Nosocomial spread of COVID-19: lessons learned from an audit on a stroke/neurology ward in a UK district general hospital

Abstract

We describe the details of a COVID-19 outbreak in a 25-bedded Birmingham neurology/stroke ward in the early phase of the pandemic (March to May 2020). Twenty-one of 133 admissions (16%) tested positive for COVID-19 and of those, 8 (6% of all admissions to the ward) were determined to be nosocomial. Thus 38% (8/21) of COVID-19 infections were hospital-acquired. Ten of the patients that contracted COVID-19 died; of these three were hospital-acquired cases. Five of the 21 patients had negative swabs prior to receiving a positive test result. This study highlights the importance of appropriate use of personal protective equipment (PPE) with high-risk patients (including those with stroke and complex brain injury with tracheostomies) and the difficulties of COVID-19 management in a high-risk patient population.

Keywords: COVID-19; infection control; neurology; nosocomial infection; stroke.

Fig 1.

Ward layout and the movements of inpatients on three selected days in March 2020. All patients shown are either COVID-19-positive or will test positive later in the admission. a) 16 March. Patient A was the first patient on the ward to later test positive for COVID-19. The patient moved into the bay indicated and the patient opposite both later went on to test positive. b) 23 March. The UK entered full lockdown. Two patients became symptomatic on this day. As a result, the entire bay was isolated and all patients swabbed until the status of all patients were known. Patient B tested positive, while the other three tested negative. They would all go on to test positive later in their admissions. Patient C also became symptomatic and was isolated in a side room. c) 31 March. Multiple patient moves occurring on one day. Notably, patient A moved bed space three times in a 24-hour period, only to receive a positive COVID-19 test the subsequent day.