Background: Singapore General Hospital (SGH) is the largest acute tertiary-care hospital in Singapore. Healthcare workers (HCWs) are at risk of acquiring COVID-19 in both the community and workplaces. SGH has a robust exposure management process including prompt contact tracing, immediate ring fencing, lock down of affected cubicles or single room isolation for patient contacts, and home isolation orders for staff contacts of COVID-19 cases during the containment phase of the pandemic. Contacts were also placed on enhanced surveillance with PCR testing on days 1 and 4 as well as daily antigen rapid tests (ARTs) for 10 days after exposure. Here, we describe the characteristic of HCWs with COVID-19 during the third wave of the COVID-19 pandemic. Methods: This retrospective observational study included all SGH HCWs who acquired COVID-19 during the third wave (ie, the 18-week period from September 1 to December 31, 2021) of the COVID-19 pandemic. Univariate analysis was used to compare characteristics of work-associated infection (WAI) and community-acquired infection (CAI) among HCWs. Results: Among a workforce of >10,000 at SGH, 335 HCWs acquired COVID-19 during study period. CAI (exposure to known clusters or household contact) accounted for 111 HCW infections (33.1%). Also, 48 HCWs (14.3%) had a WAI (ie, acquired at their work places where there was no patient contact). Among WAsI, only 5 HCWs had hospital-acquired infection (confirmed by phylogenetic analysis). The sources of exposure for the remaining 176 HCWs were unknown. Weekly incidence of COVID-19 among HCWs was comparable to the epidemiology curve of all cases in Singapore (Fig. 1 and 2). The mean age of HCWs with COVID-19 was 39.6 years, and most were women. At the time of positive SARS-CoV-2 PCR test, 223 HCWs were symptomatic, and 67 (20.0%) of them had comorbidities. Only 16 HCWs (4.8%) required hospitalization, and all recovered fully with no mortality (Table 1). Being female was associated with community COVID-19 acquisition (OR, 4.6, P Conclusions: During the thrid wave of the COVID-19 pandemic, a higher percentage of HCWs at SGH acquired the infection from the community than from the workplace. Safe management measures, such as universal masking, social distancing, and robust exposure management processes including prompt contact tracing and environmental disinfection, can reduce the risk of COVID-19 in the hospital work environment.

Funding: None

Disclosures: None

The development of microfabricated liquid cells has enabled dynamic studies of nanostructures within a liquid environment with electron microscopy. While such setups are most commonly found in transmission electron microscope (TEM) holders, their implementation in a scanning electron microscope (SEM) offers intriguing potential for multi-modal studies where the large chamber volume allows for the integration of multiple detectors. Here, we describe an electrochemical liquid cell SEM platform that employs the same cells enclosed by silicon nitride membrane windows found in liquid cell TEM holders and demonstrate the imaging of copper oxide nanoparticles in solution using both backscattered and transmitted electrons. In particular, the transmitted electron images collected at high scattering angles show contrast inversion at liquid layer thicknesses of several hundred nanometers, which can be used to determine the presence of liquid in the cell, while maintaining enough resolution to image nanoparticles that are tens of nanometers in size. Using Monte Carlo simulations, we show that both imaging modes have their advantages for liquid phase imaging and rationalize the contrast inversion observed in the transmitted electron image.

While the growth of pits in passive metals exposed to chloride solutions is well understood, the processes associated with the initiation and propagation of stable pits, versus pits that form and apparently re-passivate, are still a matter of conjecture. A major challenge in studying pit initiation using electron microscopy has been alteration of the structure and chemistry of the hydrated corrosion films upon transfer to the vacuum environment of the microscope. A recently developed technique uses a microfluidic liquid cell to maintain the aqueous environment in contact with the sample. This work uses such cells to directly observe pits initiating, and growing before reaching stability, in aluminum thin films under potentiostatic polarization in situ in the electron microscope. Polarization curves developed in the cell show good agreement with those observed under conventional electrochemical experimental conditions. We observed current transients representative of metastable pitting and were able to relate crystalline features found in situ with topographic features using atomic force microscopy (AFM). An accumulation of aluminum surrounding an initiated pit, combined with depth profiling using Auger electron spectroscopy suggests that aluminum metal is deposited during the pit initiation process, and may serve to reduce lateral dissolution of the aluminum film. Work is currently underway to determine if this observation is unique to the geometry of the microfluidics cell or if is a general result that occurs at the very beginning of pit initiation.

One of the fundamental challenges in understanding the early stages of corrosion pitting in metals protected with an oxide film is that there are relatively few techniques that can probe microstructure with sufficient resolution while maintaining a wet environment. Here, we demonstrate that microstructural changes in Al thin films caused by aqueous NaCl solutions of varying chloride concentrations can be directly observed using a liquid flow cell enclosed within a transmission electron microscope (TEM) holder. In the absence of chloride, Al thin films did not exhibit significant corrosion when immersed in de-ionized water for 2 days. However, introducing 0.01 M NaCl solutions led to extensive random formation of blisters over the sample surface, while 0.1 M NaCl solutions formed anomalous structures that were larger than the typical grain size. Immersion in 1.0 M NaCl solutions led to fractal corrosion consistent with previously reported studies of Al thin films using optical microscopy. These results show the potential of in situ liquid cell electron microscopy for probing the processes that take place before the onset of pitting and for correlating pit locations with the underlying microstructure of the material.

A fundamental understanding of the processes that occur during early stages of corrosion is traditionally limited by the dearth of techniques that probe the liquid-solid interface with both high spatial resolution and microstructural detail such as grain size and orientation. Here, we demonstrate that with a microfluidic liquid flow cell holder, we can track the progress of corrosion in situ in Al thin films with transmission electron microscopy (TEM). To mitigate the loss of resolution caused by imaging through liquid, we developed a method in which the liquid is temporarily de-wetted from the entire windowed area by switching the liquid stream from pure water to a mixture of ethanol and water. In the de-wetted region, we then collected images of the film microstructure with high spatial resolution over regular intervals while maintaining a low electron flux over the imaged area to minimize beam-induced effects. For as-deposited films, we find that the corrosion progresses in a fractal manner, consistent with reported behavior for films studied in water with low iron and chloride concentrations. For films that were subjected to rapid thermal annealing, we observe a higher density of pitting events, which we attribute to defects created by thermal stress in the oxide film. Furthermore, we observe that the pits can form at multiple locations in a single grain and are not confined to grain boundaries.

We report the evolution of titanium dioxide nanostructures when Au nanoparticles, supported on single crystal TiO2 substrates, were heated under ∼260 Pa of flowing O2 in an environmental transmission electron microscope. Nanostructures with different morphologies were first observed around 500°C. Our measurements show that temperature, oxygen pressure, and the electron beam control the nanostructure growth. We propose a reaction-controlled growth mechanism where mobile Ti atoms generated by the electron- beam-induced reduction of TiO2 are preferentially reoxidized at the Au-TiO2 interface.