A novel cohorting and isolation strategy for suspected COVID-19 cases during a pandemic

Abstract

Background: The COVID-19 pandemic presents a significant infection prevention and control challenge. The admission of large numbers of patients with suspected COVID-19 disease risks overwhelming the capacity to protect other patients from exposure. The delay between clinical suspicion and confirmatory testing adds to the complexity of the problem. Methods: We implemented a triage tool aimed at minimizing hospital-acquired COVID-19 particularly in patients at risk of severe disease. Patients were allocated to triage categories defined by likelihood of COVID-19 and risk of a poor outcome. Category A (lowlikelihood; high-risk), B (high-likelihood; high-risk), C (high-likelihood; low-risk) and D (low-likelihood; low-risk). This determined the order of priority for isolation in singleoccupancy rooms with Category A the highest. Patients in other groups were cohorted when isolation capacity was limited with additional interventions to reduce transmission. Results: Ninety-three patients were evaluated with 79 (85%) receiving a COVID-19 diagnosis during their admission. Of those without a COVID-19 diagnosis: 10 were initially triaged to Category A; 0 to B; 1 to C and 4 to D. All high-risk patients requiring isolation were, therefore, admitted to single-occupancy rooms and protected from exposure. Twenty-eight (30%) suspected COVID-19 patients were evaluated to be low risk (groups C and D) and eligible for cohorting. No symptomatic hospital-acquired infections were detected in the cohorted patients. Discussion: Application of a clinical triage tool to guide isolation and cohorting decisions may reduce the risk of hospital-acquired transmission of COVID-19 especially to individuals at the greatest of risk of severe disease.

Rational use of SARS-CoV-2 polymerase chain reaction tests within institutions caring for the vulnerable

“…People with COVID-19 symptoms, or imaging and blood tests consistent with COVID, but a negative SARS-CoV-2 PCR are commonly seen in clinical practice 29 . Sometimes repeat PCR testing, particularly if a sample from the lower respiratory tract can be obtained, can confirm the diagnosis.…”

“…Where individuals’ infection status cannot be resolved and side rooms are not available, every effort should be taken to avoid placing individuals who would be particularly at risk of severe disease should they newly acquire infection in a space with individuals who may be infectious. Such a triage approach has been piloted at one hospital – in this case with the triage decision taken prior to the PCR result being available 29 . The performance of any such algorithm will vary with the background prevalence of SARS-CoV-2 infection.…”

Infection Control and Management of COVID-19: Challenges for Paediatric Tertiary Care Hospitals

“…Taking these potential risks into account, tertiary care children's hospitals with a high proportion of children with comorbidities face challenges with organisational and clinical management during the pandemic. A particular challenge is the maintenance of medical care for children with suspected COVID-19 combined with provision of specialised care for risk groups [19]. Although the usual turnaround time for SARS-CoV-2 testing was less than 24 hours at our hospital, fast and effective triage procedures are hampered while waiting for the test result.…”

Restructuring the Healthcare System to Protect Healthcare Personnel Amidst the COVID-19 Pandemic

“…Patient zoning and flow should be managed strategically. It has been demonstrated that clinical triage tools to cohort and isolate the virus, potentially reducing the chances of hospital-acquired COVID-19 infection (39). The establishment of a separate triage building that would serve the purpose of efficient triage of patients should also be considered (40).…”

“…Crowd control measures should be implemented. Cohorts of health staff that are divided into two sections reduce the risk of crossinfection of staff working in the high risk areas compared to staff working in the low risk area (39). The placement of staff in high-risk buildings should be assessed based on age, presence of comorbidity, social and familial circumstances (for instance if they are a single parent, etc.)…”