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Containing COVID-19 outside the isolation ward: The impact of an infection control bundle on environmental contamination and transmission in a cohorted general ward.
Am J Infect Control. 2020 09; 48(9):1056-1061.AJ

Abstract

BACKGROUND

During an ongoing outbreak of COVID-19, unsuspected cases may be housed outside of dedicated isolation wards.

AIM

At a Singaporean tertiary hospital, individuals with clinical syndromes compatible with COVID-19 but no epidemiologic risk were placed in cohorted general wards for COVID-19 testing. To mitigate risk, an infection control bundle was implemented comprising infrastructural enhancements, improved personal protective equipment, and social distancing. We assessed the impact on environmental contamination and transmission.

METHODS

Upon detection of a case of COVID-19 in the dedicated general ward, patients and health care workers (HCWs) contacts were identified. All patient and staff close-contacts were placed on 14-day phone surveillance and followed up for 28 days; symptomatic contacts were tested. Environmental samples were also obtained.

FINDINGS

Over a 3-month period, 28 unsuspected cases of COVID-19 were contained in the dedicated general ward. In 5 of the 28 cases, sampling of the patient's environment yielded SARS-CoV-2; index cases who required supplemental oxygen had higher odds of environmental contamination (P = .01). A total of 253 staff close-contacts and 45 patient close-contacts were identified; only 3 HCWs (1.2%, 3/253) required quarantine. On 28-day follow-up, no patient-to-HCW transmission was documented; only 1 symptomatic patient close-contact tested positive.

CONCLUSIONS

Our institution successfully implemented an intervention bundle to mitigate COVID-19 transmission in a multibedded cohorted general ward setting.

Authors+Show Affiliations

Singhealth Infectious Diseases Residency, Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore. Electronic address: ian.wee@mohh.com.sg.Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.Department of Microbiology, Singapore General Hospital, Singapore, Singapore; Department of Molecular Pathology, Singapore General Hospital, Singapore, Singapore.Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32599101

Citation

Wee, Liang En Ian, et al. "Containing COVID-19 Outside the Isolation Ward: the Impact of an Infection Control Bundle On Environmental Contamination and Transmission in a Cohorted General Ward." American Journal of Infection Control, vol. 48, no. 9, 2020, pp. 1056-1061.
Wee LEI, Sim XYJ, Conceicao EP, et al. Containing COVID-19 outside the isolation ward: The impact of an infection control bundle on environmental contamination and transmission in a cohorted general ward. Am J Infect Control. 2020;48(9):1056-1061.
Wee, L. E. I., Sim, X. Y. J., Conceicao, E. P., Aung, M. K., Tan, K. Y., Ko, K. K. K., Wong, H. M., Wijaya, L., Tan, B. H., Venkatachalam, I., & Ling, M. L. (2020). Containing COVID-19 outside the isolation ward: The impact of an infection control bundle on environmental contamination and transmission in a cohorted general ward. American Journal of Infection Control, 48(9), 1056-1061. https://doi.org/10.1016/j.ajic.2020.06.188
Wee LEI, et al. Containing COVID-19 Outside the Isolation Ward: the Impact of an Infection Control Bundle On Environmental Contamination and Transmission in a Cohorted General Ward. Am J Infect Control. 2020;48(9):1056-1061. PubMed PMID: 32599101.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Containing COVID-19 outside the isolation ward: The impact of an infection control bundle on environmental contamination and transmission in a cohorted general ward. AU - Wee,Liang En Ian, AU - Sim,Xiang Ying Jean, AU - Conceicao,Edwin Philip, AU - Aung,May Kyawt, AU - Tan,Kwee Yuen, AU - Ko,Kwan Ki Karrie, AU - Wong,Hei Man, AU - Wijaya,Limin, AU - Tan,Ban Hock, AU - Venkatachalam,Indumathi, AU - Ling,Moi Lin, Y1 - 2020/06/26/ PY - 2020/04/21/received PY - 2020/06/16/revised PY - 2020/06/17/accepted PY - 2020/7/1/pubmed PY - 2020/7/1/medline PY - 2020/6/30/entrez KW - Cohort KW - Containment KW - Coronavirus KW - Nosocomial KW - Open ward KW - SARS-CoV-2 SP - 1056 EP - 1061 JF - American journal of infection control JO - Am J Infect Control VL - 48 IS - 9 N2 - BACKGROUND: During an ongoing outbreak of COVID-19, unsuspected cases may be housed outside of dedicated isolation wards. AIM: At a Singaporean tertiary hospital, individuals with clinical syndromes compatible with COVID-19 but no epidemiologic risk were placed in cohorted general wards for COVID-19 testing. To mitigate risk, an infection control bundle was implemented comprising infrastructural enhancements, improved personal protective equipment, and social distancing. We assessed the impact on environmental contamination and transmission. METHODS: Upon detection of a case of COVID-19 in the dedicated general ward, patients and health care workers (HCWs) contacts were identified. All patient and staff close-contacts were placed on 14-day phone surveillance and followed up for 28 days; symptomatic contacts were tested. Environmental samples were also obtained. FINDINGS: Over a 3-month period, 28 unsuspected cases of COVID-19 were contained in the dedicated general ward. In 5 of the 28 cases, sampling of the patient's environment yielded SARS-CoV-2; index cases who required supplemental oxygen had higher odds of environmental contamination (P = .01). A total of 253 staff close-contacts and 45 patient close-contacts were identified; only 3 HCWs (1.2%, 3/253) required quarantine. On 28-day follow-up, no patient-to-HCW transmission was documented; only 1 symptomatic patient close-contact tested positive. CONCLUSIONS: Our institution successfully implemented an intervention bundle to mitigate COVID-19 transmission in a multibedded cohorted general ward setting. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/32599101/Containing_COVID_19_outside_the_isolation_ward:_The_impact_of_an_infection_control_bundle_on_environmental_contamination_and_transmission_in_a_cohorted_general_ward_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(20)30569-1 DB - PRIME DP - Unbound Medicine ER -