ABSTRACT
Despite the hospital triage system trying to prevent COVID-19 patients from getting admitted to wards other than isolation/quarantine units, COVID-19 patients were accidentally being discovered time to time from non-COVID-19 wards due to atypical or asymptomatic presentations. Consequently, post-exposure risk assessment was carried out for the relevant health care workers (HCW) and the other patients to assess their risk level of acquiring COVID-19, and to quarantine them if concluded as high risk. Hence, the objective of the study was to assess the outcome and the adequacy of COVID-19 post-exposure risk assessment of health care workers which would be useful in future outbreaks. We studied all events of accidental detection of COVID-19 patients happened in non-COVID-19 wards which were leading to subsequent risk assessment using the 5-questions based tool adapted from the WHO recommendations. The 5 questions discussed the protective measures during face to face meetings or in physical contacts, protective measures during aerosol generating procedures, splashes onto the face, and hand hygiene measures. A retrospective cross-sectional study carried out in the Teaching Hospital Karapitiya, Galle, Sri Lanka, for 4 months covering the second wave of the pandemic. Hospital data base of risk assessments was accessed anonymously and the "yes” or "no” responses to the 5-questions assessment tool were analysed. There were 62 events involving 891 health care workers who underwent post-exposure risk assessment. From the responses the highest score of "yes” was recorded against question 3 (25.7% of total "yes” answers for all questions and 5.8% of total answers for the question number 3) revealing inadequate precautions taken by HCWs in aerosol generating procedures. Hundred and sixty two (18.2%) HCWs were quarantined as high risk and only one became positive for COVID-19 during the quarantine period. Though the 5-question based risk assessment tool effectively helps to identify breaches in infection control during an exposure to a positive COVID-19 patient, it may not be adequate at times as the only tool in deciding the assessee's risk level.
ABSTRACT
OBJECTIVES: To determine aetiology of illness among children and adults presenting during outbreak of severe respiratory illness in Southern Province, Sri Lanka, in 2018. DESIGN: Prospective, cross-sectional study. SETTING: 1600-bed, public, tertiary care hospital in Southern Province, Sri Lanka. PARTICIPANTS: 410 consecutive patients, including 371 children and 39 adults, who were admitted with suspected viral pneumonia (passive surveillance) or who met case definition for acute respiratory illness (active surveillance) in May to June 2018. RESULTS: We found that cocirculation of influenza A (22.6% of cases), respiratory syncytial virus (27.8%) and adenovirus (AdV) (30.7%; type B3) was responsible for the outbreak. Mortality was noted in 4.5% of paediatric cases identified during active surveillance. Virus type and viral coinfection were not significantly associated with mortality. CONCLUSIONS: This is the first report of intense cocirculation of multiple respiratory viruses as a cause of an outbreak of severe acute respiratory illness in Sri Lanka, and the first time that AdV has been documented as a cause of a respiratory outbreak in the country. Our results emphasise the need for continued vigilance in surveying for known and emerging respiratory viruses in the tropics.