A hospital-wide response to multiple outbreaks of COVID-19 in health care workers: lessons learned from the field
A/Prof. Caroline Marshall1,2,3, A/Prof Kirsty Buising1,2,3, Professor Deborah Williamson1,2,3, Professor Benjamin Cowie1,3,4, Jennifer MacLachlan3,4, Elizabeth Orr1, Professor Christopher MacIsaac1,2, Dr Eloise Williams1, Dr Katherine Bond1, Dr Stephen Muhi1,2, Professor James McCarthy1,2,3, Professor Andrea Maier1, Professor Louis Irving1, Associate Professor Denise Heinjus1, Dr Cate Kelly1
1The Royal Melbourne Hospital, Grattan St, Australia
2The University of Melbourne, Parkville, Australia
3Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
4Victorian Infectious Diseases Reference Laboratory, Melbourne , Australia
Introduction
The Royal Melbourne Hospital (RMH) experienced a significant number of staff COVID-19 infections during July and August 2020 concurrent with a state-wide surge in cases. We describe the epidemiology of the infections and the interventions associated with outbreak control.
Methods
The RMH is a large tertiary hospital on multiple sites including geriatric and rehabilitation beds at the Royal Park Campus (RPC). The Infection Prevention service managed the outbreaks and exposures, including staff and patient contact tracing, in conjunction with the Victorian Department of Health and Human Services using their COVID-19 guidelines and definitions. A staff well-being service was set up to manage infected and furloughed staff. Data were entered into a REDCap database and analysed using Stata 16.
Results
Between 1 July and 31 August 2020, 262 COVID-19 cases occurred in RMH staff including 179 (68.3%) nurses and 38 (14.5%) support staff. 107 (40.8%) were at RPC and coincided with a large number of patient infections (peak of 60). 57 (21.8%) infections occurred on COVID-19 wards, the emergency department and intensive care unit. Twenty (7.6%) occurred on “cold” wards which experienced unexpected outbreaks. Mitigation strategies according to a hierarchy of controls were introduced. These included elimination, engineering and administrative controls and personal protective equipment as well as frequent testing of staff and patients with rapid access to results under a previously established governance structure.
Discussion
A large institutional outbreak of COVID-19 was controlled using a pragmatic and iterative suite of interventions.
Biography:
Associate Professor Marshall is an infectious diseases physician at the Royal Melbourne Hospital where she is also Head of the Infection Prevention and Surveillance Service. She is also Principal Research Fellow in the Department of Medicine at the University of Melbourne. She has been part of the senior management team managing the COVID-19 outbreak at the Royal Melbourne Hospital.