A SARS-CoV-2 Cluster in an Acute Care Hospital

Abstract

Background: Little is known about clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in acute care hospitals.

Objective: To describe the detection, mitigation, and analysis of a large cluster of SARS-CoV-2 infections in an acute care hospital with mature infection control policies.

Design: Descriptive study.

Setting: Brigham and Women's Hospital, Boston, Massachusetts.

Participants: Patients and staff with cluster-related SARS-CoV-2 infections.

Intervention: Close contacts of infected patients and staff were identified and tested every 3 days, patients on affected units were preemptively isolated and repeatedly tested, affected units were cleaned, room ventilation was measured, and specimens were sent for whole-genome sequencing. A case-control study was done to compare clinical interactions, personal protective equipment use, and breakroom and workroom practices in SARS-CoV-2-positive versus negative staff.

Measurements: Description of the cluster, mitigation activities, and risk factor analysis.

Results: Fourteen patients and 38 staff members were included in the cluster per whole-genome sequencing and epidemiologic associations. The index case was a symptomatic patient in whom isolation was discontinued after 2 negative results on nasopharyngeal polymerase chain reaction testing. The patient subsequently infected multiple roommates and staff, who then infected others. Seven of 52 (13%) secondary infections were detected only on second or subsequent tests. Eight of 9 (89%) patients who shared rooms with potentially contagious patients became infected. Potential contributing factors included high viral loads, nebulization, and positive pressure in the index patient's room. Risk factors for transmission to staff included presence during nebulization, caring for patients with dyspnea or cough, lack of eye protection, at least 15 minutes of exposure to case patients, and interactions with SARS-CoV-2-positive staff in clinical areas. Whole-genome sequencing confirmed that 2 staff members were infected despite wearing surgical masks and eye protection.

Limitation: Findings may not be generalizable.

Conclusion: SARS-CoV-2 clusters can occur in hospitals despite robust infection control policies. Insights from this cluster may inform additional measures to protect patients and staff.

Primary funding source: None.

Visual Abstract.. SARS-CoV-2 Cluster in an Acute Care Hospital

This study describes the detection, mitigation, and analysis of a large cluster of SARS-CoV-2 infections in an acute care hospital with mature infection control policies and discusses insights that may inform additional measures to protect patients and staff.

Figure 1.. Epidemic curve showing the count of new patient and staff cases per day (by date of symptom onset or test date, whichever was earlier).

Figure 2.. Cluster map depicting locations, role groups, medical teams, and interconnections among infected staff members and patients.

The colors of rectangles (patients) and diamonds (physicians) refer to their medical team affiliation (general medicine teams 1 to 4, neurology, pulmonary transplant, and cardiology). Nurses and other staff members are not affiliated with a specific team but rather with a specific inpatient unit. “WGS” indicates whole-genome sequencing confirmation of cluster association. Patients and staff without the “WGS” indicator were associated with the cluster on epidemiologic grounds. Solid lines between patient rectangles indicate that the 2 patients shared a room. CT Tech = computed tomography radiology technician; Dx = day of positive SARS-CoV-2 test result or symptom onset (whichever occurred earlier) relative to the start of the cluster; MD = medical doctor; PCA = patient care assistant; Phleb = phlebotomist; RN = registered nurse; RPH = registered pharmacist; SLP = speech and language pathology technician; UA = unit associate (environmental services worker).