Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-25T21:45:27.525Z Has data issue: false hasContentIssue false
  • English
  • Français

Multipronged infection control strategy to achieve zero nosocomial coronavirus disease 2019 (COVID-19) cases among Hong Kong healthcare workers in the first 300 days of the pandemic

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  19 March 2021

Vincent Chi-Chung Cheng ,
Shuk-Ching Wong ,
Danny Wah-Kun Tong ,
Vivien Wai-Man Chuang ,
Jonathan Hon-Kwan Chen ,
Larry Lap-Yip Lee ,
Kelvin Kai-Wang To ,
Ivan Fan-Ngai Hung ,
Pak-Leung Ho  and
Deacons Tai-Kong Yeung
...Show all authors
Vincent Chi-Chung Cheng
Affiliation:
Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Shuk-Ching Wong
Affiliation:
Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Danny Wah-Kun Tong
Affiliation:
Nursing Services Department, Cluster Services, Hospital Authority, Hong Kong Special Administrative Region, China
Vivien Wai-Man Chuang
Affiliation:
Quality & Safety Division, Hospital Authority, Hong Kong Special Administrative Region, China
Jonathan Hon-Kwan Chen
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Larry Lap-Yip Lee
Affiliation:
Department of Accident and Emergency, Tin Shui Wai Hospital, New Territories West Cluster, Hong Kong Special Administrative Region, China
Kelvin Kai-Wang To
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Ivan Fan-Ngai Hung
Affiliation:
Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Pak-Leung Ho
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Deacons Tai-Kong Yeung
Affiliation:
Cluster Services, Hospital Authority, Hong Kong Special Administrative Region, China
Kin-Lai Chung
Affiliation:
Quality & Safety Division, Hospital Authority, Hong Kong Special Administrative Region, China
Kwok-Yung Yuen*
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
*
Author for correspondence: Kwok-Yung Yuen, E-mail: kyyuen@hku.hk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Nosocomial outbreaks leading to healthcare worker (HCW) infection and death have been increasingly reported during the coronavirus disease 2019 (COVID-19) pandemic.

Objective:

We implemented a strategy to reduce nosocomial acquisition.

Methods:

We summarized our experience in implementing a multipronged infection control strategy in the first 300 days (December 31, 2019, to October 25, 2020) of the COVID-19 pandemic under the governance of Hospital Authority in Hong Kong.

Results:

Of 5,296 COVID-19 patients, 4,808 (90.8%) were diagnosed in the first pandemic wave (142 cases), second wave (896 cases), and third wave (3,770 cases) in Hong Kong. With the exception of 1 patient who died before admission, all COVID-19 patients were admitted to the public healthcare system for a total of 78,834 COVID-19 patient days. The median length of stay was 13 days (range, 1–128). Of 81,955 HCWs, 38 HCWs (0.05%; 2 doctors and 11 nurses and 25 nonprofessional staff) acquired COVID-19. With the exception of 5 of 38 HCWs (13.2%) infected by HCW-to-HCW transmission in the nonclinical settings, no HCW had documented transmission from COVID-19 patients in the hospitals. The incidence of COVID-19 among HCWs was significantly lower than that of our general population (0.46 per 1,000 HCWs vs 0.71 per 1,000 population; P = .008). The incidence of COVID-19 among professional staff was significantly lower than that of nonprofessional staff (0.30 vs 0.66 per 1,000 full-time equivalent; P = .022).

Conclusions:

A hospital-based approach spared our healthcare service from being overloaded. With our multipronged infection control strategy, no nosocomial COVID-19 in was identified among HCWs in the first 300 days of the COVID-19 pandemic in Hong Kong.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 3 , March 2022 , pp. 334 - 343
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

References

Weekly epidemiological update – 27 January 2021. World Health Organization website. https://www.who.int/publications/m/item/weekly-epidemiological-update---27-january-2021 Published January 27, 2021. Accessed January 30, 2020.Google Scholar
Critical shortage or lack of personal protective equipment in the context of COVID-19. Western Pacific Region. World Health Organization website. https://www.who.int/westernpacific/internal-publications-detail/critical-shortage-or-lack-of-personal-protective-equipment-in-the-context-of-covid-19. Published June 29, 2020. Accessed January 18, 2021.Google Scholar
Nguyen, LH, Drew, DA, Graham, MS, et al. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. Lancet Public Health 2020;5:e475–e483.CrossRefGoogle Scholar
Bandyopadhyay, S, Baticulon, RE, Kadhum, M, et al. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. BMJ Glob Health 2020. doi: 10.1136/bmjgh-2020-003097.CrossRefGoogle Scholar
Gomez-Ochoa, SA, Franco, OH, Rojas, LZ, et al. COVID-19 in healthcare workers: a living systematic review and meta-analysis of prevalence, risk factors, clinical characteristics, and outcomes. Am J Epidemiol 2021;190:161–175.CrossRefGoogle ScholarPubMed
Pan American Health Organization website. https://www.paho.org/en/news/2-9-2020-covid-19-has-infected-some-570000-health-workers-and-killed-2500-americas-paho. Published September 2, 2020. Accessed January 18, 2020.Google Scholar
Cheng, VC, Wong, SC, Yuen, KY. Estimating coronavirus disease 2019 infection risk in healthcare workers. JAMA Netw Open 2020;3:e209687.CrossRefGoogle Scholar
Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003 (based on data as of the 31 December 2003). World Health Organization website. https://www.who.int/csr/sars/country/table2004_04_21/en/. Accessed January 21, 2021.Google Scholar
The Centre for Health Protection closely monitors cluster of pneumonia cases on Mainland. Department of Health, Hong Kong Special Administrative Region website. https://www.info.gov.hk/gia/general/201912/31/P2019123100667.htm. Accessed January 21, 2021.Google Scholar
Wong, SC, Leung, M, Tong, DW, et al. Infection control challenges in setting up community isolation and treatment facilities for patients with coronavirus disease 2019 (COVID-19): implementation of directly-observed environmental disinfection. Infect Control Hosp Epidemiol 2020. doi: 10.1017/ice.2020.1355.CrossRefGoogle Scholar
Hospital Authority Annual Report, 2019–2020. Hong Kong Hospital Authority website. https://www.ha.org.hk/ho/corpcomm/AR201920/PDF/HA_Annual_Report_2019-2020.pdf. Accesssed January 19, 2021.Google Scholar
Centre for health protection. Hong Kong Hospital Authority coronavirus website. https://www.coronavirus.gov.hk/eng/index.html. Accessed January 12, 2021.Google Scholar
To, KK, Chan, WM, Ip, JD, et al. Unique SARS-CoV-2 clusters causing a large COVID-19 outbreak in Hong Kong. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1119.CrossRefGoogle Scholar
Cheng, VCC, Wong, SC, Chuang, VWM, et al. Absence of nosocomial transmission of coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in the prepandemic phase in Hong Kong. Am J Infect Control 2020;48:890–896.CrossRefGoogle ScholarPubMed
To, KK, Cheng, VC, Cai, JP, et al. Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated from Hubei province, China: a multicohort study. Lancet Microbe 2020;1:e111–e118.CrossRefGoogle Scholar
Wong, SC, Leung, M, Lee, LL, Chung, KL, Cheng, VC. Infection control challenge in setting up a temporary test centre at Hong Kong International Airport for rapid diagnosis of COVID-19 due to SARS-CoV-2. J Hosp Infect 2020;105:571–573.CrossRefGoogle ScholarPubMed
Cheng, VCC, Wong, SC, Chen, JHK, et al. Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol 2020;41:493–498.CrossRefGoogle Scholar
Recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings. Centers for Disease Control and Prevention website. https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html#ref10. Accessed January 19, 2021.Google Scholar
Lynch, JB, Davitkov, P, Anderson, DJ, et al. Infectious Diseases Society of America Guidelines on infection prevention for health care personnel caring for patients with suspected or known COVID-19. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1063.CrossRefGoogle Scholar
Wong, SC, Lam, GK, AuYeung, CH, et al. Absence of nosocomial influenza and respiratory syncytial virus infection in the coronavirus disease 2019 (COVID-19) era: implication of universal masking in hospitals. Infect Control Hosp Epidemiol 2021;42:218–221.CrossRefGoogle ScholarPubMed
Abbas, M, Robalo Nunes, T, Martischang, R, et al. Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers. Antimicrob Resist Infect Control 2021. doi: 10.1186/s13756-020-00875-7.CrossRefGoogle Scholar
Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19). Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. Accessed January 30, 2021.Google Scholar
COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community. National Institute for Health and Care Excellence website. https://www.nice.org.uk/guidance/ng163/resources/covid19-rapid-guideline-managing-symptoms-including-at-the-end-of-life-in-the-community-pdf-66141899069893. Published April 3, 2020. Updated October 13, 2020. Accessed January 30, 2021.Google Scholar
Hung, IF, Cheng, VC, Li, X, et al. SARS-CoV-2 shedding and seroconversion among passengers quarantined after disembarking a cruise ship: a case series. Lancet Infect Dis 2020;20:1051–1060.CrossRefGoogle ScholarPubMed
Chou, R, Dana, T, Buckley, DI, Selph, S, Fu, R, Totten, AM. Epidemiology of and risk factors for coronavirus infection in healthcare workers: a living rapid review. Ann Intern Med 2020;173:120–136.CrossRefGoogle ScholarPubMed
Wong, SC, AuYeung, CH, Lam, GK, et al. Is it possible to achieve 100% hand hygiene compliance during the coronavirus disease 2019 (COVID-19) pandemic? J Hosp Infect 2020;105:779–781.CrossRefGoogle ScholarPubMed
Cheng, VC, Wong, SC, Chan, VW, et al. Air and environmental sampling for SARS-CoV-2 around hospitalized patients with coronavirus disease 2019 (COVID-19). Infect Control Hosp Epidemiol 2020;41:1258–1265.CrossRefGoogle Scholar
LoSavio, PS, Eggerstedt, M, Tajudeen, BA, et al. Rapid implementation of COVID-19 tracheostomy simulation training to increase surgeon safety and confidence. Am J Otolaryngol 2020;41:102574.CrossRefGoogle ScholarPubMed
Diaz, MCG, Dawson, K. Use of simulation to develop a COVID-19 resuscitation process in a pediatric emergency department. Am J Infect Control 2020;48:1244–1247.CrossRefGoogle Scholar
Marrs, R, Horsley, TL, Hackbarth, D, Landon, E. High consequence infectious diseases training using interprofessional simulation and TeamSTEPPS. Am J Infect Control 2020;48:615–620.CrossRefGoogle ScholarPubMed
Kluytmans-van den Bergh, MFQ, Buiting, AGM, Pas, SD, et al. Prevalence and clinical presentation of health care workers with symptoms of coronavirus disease 2019 in 2 Dutch hospitals during an early phase of the pandemic. JAMA Netw Open 2020;3:e209673.CrossRefGoogle ScholarPubMed
Misra-Hebert, AD, Jehi, L, Ji, X, et al. Impact of the COVID-19 pandemic on healthcare workers’ risk of infection and outcomes in a large, integrated health system. J Gen Intern Med 2020;35:3293–3301.CrossRefGoogle Scholar
Shah, ASV, Wood, R, Gribben, C, et al. Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study. BMJ 2020;371:m3582.CrossRefGoogle ScholarPubMed
Cheng, VC, Wong, SC, Chuang, VW, et al. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020;81:107–114.CrossRefGoogle ScholarPubMed
Coppeta, L, Somma, G, Ippoliti, L, et al. Contact screening for healthcare workers exposed to patients with COVID-19. Int J Environ Res Public Health 2020. doi: 10.3390/ijerph17239082.CrossRefGoogle Scholar
Gao, CX, Li, Y, Wei, J, et al. Multiroute respiratory infection: when a transmission route may dominate. Sci Total Environ 2021;752:141856.CrossRefGoogle Scholar
Lu, J, Gu, J, Li, K, et al. COVID-19 outbreak associated with air conditioning in restaurant, Guangzhou, China, 2020. Emerg Infect Dis 2020;26:1628–1631.CrossRefGoogle Scholar
Leung, K, Shum, MH, Leung, GM, Lam, TT, Wu, JT. Early transmissibility assessment of the N501Y mutant strains of SARS-CoV-2 in the United Kingdom, October to November 2020. Euro Surveill 2021. doi: 10.2807/1560-7917.ES.2020.26.1.2002106.CrossRefGoogle Scholar
Wong, SCY, Kwong, RT, Wu, TC, et al. Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong. J Hosp Infect 2020;105:119–127.CrossRefGoogle Scholar
Supplementary material: File

Cheng et al. supplementary material

Cheng et al. supplementary material 1
Download Cheng et al. supplementary material(File)
File 1.1 MB
Supplementary material: File

Cheng et al. supplementary material

Cheng et al. supplementary material 2

Download Cheng et al. supplementary material(File)
File 18.1 KB
Supplementary material: File

Cheng et al. supplementary material

Cheng et al. supplementary material 3

Download Cheng et al. supplementary material(File)
File 637.5 KB