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All patients and staff on the outbreak ward (case cluster), and randomly selected patients and staff on COVID-19 wards (positive control cluster) and a non-COVID-19 wards (negative control cluster) underwent RT-PCR testing. Hand hygiene and personal protective equipment (PPE) compliance, detection of environmental SARS-COV-2 RNA, patient behavior, and SARS-CoV-2 IgG antibody prevalence were assessed.
Results:
145 staff and 26 patients were exposed resulting in 24 secondary cases. 4/14 (29%) staff and 7/10 (70%) patients were asymptomatic or pre-symptomatic. There was no difference in mean cycle threshold between pre/asymptomatic and symptomatic individuals. 0/32 randomly selected staff from the control wards tested positive. Environmental RNA was higher on the COVID-19 ward than on the negative control ward, (OR 19.98; 95% CI 2.63-906.38; p<0.001). RNA levels on the COVID-19 ward (where there were no outbreaks) and the outbreak ward were similar (OR 2.38; p=0.18). Mean monthly hand hygiene compliance, based on 20,146 observations (over preceding year), was lower on the outbreak ward (p<0.006). Compared to both control wards, the proportion staff with detectable antibodies was higher on the outbreak ward (OR 3.78; 95% CI:1.01-14.25; p=0.008).
Conclusion:
Staff seroconversion was more likely during a short-term outbreak than from sustained duty on a COVID-19 ward. Environmental contamination and PPE use were similar on outbreak and control wards. Patient noncompliance, decreased hand hygiene, and pre/asymptomatic transmission were more frequent on the outbreak ward.
In November and December 2012, 6 patients at a hemodialysis clinic were given a diagnosis of new hepatitis C virus (HCV) infection.
OBJECTIVE
To investigate the outbreak to identify risk factors for transmission.
METHODS
A case patient was defined as a patient who was HCV-antibody negative on clinic admission but subsequently was found to be HCV-antibody positive from January 1, 2008, through April 30, 2013. Patient charts were reviewed to identify and describe case patients. The hypervariable region 1 of HCV from infected patients was tested to assess viral genetic relatedness. Infection control practices were evaluated via observations. A forensic chemiluminescent agent was used to identify blood contamination on environmental surfaces after cleaning.
RESULTS
Eighteen case patients were identified at the clinic from January 1, 2008, through April 30, 2013, resulting in an estimated 16.7% attack rate. Analysis of HCV quasispecies identified 4 separate clusters of transmission involving 11 case patients. The case patients and previously infected patients in each cluster were treated in neighboring dialysis stations during the same shift, or at the same dialysis station on 2 consecutive shifts. Lapses in infection control were identified. Visible and invisible blood was identified on multiple surfaces at the clinic.
CONCLUSIONS
Epidemiologic and laboratory data confirmed transmission of HCV among numerous patients at the dialysis clinic over 6 years. Infection control breaches were likely responsible. This outbreak highlights the importance of rigorous adherence to recommended infection control practices in dialysis settings.
Infect. Control Hosp. Epidemiol. 2016;37(2):125–133
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