Respiratory surveillance wards as a strategy to reduce nosocomial transmission of COVID-19 through early detection: the experience of a tertiary hospital in Singapore.
Infect Control Hosp Epidemiol. 2020 May 08;:1-16
Authors: Wee LE, Hsieh JYC, Puah GC, Tan Y, Conceicao EP, Wijaya L, Tan TT, Tan BH
Abstract
OBJECTIVES: Patients with COVID-19 may present with respiratory syndromes indistinguishable from those caused by common viruses. Early isolation and containment is challenging. While screening all patients with respiratory symptoms for COVID-19 has been advocated, the practicality of such an effort has yet to be assessed.
METHODS: Over a six-week period during a COVID-19 outbreak, our institution introduced a "respiratory surveillance ward" (RSW) to segregate all patients with respiratory symptoms in designated areas, where appropriate personal protective equipment (PPE) could be utilised till COVID-19 testing was done. Patients could be transferred out if COVID-19 tests were negative on 2 consecutive occasions, 24 hours apart.
RESULTS: Over the study period, 1178 patients were admitted to the RSWs. The mean length-of-stay (LOS) was 1.89 days (S.D=1.23). Amongst confirmed cases of pneumonia admitted to the RSW, 1.61% (5/310) of patients tested positive for COVID-19. This was comparable to the pickup rate from our isolation ward. A total of 126 HCWs were potentially exposed to these cases; however, only 3 HCWs (2.38%, 3/126) required quarantine as the majority used appropriate PPE. A total of 13 inpatients overlapped with the index cases during their stay in the RSW; of the 13 exposed inpatients, 1 patient subsequently developed COVID-19 post-exposure. No patient-HCW transmission was detected despite intensive surveillance.
CONCLUSION: Our institution successfully utilised the strategy of an RSW over a six-week period to contain a cluster of COVID-19 infection and avoid patient-HCW transmission. However, this was resource-intensive in terms of testing and bed capacity.
PMID: 32381147 [PubMed - as supplied by publisher]