Investigation and management of an outbreak of COVID-19 infection in an acute admission unit in a District General Hospital: lessons learnt

Abstract

Background SARS-CoV-2 outbreaks are difficult to recognise and control due to its high infectivity and the wide range of clinical manifestations of the infection. An outbreak at Watford general hospital provided an opportunity to recognise the complexity involved in a COVID-19 outbreak investigation. Methods An outbreak control team (OCT) was convened. The terms outbreak, a case and a significant exposure were defined as per Public Health England (PHE) Guidance and in the context of the local outbreak. Root cause analyses (RCAs) were carried out on cases to identify possible causes, possible route of transmission and any learning points. All contact patients and staff were screened with RT PCR and genomic sequencing was performed on a set of positive specimens. In addition to active contact tracing, screening and cohorting of patients and staff, standard and transmission-based precautions were reinforced to control the outbreak. Findings Fifteen patients and four staff members were identified in this outbreak investigation. With contact tracing, screening and through strict infection control measures the outbreak was brought under control. Conclusion We could successfully contain the spread of this outbreak following PHE outbreak control guidelines and our local guidelines. We recognised several challenges in investigating a COVID-19 outbreak in a hospital setting. Problems arising from variable sensitivity of the tests, difficulty in differentiating COVID-19 related symptoms from underlying diseases, problems related to establishing the route of transmission, issues with contact tracing are discussed. Additionally, the importance and limitations of genomic studies in COVID-19 are discussed.

Outbreak caused by the SARS-CoV-2 Omicron variant in the psychiatric ward of a general hospital in Brazil

“…The increased transmissibility and potential immune evasion of new variants, such as the Omicron variant of concern (VOC), pose additional challenges to surveillance and infection control efforts in different settings [1][2][3] . Rapid detection and control of healthcare-associated outbreaks are paramount to prevent a wider spread of infection, cases, and deaths [4][5][6] . However, these measures are difficult to implement in settings such as psychiatric wards due to difficulties in risk awareness and clinical symptom communication 4,6 .…”

“…Nosocomial outbreaks of SARS-CoV-2 have been reported among patients and healthcare workers in hospitals and long-term term care facilities [4][5][6]10 . However, due to the recent emergence of Omicron VOC, there is limited understanding of their epidemiological and clinical presentation in different settings.…”