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. 2023 May;51(5):506-513.
doi: 10.1016/j.ajic.2022.07.019. Epub 2022 Jul 25.

Nosocomial COVID-19 at a comprehensive cancer center during the first year of the pandemic: Lessons learned

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Nosocomial COVID-19 at a comprehensive cancer center during the first year of the pandemic: Lessons learned

Fareed Khawaja et al. Am J Infect Control. 2023 May.

Abstract

Background: The spread of coronavirus disease 2019 (COVID-19) in health care settings endangers patients with cancer. As knowledge of the transmission of COVID-19 emerged, strategies for preventing nosocomial COVID-19 were updated. We describe our early experience with nosocomial respiratory viral infections (RVIs) at a cancer center in the first year of the pandemic (March 2020-March 2021).

Methods: Nosocomial RVIs were identified through our infection control prospective surveillance program, which conducted epidemiologic investigations of all microbiologically documented RVIs. Data was presented as frequencies and percentages or medians and ranges.

Results: A total of 35 of 3944 (0.9%) documented RVIs were determined to have been nosocomial acquired. Majority of RVIs were due to SARS CoV-2 (13/35; 37%) or by rhinovirus/enterovirus (12/35; 34%). A cluster investigation of the first 3 patients with nosocomial COVID-19 determined that transmission most likely occurred from employees to patients. Five patients (38%) required mechanical ventilation and 4 (31%) died during the same hospital encounter.

Conclusions: Our investigation of the cluster led to enhancement of our infection control measures. The implications of COVID-19 vaccination on infection control policies is still unclear and further studies are needed to delineate its impact on the transmission of COVID-19 in a hospital setting.

Keywords: Hospital-associated transmission; Immunocompromised; Malignancy; Respiratory viruses; SARS CoV-2.

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Figures

Fig 1
Fig 1
Number of community-acquired respiratory viral infections detected, March 2020-March 2021. Abbreviations: HPMV, human metapneumovirus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Fig 2
Fig 2
Distribution of COVID-19 cases by month, March 2020-March 2021.
Fig 3
Fig 3
Comparison of nosocomial respiratory viral infections during the year before the COVID-19 pandemic (March 2019-February 2020) and during the first year of the pandemic (March 2020-March 2021).
Fig 4
Fig 4
Potential nosocomial COVID-19 transmission dynamics between patients and health care workers, June-July 2020. Top: Timeline of positive COVID-19 patients and employees in the same unit from 6/10/2020 to 7/16/2020 Bottom: Transmission tree linking possible exposures to infected patients from 6/17/2020 to 7/5/2020. Examples of health care workers involved included nurses, patient care technicians and patient care navigators.

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