key: cord-0730504-zk36y0wm
authors: Ellsworth, Misti; Chang, Michael; Ostrosky-Zeichner, Luis
title: Mind the gap: The hospital breakroom
date: 2020-06-17
journal: Am J Infect Control
DOI: 10.1016/j.ajic.2020.06.179
sha: ec850959e4de4b3821cbad6614b3652ea47ffd70
doc_id: 730504
cord_uid: zk36y0wm

nan

UV radiation. Despite the association of lower temperature and UV-index with the influenza transmission, 1 no association of temperature and UV radiation with the COVID-19 epidemics has been reported, 2 however, which may be denied by the present results of the association of higher temperature/UV index/sun hours/solar DNI and lower sky cover with lower COVID-19 prevalence. In conclusion, higher temperature/UV index/sun hours/solar DNI and lower wind speed/sky cover may be associated with lower COVID-19 prevalence (ie, lower temperature/UV index/ sun hours/solar DNI and higher wind speed/sky cover may be associated with higher COVID-19 prevalence), which should be confirmed by further epidemiological researches adjusting for various risk and protective factors (in addition to meteorological conditions) of COVID-19. Mind the gap: The hospital breakroom Preventing nosocomial transmission of CoVID-19 from patients to health care workers (HCW) has been a top priority for hospitals across the country. Despite rapid implementation of infection prevention practices including universal masking, early contact and droplet isolation for any patients with fever or viral symptoms, restriction of visitors, and adequate PPE supplies, we began to uncover clusters of COVID-19 infections occurring in HCW in the same unit.

The first known cluster occurred in a small unit which was not open to PUIs or COVID positive patients. On March 20th and 21st, health care worker A (HCW A) and HCW B developed symptoms consistent with COVID. In the 72 hours preceding symptom onset, both had worked on the unit. On March 25th, HCW C developed fever and cough, followed by HCW D on the 26th. Three additional HCW (E, F, G), subsequently developed similar symptoms between the dates of March 30th through April 2nd.

On March 29th, Patient 1, who was admitted to the unit on March 20th, developed fever and cough. On the same day, the unit was notified that HCW A was COVID positive. Due to HCW A caring for Patient 1 prior to symptom onset, COVID testing was sent on Patient 1 and was positive.

The infection prevention team was notified of the positive COVID tests for HCW A and Patient 1 on April 1st. The unit was immediately closed to new admissions and all remaining patients were placed in contact and droplet isolation. COVID testing was subsequently sent on HCW C-G, all remaining patients, and 29 additional HCW who worked on the unit during the dates of March 20th−March 27th. Health care workers C, D, E, F, and G were COVID positive. Healthcare worker H, who was asymptomatic, was the only additional positive HCW on the unit.

Two additional patients were also found to be positive. One patient developed fever the day of testing while the other remained asymptomatic.

Further investigation of the unit layout revealed small work spaces making social distancing difficult with one shared breakroom where it was common practice for HCWs to remove masks to eat lunch while sitting in close proximity to one another.

Subsequent COVID-19 clusters occurred in a hospital based clinic and a telemetry monitoring unit. Layouts of both areas were similar to the area of the initial cluster with small work spaces making social distancing difficult. Healthcare workers also reported eating lunch and spending time in the breakroom without masks.

In the previous SARS-CoV pandemic, nosocomial transmission occurred in the setting of exposure to positive patients, and prevention focused on PPE and other protective measures to prevent patient to healthcare worker transmission. 1,2 In our experience, none of the clusters could be traced back to an index patient. It is possible that a pre symptomatic or asymptomatic patient could have been shedding virus without detection, however this would not explain the ongoing transmission within the units. These clusters highlight the importance of strict adherence to infection control practices not only with patients, but also with coworkers.

Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi

Using an integrated infection control strategy during outbreak control to minimize nosocomial infection of severe acute respiratory syndrome among healthcare workers