Validation of a Real-Time Locating System for Contact Tracing of Healthcare Workers during the COVID-19 Pandemic in Singapore

ABSTRACT

BACKGROUND: In early 2020, the 2019 coronavirus disease (COVID-19) emerged and resulted in community and nosocomial transmissions. Effective contact tracing for potentially exposed healthcare workers (HCWs) is crucial for the prevention and control of infectious disease outbreaks in the healthcare setting. OBJECTIVE: This study aimed to evaluate the comparative effectiveness of contact tracing through real-time locating systems (RTLS) and electronic medical records (EMRs) review at the designated hospital for COVID-19 response in Singapore, during the COVID-19 pandemic. METHODS: Over a two-day study period, all admitted COVID-19 patients, their ward locations, and the HCWs rostered to each ward, were identified to determine the total number of potential contacts between COVID-19 patients and HCWs. The number of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR and RTLS-based contact tracing methods were further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by HCWs. RESULTS: Of 796 potential staff-patient contacts (between 17 patients and 162 staff), 104(13.1%) were identified on both RTLS and EMR, 54(6.8%) by RTLS alone, 99(12.4%) by EMR alone, and 539(67.7%) not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and specificity of 77.9%, while RTLS had a sensitivity of 72.2% and specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either RTLS or EMR (sensitivity 77.8%, specificity 73.4%). CONCLUSIONS: RTLS-based contact tracing had higher sensitivity and specificity than EMR reviews. An integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing RTLS tags consistently remain necessary. CLINICALTRIAL