Strategies utilized to prevent and control SARS-CoV-2 transmission in two congregate, psychiatric healthcare settings during the pandemic

Abstract

Background The COVID-19 pandemic has had a substantial effect on the delivery of psychiatric healthcare. Inpatient psychiatric healthcare facilities have experienced outbreaks of COVID-19, making these areas particularly vulnerable. Methods Our facility used a multidisciplinary approach to implement enhanced infection prevention and control (IPC) interventions in our psychiatric healthcare areas. Results In a sixteen-month period during the COVID-19 pandemic, our two facilities provided >29,000 patient days of care to 1,807 patients and identified only forty-seven COVID-19 positive psychiatric health inpatients (47/1,807, or 2.6%). We identified the majority of these cases by testing all patients at admission, preventing subsequent outbreaks. Twenty-one psychiatric healthcare personnel were identified as COVID+ during the same period, with 90% linked to an exposure other than a known positive case at work. Discussion The IPC interventions we implemented provided multiple layers of safety for our patients and our staff. Ultimately, this resulted in low SARS-CoV-2 infection rates within our facilities. Conclusions Psychiatric healthcare facilities are uniquely vulnerable to COVID-19 outbreaks because they are congregate units that promote therapeutic interactions in shared spaces. IPC interventions used in acute medical care settings can also work effectively in psychiatric healthcare, but often require modifications to ensure staff and patient safety.

Recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic: a scoping review

“…Most papers were identified as expert consensus (n=56, 44.8%), followed by literature review (n=35, 28.0%). Many articles described specific recommendations for performing intubation15–19 or for certain areas, such as psychiatric services,20–22 orthopaedics,23 haemodynamic,24 intrahospital transport,25 oncology,26 27 field hospitals,28 29 paediatrics,30–34 diagnostic centres,35–37 inpatient units,38–43 endoscopy and gastroenterology centres,44–48 gynaecology and obstetrics,40 49–55 emergency units,56–60 intensive care unit40 41 56 61–68 and the most common was the surgical centres 48 61 69–99. Other articles made recommendations for the hospital service as a whole 19 58 64 100–138.…”

“…The reorganisation of the health services category addresses 17 recommendations related to the flow of patients, the management of human and material resources and the reorganisation of the hospital environment in order to prevent the transmission of COVID-19. It is recommended that all patients are considered suspects47 70 80 90 91 101 128 and undergo risk stratification20 21 23 24 27 31 32 36 39 43–47 49 53 66 70 72–74 76 81 85 91 93 100–102 108 110 119 125 126 133 135 139 with a history of clinical and epidemiological data20 22–24 39 45–47 49 72 81 92 93 95 96 101 124–126 133–135 and a test20 22 23 26 30 39 48–51 53 61 65 68 72 73 81 84 90 92 96 102 110 119 124 133 of RT-PCR,23 36 47 69 72 81 87 88 91 96 119 125 126 133 134 ELISA23 47 or nasal swab84 95 101 at admission screening,21 22 36 39 49–51 53 69 95 108 133 in the preoperative period,23 26 47 48 61 69 72 87 90 95 102 124 in referrals31 84 and before non-emergency procedures involving airway approaches 66 79 95…”

“…To reduce the movement of people, hospitalisations and elective procedures should be suspended,20 23 26 36 37 40 46 48 51 52 69 72 75 76 84 91 95 96 98 100 101 108 110 124 125 134 the number of professionals in the areas of patients with COVID-19 should be kept to a minimum15 17 18 23 26 27 33 36 37 46–48 53 60 65 66 70 75 76 78 83–85 90 94 97–100 102 104 139 and family visits to patients should also be restricted 20–22 32 38 40 46 48 49 52–55 68 81 96 100 101 104 108 119 129 130 135 139…”

“…Patients should clean their skin with soap and water102 110 and pack their personal clothes in sealed bags 47 70 102. Everyone (patients, accompanying persons and professionals) must wash their hands frequently, with standard technique, using alcohol products when they are visibly clean or soap and water when they are dirty 16 20 22 24 28 32–34 38–40 44 47 48 51 55 56 58 59 63 65 73 74 78 80 94 96 99–102 104 105 107 109 112 115 119–124 129–132 135 138 139…”

“…The reorganisation of the health services category addresses 17 recommendations related to the flow of patients, the management of human and material resources and the reorganisation of the hospital environment in order to prevent the transmission of COVID-19. It is recommended that all patients are considered suspects 47 70 80 90 91 101 128 and undergo risk stratification 20 21 23 23 47 or nasal swab 84 95 101 at admission screening, 21 22 36 39 49-51 53 69 95 108 133 in the preoperative period, 23 26 47 48 61 69 72 87 90 95 102 124 in Open access referrals 31 84 and before non-emergency procedures involving airway approaches. 66 79 95 Suspected and confirmed patients should be isolated, 20 115 134 In case of death, the body must be wrapped in a sheet soaked in a disinfectant solution and placed in the coffin.…”