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. 2020 Sep;48(9):1056-1061.
doi: 10.1016/j.ajic.2020.06.188. Epub 2020 Jun 26.

Containing COVID-19 outside the isolation ward: The impact of an infection control bundle on environmental contamination and transmission in a cohorted general ward

Liang En Ian Wee  1 , Xiang Ying Jean Sim  2 , Edwin Philip Conceicao  3 , May Kyawt Aung  3 , Kwee Yuen Tan  3 , Kwan Ki Karrie Ko  4 , Hei Man Wong  2 , Limin Wijaya  5 , Ban Hock Tan  5 , Indumathi Venkatachalam  2 , Moi Lin Ling  3
Affiliations

Containing COVID-19 outside the isolation ward: The impact of an infection control bundle on environmental contamination and transmission in a cohorted general ward

Liang En Ian Wee et al. Am J Infect Control. 2020 Sep.

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.

Keywords: Cohort; Containment; Coronavirus; Nosocomial; Open ward; SARS-CoV-2.

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Figures

Fig 1
Fig 1
Location of positive environmental sampling results for SARS-CoV-2 in multibedded general ward cohort rooms prior to terminal cleaning.
Fig 2
Fig 2
Layout of cohort room in dedicated general ward and key findings of epidemiologic investigation for cluster of COVID-19 cases A: Layout of cohort room and epidemiologic investigations for cluster of positive cases B: Airflow diagram in cohort room (self-contained) C: Results of environmental sampling in cohort room after confirmation of index case, prior to terminal cleaning (all negative)
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