Reduction of healthcare-associated viral infections during COVID-19 pandemic

Background. Healthcare-associated viral infections (HAVI) are a common cause of preventable harm, particularly in pediatric patients. We utilized routine hospital- wide surveillance data for HAVIs at a quaternary care pediatric hospital in order to assess the impact of enhanced public health measures on rates of HAVI at our institution during the COVID-19 pandemic. Methods. Patient cases of HAVI were detected through routine house-wide microbiologic surveillance. Compliance with our institutional prevention bundle, which includes hand hygiene, appropriate use of isolation precautions and personal protective equipment (PPE), maintaining a clean and clutter free environment, employee illness policy, and restrictions on sick visitors, was measured through use of Kamishibai-card rounding. Results. During the most acute period of the COVID-19 pandemic, intensification of the majority of elements of the HAVI bundle occurred by nature of our institutional response, including use of PPE monitors in certain locations, increased used of eye protection, universal masking for staff and caregivers, re-education for employees on not coming to work sick, and further restrictions to visitation. The monthly HAVI rate in the acute phase of the COVID-19 pandemic was lower in March (0.76), April (0.27) and May (0.0) 2020 compared to the same time period last year (0.8, 0.8, 0.56). Bundle compliance during those months in 2020 was 83%, 89%, and 100%, respectively. In May, zero HAVIs were identified. (Figure 1) Healthcare-associated viral infections rate and bundle compliance after COVID-19 prevention measures Conclusion. The intensification of routine infection prevention practices aimed at minimizing the transmission of COVID-19 may also reduce rates of HAVI. During our COVID response, we identified a decrease in our institutional HAVI rate compared to the same time last year, reaching lower special cause in May with a rate of 0. We will have ongoing measurement of the HAVI rate throughout the pandemic to determine if this reduction can be sustained and understand which intensified bundle elements need to be maintained in non-pandemic hospital operations.

Patient outcomes of contact tracing for COVID-19 in a pediatric hospital

Background: Contact tracing is a critical component in controlling the spread of infectious diseases. During the COVID-19 pandemic, the demands for contract tracing far exceeded the resources available to infection prevention and control (IPC) programs. Leveraging our Poison Control Center, our organization established a Contact Tracing Center (CTC) with content expertise and oversight by IPC and Occupational Health. The CTC identifies exposed patients and employees, provides testing guidance and scheduling, and offers post-exposure recommendations for employees. We describe patient outcomes due to employee exposures in a pediatric healthcare system. Methods: Exposure data about employee to patient exposures (EPE) were captured real-time by scripted telephone interviews by our CTC. Chart review was performed to determine outcomes of exposed patients. A concerning exposure from a direct patient care provider to a patient was defined as unprotected contact at less than 6 feet for greater than 5 minutes in the 24 hours prior to developing symptoms. Data were analyzed to determine COVID-19 conversion rates for children exposed to pre-symptomatic and symptomatic employees based upon exposure risk stratification, window of exposure, and employees who worked with symptoms. Results: From March 2020 - present, we identified 38 EPE that involved 10 employees;26 EPE were pre-symptomatic and 12 EPE symptomatic exposures. The average number of EPE per employee was 3.8 (SD 3.01). There were no secondary transmission events to patients from either pre-symptomatic or symptomatic employees. After instituting universal masking, the number of concerning exposures to patients were 3 compared to 35 prior to universal masking. Conclusion: We describe the experience of a novel Contact Tracing Center, leveraging alternate staffing pools to track EPE resulting in no secondary transmission to patients either before or after universal masking. We credit sick policy adherence, high hand hygiene compliance, use of standard precautions, universal masking, robust contact tracing operations and a strong data collection system to identify process gaps.

The utility of paired upper and lower COVID-19 sampling in patients with artificial airways

Background: The Centers for Disease Control and Prevention (CDC) recommends upper respiratory tract (URT) polymerase chain reaction (PCR) testing as the initial diagnostic test for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Lower respiratory tract (LRT) testing for patients requiring mechanical ventilation is also recommended. The goal of this study was to evaluate concordance between paired URT and LRT specimens in children undergoing pre-admission/procedure screening or diagnostic testing. We hypothesized that < 10% of paired tests would have discordant results. Methods: Single center cross-sectional study including children with artificial airways who had paired URT and LRT SARS-CoV-2 PCR testing between 4/1/2020 and 6/8/2020. URT specimens included nasopharyngeal (NP) swabs and aspirates. LRT specimens included tracheal aspirates and bronchoalveolar lavages. URT and LRT specimens were classified as paired if the two specimens were collected within 24 hours. Artificial airways included tracheostomies and endotracheal tubes. Tests were classified as diagnostic versus screening based on the indication selected in the order. Results: 102 paired specimens were obtained during the study period. Fifty-nine were performed for screening and 43 were performed for diagnosis of suspected SARS-CoV-2. Overall, 94 specimens (92%) were concordant, including 89 negative from both sources and 5 positive from both sources. Eight specimens (8%) were discordant, all of which were positive from the URT and negative from the LRT (Figure 1). Among patients undergoing screening, 3 of 4 positive tests were discordant and among symptomatic patients, 5 of 9 positive tests were discordant. There were no instances of a positive LRT specimen with a negative URT specimen. Conclusion: Overall, most paired samples from the URT and LRT yielded concordant results with no pairs positive from the LRT and negative from the URT. These data support the CDC recommendation that URT specimens are the preferred initial SARS-CoV-2 test, while LRT specimens should be collected only from mechanically ventilated with suspected SARS-CoV-2. (Figure Presented).