Provision of safe patient care during the COVID-19 pandemic despite shared patient rooms in a tertiary hospital

Abstract

Background The COVID-19 pandemic has resulted in the disruption of healthcare systems. Vienna General Hospital (VGH), a tertiary hospital located in Austria, ran at almost full capacity despite high levels of community SARS-CoV-2 transmission and limited isolation room capacity. To ensure safe patient care, a bundle of infection prevention and control (IPC) measures including universal pre-admission screening and serial SARS-CoV-2 testing during hospitalization was implemented. We evaluated whether testing as part of our IPC approach was effective in preventing hospital outbreaks during different stages of the pandemic. Methods In this retrospective single center study, we analyzed the SARS-CoV-2 PCR test results of cases admitted to VGH between a low (15/05/2020–01/08/2020) and a high incidence period (15/09/2020–18/05/2021). Outcomes were the diagnostic yield of (a) admission screening, (b) the yield of serial testing during hospitalization and (c) the occurrence of healthcare-associated COVID-19 (HA-COVID-19) and SARS-CoV-2 related hospital outbreaks. Results The admission test positivity rate was 0.2% during the low and 2.3% during the high incidence phase. Regarding test conversions, 0.04% (low incidence phase) and 0.5% (high incidence phase) of initially negative cases converted to a positive test result within 7 days after admission The HA-COVID-19 incidence rate per 100,000 patient days was 1.0 (low incidence phase) and 10.7 (high incidence phase). One COVID-19 outbreak affecting eight patients in total could be potentially ascribed to the non-compliance with our IPC protocol. Conclusion Testing in conjunction with other IPC measures enabled the safe provision of patient care at a hospital with predominantly shared patient rooms despite high case numbers in the community.

Impact of universal admission testing for severe acute respiratory coronavirus 2 (SARS-CoV-2) in era of the omicron variant

“…1). 4,5 Our findings suggest that universal admission testing has been more valuable during the omicron era and should be maintained for the time being. This change may be due to the higher rate of asymptomatic infection with the omicron variant, the broader community prevalence during this period, or both.…”

“…3 Facilities that implemented and evaluated routine admission testing early in the COVID-19 pandemic generally identified low numbers of infectious cases and concerns regarding unnecessary isolation and costs during periods of low community prevalence has limited widespread adoption. 4,5 The value of universal admission testing in the era of the SARS-CoV-2 omicron variant is even less clear. We hypothesized that, given its broader transmission and higher rate of asymptomatic infection, routine admission testing during the omicron era may identify more asymptomatic infectious cases and avert in-hospital transmission.…”

COVID-19 patient and personal safety – lessons learnt for pandemic preparedness and the way to the next normal

“…The hospital’s management and IPC teams set up an elaborate testing strategy for elective patients, acute patients, staff and visitors [ 20 ], enabled by the widespread availability of PCR tests [ 21 ]. Briefly, universal pre-admission screening was introduced, and separate testing sites established for symptomatic and asymptomatic patients.…”

Universal admission laboratory screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) asymptomatic infection across a large health system

“…For example, hospitals with a higher proportion of semiprivate rooms or congregate settings (eg, in behavioral health facilities) may have a more conservative threshold to relax admission screening programs, given the challenges of compliance with other infection prevention practices such as patient masking. 17,18 Individual patient immune status or admission to a unit typically houses other severely immune compromised patients may also consider a more conservative threshold as well, given the more detrimental ramifications of missing an asymptomatic case. Although these findings provide important insight on the impact of an admission screening program, this analysis has some limitations.…”