wave. Materials and Methods: We conducted a retrospective, single-center, cohort study of 206 patients with cancer and SARS-CoV-2 infection in southern Taiwan. Clinical characteristics, laboratory data, and cancer characteristics were compared between survivors and nonsurvivors. Risk factors for mortality were identified by univariable and multivariable logistic regression models. Results: The median patient age was 69.5 years. Male preponderance was noted (65%). Comorbidities were present in 186 (90%) cases. A total of 113 (54%) patients had active cancer. Metastatic disease accounted for 78 (38%) cases, of whom 19 (9%) had lung metastasis. Sixty-four (31%) patients had active and progressing cancer status. The overall inhospital mortality rate was 17.4%. Univariate logistic regression revealed the following factors to be significantly associated with a higher risk of inhospital mortality among the patients with cancer and COVID-19: nosocomial COVID-19 infection (P = 0.037), lung metastasis (P = 0.005), received anticancer therapy in the preceding 3 months (P = 0.083), active and progressing cancer (P = 0.008), and quick Sequential Organ Function Assessment (qSOFA) score ≥2 (P &lt; 0.001). However, only nosocomial infection (P = 0.021) and qSOFA score ≥2 (P &lt; 0.001) were independent predictors of inhospital mortality in the multivariate logistic regression analysis. Conclusion: Cancer patients are a population vulnerable to the Omicron variant with higher mortality rate, especially those with nosocomial COVID-19 infection and those with a qSOFA score of ≥2 immediately after confirmation of COVID-19 infection. Thus, the rapid recognition of high-risk groups and nosocomial infection control are critical to prevent COVID-19 in patients with cancer.

COVID-19: A Retrospective Cohort Study of Nosocomial Transmission in a District General Hospital.

Background and objectives Since the outbreak of coronavirus disease 2019 (COVID-19) in the UK, there has been concern that a higher proportion of COVID-19 deaths amonginpatients were a result of nosocomial infections. We sought to investigate the proportion of nosocomial COVID-19 infections within our hospital and patient outcomes within this category. Methods This was a retrospective cohort study of 616 patients admitted to the hospital and tested positive for SARS-CoV-2 through a polymerase chain reaction test with particular emphasis on 104 patients who were classed as probable or definite hospital-acquired COVID-19. Demographic and clinical data were extracted from the electronic records of patients, and the outcome of their stay was recorded. Results The median (interquartile range) age of inpatients testing positive for SARS-CoV-2 was 76 (62, 84) years, and the ethnic breakdown of patients was similar to that of the local population. Inpatient mortality was similar to other hospitals in the UK at 41%. Patients with a hospital-acquired infection were older, with a median age of 79 (69, 86) years, more likely to be of White ethnicity, and more likely to die in the hospital. Conclusion Older age was associated with a higher risk of healthcare-associated infection, andas a result, patients were more likely to die.

Epidemiological and molecular description of nosocomial outbreak of COVID-19 Alpha (B.1.1.7) variant in Saudi Arabia

BackgroundNosocomial outbreaks frequently occurred during the Coronavirus disease 2019 (COVID-19) pandemic; however, sharing experiences on outbreak containment is vital to reduce the related burden in different locations. ObjectivesThis article aims at sharing a practical experience on COVID-19 outbreak containment, including contact tracing, screening of target population, testing including molecular analysis, and preventive modalities. It also provides an epidemiological and molecular analysis of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‑CoV‑2) infection outbreak in a tertiary care hospital in Saudi Arabia. MethodsThe outbreak occurred in a non-COVID medical ward at a tertiary care hospital in Jeddah, Saudi Arabia, from 22nd March and 15th April 2021. The multidisciplinary outbreak response team performed clinical and epidemiological investigations. Whole-Genome Sequencing (WGS) was implemented on selected isolates for further molecular characterization. ResultsA total of eight nurses (20 % of the assigned ward nurses) and six patients (16.2 % of the ward admitted patients at the time of the outbreak) tested positive for the SARS-CoV-2 virus based on PCR testing. The outbreak investigation identified strong evidence of an epidemiologic link between the affected cases. WGS revealed a set of spike mutations and deletions specific to the Alpha variant (B.1.1.7 lineage). All the nurses had mild symptoms, and the fatality among the patients was 50 % (three out of the six patients). ConclusionsThe current nosocomial COVID-19 outbreak, caused by the Alpha variant, revealed multiple breaches in the adherence to the hospital infection control recommended measures. Containment strategies were successful in controlling the outbreak and limiting infection spread. Molecular analysis and genome sequencing are essential tools besides epidemiological investigation to inform appropriate actions, especially with emerging pathogens.

Nosocomial COVID-19 at a comprehensive cancer center during the first year of the pandemic: Lessons learned

BackgroundThe spread of coronavirus disease 2019 (COVID-19) in health care settings endangers patients with cancer. As knowledge of the transmission of COVID-19 emerged, strategies for preventing nosocomial COVID-19 were updated. We describe our early experience with nosocomial respiratory viral infections (RVIs) at a cancer center in the first year of the pandemic (March 2020-March 2021). MethodsNosocomial RVIs were identified through our infection control prospective surveillance program, which conducted epidemiologic investigations of all microbiologically documented RVIs. Data was presented as frequencies and percentages or medians and ranges. ResultsA total of 35 of 3944 (0.9%) documented RVIs were determined to have been nosocomial acquired. Majority of RVIs were due to SARS CoV-2 (13/35; 37%) or by rhinovirus/enterovirus (12/35; 34%). A cluster investigation of the first 3 patients with nosocomial COVID-19 determined that transmission most likely occurred from employees to patients. Five patients (38%) required mechanical ventilation and 4 (31%) died during the same hospital encounter. ConclusionsOur investigation of the cluster led to enhancement of our infection control measures. The implications of COVID-19 vaccination on infection control policies is still unclear and further studies are needed to delineate its impact on the transmission of COVID-19 in a hospital setting.

Reintroducing Flap Reconstruction: One Institution's Safe Return to Flap Surgery during the COVID-19 Pandemic.

Prevention of nosocomial coronavirus disease 2019 (COVID-19) infection for patients undergoing flap-based reconstructive surgery is crucial to providing care and maintaining operative volume and income to support plastic surgery programs. We conducted this study to (1) determine the postoperative incidence of COVID-19 among patients undergoing flap reconstruction from December 1, 2019 to November 1, 2020 and (2) compare 30-day outcomes between patients who underwent surgery before and during the early pandemic. We conducted an 11-month retrospective cohort study of all patients who underwent flap reconstruction across our institution. We abstracted patient demographics, intraoperative management, COVID-19 testing history, and 30-day postoperative complications from electronic health records. Nosocomial COVID-19 infection was defined as reverse transcription polymerase chain reaction (RT-PCR) viral ribonucleic acid detection within 30 days of patients' postoperative course or during initial surgical admission. We used chi-squared tests to compare postoperative outcomes between patients who underwent surgery before (prior to March 12, 2021, when our institution admitted its first COVID-19 patient) versus during (on/after March 12, 2021) the pandemic. Among the 220 patients (mean [standard deviation] age = 53.8 [18.1] years; female = 54.8%) who underwent flap reconstruction, none had nosocomial COVID-19 infection. Five (2%) patients eventually tested COVID-19 positive (median time from surgery to diagnosis: 9 months, range: 1.5-11 months) with one developing partial flap loss while infected. Between patients who underwent free flap surgery before and during the pandemic, there were no significant differences in 30-day takebacks (15.6% vs. 16.6%, respectively; p > 0.999), readmissions (9.4% vs. 12.6%, respectively; p = 0.53), and surgical complications (e.g., total flap loss 1.6% vs. 2.1%, p = 0.81). Robust precautions can ensure the safety of patients undergoing flap surgeries across an academic medical institution, even during periods of high COVID-19 admission rates. Further studies are needed to generate evidence-based guidelines that optimize infection control and flap survival for patients undergoing reconstruction.

Predictors of mortality in patients with COVID-19 infection in different health-care settings: A retrospective analysis from a CORACLE study group.

BackgroundDespite the large number of hospitalized patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, few data are available about risk factors and mortality in subjects with nosocomially acquired respiratory infection of Coronavirus Disease 2019 (COVID-19).MethodsWe retrospectively evaluated in a multicentric study -during the pre-vaccination era-all patients admitted with confirmed diagnosis of nosocomial COVID-19 (NC). Patients were classified according to provenance: hospital-acquired NC or long-term care (LTC) facilities.ResultsAmong overall 1047 patients evaluated with COVID-19, 137 had a confirmed diagnosis of NC (13%). 78 (56.9%) patients had hospital-acquired NC and 59 (43%) had LTC NC. Overall mortality was 35.8%, in hospital-acquired NC 24.4%, in LTC NC 50.8% (p<0.001) (Log Rank test: p=0.001). Timing of diagnosis was significantly different between hospital acquired and LTC NC (3.5 vs 10 days, p<0.001). In multivariate analysis age, intensive-care unit admission, LTC provenance and sepsis were significant predictors of mortality in patients with NC infection.ConclusionPatients with NC are at higher risk of mortality (especially for LTC NC) and required preventive strategies, early diagnosis, and treatment to avoid COVID-19 cluster.

SARS-CoV-2 transmission: time to rethink public health strategy

SARS-CoV-2 transmission: time to rethink public health strategy

The Health Equity Impact Assessment: A Case Study in COVID-19 Visitor Policy.

The Health Equity Impact Assessment: A Case Study in COVID-19 Visitor Policy.

Unexpected details regarding nosocomial transmission revealed by whole-genome sequencing of severe acute respiratory coronavirus virus 2 (SARS-CoV-2).

Effective infection prevention and control (IPC) measures are key for protecting patients from nosocomial infections and require knowledge of transmission mechanisms in different settings. We performed a detailed outbreak analysis of the transmission and outcome of coronavirus disease 2019 (COVID-19) in a geriatric ward by combining whole-genome sequencing (WGS) with epidemiological data. Retrospective cohort study. Tertiary-care hospital. Patients and healthcare workers (HCWs) from the ward with a nasopharyngeal sample (NPS) positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) RNA during the outbreak period. Patient data regarding clinical characteristics, exposure and outcome were collected retrospectively from medical records. Stored NPSs from 32 patients and 15 HCWs were selected for WGS and phylogenetic analysis. The median patient age was 84 years and 17 (53%) of 32 were male. Also, 14 patients (44%) died within 30 days of sampling. Viral loads were significantly higher among the deceased. WGS was successful in 28 (88%) of 32 patient samples and 14 (93%) of 15 HCW samples. Moreover, 3 separate viral clades were identified: 1 clade and 2 subclades among both patient and HCW samples. Integrated epidemiological and genetic analyses revealed 6 probable transmission events between patients and supported hospital-acquired COVID-19 among 25 of 32 patients. WGS provided an insight into the outbreak dynamics and true extent of nosocomial COVID-19. The extensive transmission between patients and HCWs indicated that current IPC measures were insufficient. We recommend increased use of WGS in outbreak investigations to identify otherwise unknown transmission links and to evaluate IPC measures.

Impact of a Nosocomial COVID-19 Outbreak on a Non-COVID-19 Nephrology Ward during the First Wave of the Pandemic in Spain.

Introduction: The aim of this study was to analyze a nosocomial coronavirus disease 2019 (COVID-19) outbreak that occurred on a polyvalent non-COVID-19 ward at a tertiary care university hospital in Spain during the first wave of the pandemic and to describe the containment measures taken. The outbreak affected healthcare workers (HCWs) and kidney disease patients including transplant patients and those requiring maintenance hemodialysis. Methods: The outbreak investigation and report were conducted in accordance with the Orion statement guidelines. Results: In this study, 15 cases of COVID-19 affecting 10 patients and 5 HCWs were identified on a ward with 31 beds and 43 HCWs. The patients had tested negative for severe acute respiratory syndrome coronavirus 2 infection on admission. One of the HCWs was identified as the probable index case. Five patients died (mortality rate, 50%). They were all elderly and had significant comorbidities. The infection control measures taken included the transfer of infected patients to COVID-19 isolation wards, implementation of universal preventive measures, weekly PCR testing of patients and HCWs linked to the ward, training of HCWs on infection control and prevention measures, and enhancement of cleaning and disinfection. The outbreak was contained in 2 weeks, and no new cases occurred. Conclusion: Nosocomial COVID-19 outbreaks can have high attack rates involving both patients and HCWs and carry a high risk of patient mortality. Hospitals need to implement effective infection prevention and control strategies to prevent nosocomial COVID-19 spread.

Factors influencing risk perception and nosocomial infection prevention practices of frontline nurses during the COVID-19 pandemic

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, exploring factors influencing nosocomial infection among frontline nurses may provide evidence to optimize prevention strategies in hospitals.MethodA large-scale online questionnaire survey of nurses’ state-trait anxiety, job burnout, risk perception, workplace safety perception, knowledge about nosocomial infection, and preventive practices was conducted with 2795 frontline nurses working in the COVID-19 wards of six hospitals in Hubei Province, China, from February 1 to April 1, 2020. The questionnaire data were analyzed using the structural equation modeling (SEM) method to reveal the mechanisms influencing nurses’ risk perception and preventive practices related to nosocomial COVID-19 infection.ResultsA model of the factors that influence nurses’ risk perception and preventive practices regarding nosocomial COVID-19 infection was established. The model verified hypotheses regarding the impact of nurses’ risk perception and preventive practices. Notably, the hypothesis that risk perception has an impact on nurses’ preventive practices regarding nosocomial infection is not valid. Moreover, different marital and educational conditions are associated with significant differences in the impact of state anxiety on the execution of preventive practices, the impact of workplace safety perceptions on risk perception, and the impact of workplace safety perceptions on the execution of preventive practices. The effect of state anxiety on preventive practices differed significantly with different durations of work experience.ConclusionsAccording to the results of the influencing factor model, promoting the quality of training on nosocomial infection, meliorating workplace safety, and conducting timely and effective psychological interventions would aid in improving nurses’ preventive practices. Meliorating workplace safety and easing state anxiety would be beneficial to reduce nurses’ risk perception. These strategies are conducive to the optimization of policies for preventing nosocomial COVID-19 infections and similar infectious diseases.