Skip to main content Accessibility help
×
Home

Respiratory surveillance wards as a strategy to reduce nosocomial transmission of COVID-19 through early detection: The experience of a tertiary-care hospital in Singapore

  • Liang En Wee (a1) (a2), Jenny Yi Chen Hsieh (a3), Ghee Chee Phua (a4), Yuyang Tan (a3), Edwin Philip Conceicao (a5), Limin Wijaya (a2), Thuan Tong Tan (a2) and Ban Hock Tan (a2)...

Abstract

Objectives:

Patients with COVID-19 may present with respiratory syndromes indistinguishable from those caused by common viruses. Early isolation and containment is challenging. Although screening all patients with respiratory symptoms for COVID-19 has been recommended, the practicality of such an effort has yet to be assessed.

Methods:

Over a 6-week period during a SARS-CoV-2 outbreak, our institution introduced a “respiratory surveillance ward” (RSW) to segregate all patients with respiratory symptoms in designated areas, where appropriate personal protective equipment (PPE) could be utilized until SARS-CoV-2 testing was done. Patients could be transferred when SARS-CoV-2 tests were negative on 2 consecutive occasions, 24 hours apart.

Results:

Over the study period, 1,178 patients were admitted to the RSWs. The mean length-of-stay (LOS) was 1.89 days (SD, 1.23). Among confirmed cases of pneumonia admitted to the RSW, 5 of 310 patients (1.61%) tested positive for SARS-CoV-2. This finding was comparable to the pickup rate from our isolation ward. In total, 126 HCWs were potentially exposed to these cases; however, only 3 (2.38%) required quarantine because most used appropriate PPE. In addition, 13 inpatients overlapped with the index cases during their stay in the RSW; of these 13 exposed inpatients, 1 patient subsequently developed COVID-19 after exposure. No patient–HCW transmission was detected despite intensive surveillance.

Conclusions:

Our institution successfully utilized the strategy of an RSW over a 6-week period to contain a cluster of COVID-19 cases and to prevent patient–HCW transmission. However, this method was resource-intensive in terms of testing and bed capacity.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Respiratory surveillance wards as a strategy to reduce nosocomial transmission of COVID-19 through early detection: The experience of a tertiary-care hospital in Singapore
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Respiratory surveillance wards as a strategy to reduce nosocomial transmission of COVID-19 through early detection: The experience of a tertiary-care hospital in Singapore
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Respiratory surveillance wards as a strategy to reduce nosocomial transmission of COVID-19 through early detection: The experience of a tertiary-care hospital in Singapore
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Dr Wee Liang En Ian, E-mail: ian.wee@mohh.com.sg

References

Hide All
1.MacIntyre, CR. On a knife’s edge of a COVID-19 pandemic: is containment still possible? Public Health Res Pract 2020;30(1): pii: 3012000.
2.Thompson, RN. Novel coronavirus outbreak in Wuhan, China, 2020: intense surveillance is vital for preventing sustained transmission in new locations. J Clin Med 2020 Feb 11;9(2): pii: E498.
3.Wang, D, Hu, B, Hu, C, et al.Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020 Feb 7 [Epub ahead of print]. doi: 10.1001/jama.2020.1585.
4.Huang, CL, Wang, YM, Li, XW, et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020 Jan 24 [Epub ahead of print]. doi: 10.1016/S0140-6736(20)30183-5.
5.Hui, DSC, Zumla, A. Severe acute respiratory syndrome: historical, epidemiologic, and clinical features. Infect Dis Clin North Am 2019;33:869889.
6.Ho, PL, Tang, XP, Seto, WH. SARS: hospital infection control and admission strategies. Respirology 2003;8 suppl 1:S41S45.
7.Atabani, SF, Wilson, S, Overton-Lewis, C, et al.Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013–2015. Int J Infect Dis 2016;47:1014.
8.Tawfiq, JA, Memish, ZA. Infection control measures for the prevention of MERS coronavirus transmission in healthcare settings. Expert Rev Antiinfect Ther 2016;14:281283.
9.Guan, WJ, Ni, ZY, Hu, Y, et al.Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 Feb 28 [Epub ahead of print]. doi: 10.1056/NEJMoa2002032.
10.McMichael, TM, Clark, S, Pogosjans, S, et al.COVID-19 in a long-term care facility—King County, Washington, February 27–March 9, 2020. Morb Mortal Wkly Rep 2020 Mar 18 [Epub ahead of print]. doi: http://dx.doi.org/10.15585/mmwr.mm6912e1.
11.Klompas, M. Coronavirus disease 2019 (COVID-19): protecting hospitals from the invisible. Ann Intern Med 2020 [Epub ahead of print]. doi: 10.7326/M20-0751.
12.Lum, LH, Tambyah, PA. Outbreak of COVID-19—an urgent need for good science to silence our fears? Singapore Med J 2020 Feb 13 [Epub ahead of print]. doi: 10.11622/smedj.2020018.
13.Wong, JEL, Leo, YS, Tan, CC. COVID-19 in Singapore—current experience: critical global issues that require attention and action. JAMA 2020 Feb 20 [Epub ahead of print]. doi: 10.1001/jama.2020.2467.
14.De Salazar, PM, Niehus, R, Taylor, A, Buckee, C, Lipsitch, M. Using predicted imports of 2019-nCoV cases to determine locations that may not be identifying all imported cases. bioRxiv [Preprint]. doi: 10.1101/2020.02.04.20020495. Published February 4, 2020.
15.Pung, R, Chiew, CJ, Young, BE, et al.Investigation of three clusters of COVID-19 in Singapore: implications for surveillance and response measures. Lancet 2020 [Epub ahead of print]. doi: 10.1016/S0140-6736(20)30528-6.
16.Zhang, ZX, Yong, Y, Tan, WC, Shen, L, Ng, HS, Fong, KY. Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65. Singapore Med J 2018;59:190198.
17.Wee, LE, Fua, TP, Chua, YY, et al.Containing COVID-19 in the emergency room: the role of improved case detection and segregation of suspect cases. Acad Emerg Med 2020 [Epub ahead of print]. doi: 10.1111/acem.13984.
18.Wee, LE, Conceicao, EP, Sim, XYJ, et al.Minimising intrahospital transmission of COVID-19: the role of social distancing. J Hosp Infect 2020 [Epub ahead of print]. doi: 10.1016/j.jhin.2020.04.016.
19.Tay, JY, Lim, PL, Marimuthu, K, et al.De-isolating COVID-19 suspect cases: a continuing challenge. Clin Infect Dis 2020 Feb 26 [Epub ahead of print]. doi: 10.1093/cid/ciaa179.
20.Lee, TH, Lin, RJ, Lin, RTP, et al.Testing for SARS-CoV-2: can we stop at two? Clin Infect Dis 2020 [Epub ahead of print]. doi: 10.1093/cid/ciaa459.
21.Wee, LE, Sim, XYJ, Conceicao, EP, et al.Containment of COVID-19 cases amongst healthcare workers: the role of surveillance, early detection and outbreak management. Infect Control Hosp Epidemiol [Epub ahead of print]
22.Lauer, SA, Grantz, KH, Bi, Q, et al.The incubation period of coronavirus Disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020 Mar 10 [Epub ahead of print]. doi: 10.7326/M20-0504.
23.Lloyd-Smith, JO, Galvani, AP, Getz, WM. Curtailing transmission of severe acute respiratory syndrome within a community and its hospital. Proc Biol Sci 2003;270:19791989.
24.Tan, YM, Chow, PK, Tan, BH, et al.Management of inpatients exposed to an outbreak of severe acute respiratory syndrome (SARS). J Hosp Infect 2004;58:210215.
25.Fisher, D, Wilder-Smith, A. The global community needs to swiftly ramp up the response to contain COVID-19. Lancet 2020. [Epub ahead of print]. doi: 10.1016/S0140-6736(20)30679-6.
26.Wang, J, Zhou, M, Liu, F. Exploring the reasons for healthcare workers infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect 2020 [Epub ahead of print]. doi: 10.1016/j.jhin.2020.03.002.
27.Ng, KQ, Poon, BH, Puar, THK, et al.COVID-19 and the risk to healthcare workers: a case report. Ann Intern Med 2020 Mar 16 [Epub ahead of print]. doi: 10.7326/L20-0175.
28.Mackay, IM, Arden, KE. MERS coronavirus: diagnostics, epidemiology and transmission. Virol J 2015;12:222243.
29.Wei, WE, Li, Z, Chiew, CJ, Yong, SE, Toh, MP, Lee, VJ. Presymptomatic transmission of SARS-CoV-2—Singapore, January 23–March 16, 2020. Morb Mortal Wkly Rep 2020;69:411415.
30.Gopalakrishna, G, Choo, P, Leo, YS, et al.SARS transmission and hospital containment. Emerg Infect Dis 2004;10:395400.

Respiratory surveillance wards as a strategy to reduce nosocomial transmission of COVID-19 through early detection: The experience of a tertiary-care hospital in Singapore

  • Liang En Wee (a1) (a2), Jenny Yi Chen Hsieh (a3), Ghee Chee Phua (a4), Yuyang Tan (a3), Edwin Philip Conceicao (a5), Limin Wijaya (a2), Thuan Tong Tan (a2) and Ban Hock Tan (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.