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The limits of genomic sequencing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) exposure investigations: For nosocomial outbreak reconstruction, community exposures matter, too. Infect Control Hosp Epidemiol 2023; 44:152-154. [PMID: 35598889 PMCID: PMC9433709 DOI: 10.1017/ice.2022.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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2
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Mass COVID-19 testing of asymptomatic health-care workers in a tertiary hospital during an outbreak in another hospital in Singapore: an effective strategy? Western Pac Surveill Response J 2022; 13:1-3. [PMID: 36817501 PMCID: PMC9912269 DOI: 10.5365/wpsar.2022.13.4.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In response to a COVID-19 outbreak within a hospital in Singapore, a single mass swab exercise was conducted at another tertiary hospital to detect possible inter-hospital transmission. The exercise yielded no positive results, demonstrating non-targeted mass testing as an impractical strategy to track inter-hospital transmission.
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3
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Linking sporadic hospital clusters during a community surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) B.1.617.2 delta variant: The utility of whole-genome sequencing. Infect Control Hosp Epidemiol 2022:1-5. [DOI: 10.1017/ice.2022.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Sporadic clusters of healthcare-associated coronavirus disease 2019 (COVID-19) occurred despite intense rostered routine surveillance and a highly vaccinated healthcare worker (HCW) population, during a community surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) B.1.617.2 δ (delta) variant. Genomic analysis facilitated timely cluster detection and uncovered additional linkages via HCWs moving between clinical areas and among HCWs sharing a common lunch area, enabling early intervention.
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Liang En W, Ko KKK, Conceicao EP, Aung MK, Oo AM, Yong Y, Arora S, Venkatachalam I. Enhanced infection-prevention measures including universal N95 usage and daily testing: the impact on SARS-CoV-2 transmission in cohorted hospital cubicles through successive Delta and Omicron waves. Clin Infect Dis 2022; 75:917-919. [PMID: 35445253 PMCID: PMC9383754 DOI: 10.1093/cid/ciac320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Wee Liang En
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Karrie Kwan-Ki Ko
- Department of Molecular Pathology, Singapore General Hospital.,Department of Microbiology, Singapore General Hospital
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Aung Myat Oo
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Yang Yong
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Shalvi Arora
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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5
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Wee LE, Conceicao EP, Sim JXY, Aung MK, Aung MO, Yong Y, Arora S, Ko KKK, Venkatachalam I. Sporadic outbreaks of healthcare-associated COVID-19 infection in a highly-vaccinated inpatient population during a community outbreak of the B.1.617.2 variant: The role of enhanced infection-prevention measures. Am J Infect Control 2022; 50:465-468. [PMID: 35108584 PMCID: PMC8800934 DOI: 10.1016/j.ajic.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/22/2022] [Accepted: 01/22/2022] [Indexed: 01/12/2023]
Abstract
Sporadic clusters of health care-associated COVID-19 infection occurred in a highly vaccinated health care-workers and patient population, over a 3-month period during ongoing community transmission of the B.1.617.2 variant. Enhanced infection-prevention measures and robust surveillance systems, including routine-rostered-testing of all inpatients and staff and usage of N95-respirators in all clinical areas, were insufficient in achieving zero health care-associated transmission. The unvaccinated and immunocompromised remain at-risk and should be prioritized for enhanced surveillance.
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6
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Lim RHF, Htun HL, Li AL, Guo H, Kyaw WM, Hein AA, Ang B, Chow A. Fending off Delta - Hospital measures to reduce nosocomial transmission of COVID-19. Int J Infect Dis 2022; 117:139-145. [PMID: 35124240 PMCID: PMC8813202 DOI: 10.1016/j.ijid.2022.01.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Following the emergence of the Delta variant of SARS-CoV-2 in Singapore, our hospital experienced a Delta-linked ward cluster. In this study, we review the enhanced strategies in preventing nosocomial transmission of COVID-19 following widespread community transmission of the Delta variant. Methods We conducted a cohort study on exposures to unexpected COVID-19 cases for which contact tracing was initiated from June 2021 to October 2021. Strategies evaluated included upgraded personal protective equipment (PPE) and rostered routine testing (RRT) for staff and patients, surveillance of staff with acute respiratory illness (ARI), and expanded quarantining and testing for contacts of identified cases. Results From 193 unexpected COVID-19 exposures, 2,573 staff, 542 patients, and 128 visitor contacts were traced. Four staff contacts subsequently had SARS-CoV-2 infection. Two were likely from exposure in community settings, whereas 2 had exposure to the same COVID-19 positive staff in the hospital, forming the only hospital cluster. One inpatient had a nosocomial infection, possibly from visitors. The SARS-CoV-2 detection rate among staff was 0.3% (of 11,200 staff) from biweekly RRT and 2.5% (of 3,675 staff) from ARI surveillance. Conclusion Enhanced hospital measures, including upgraded PPE and RRT for staff and patients, staff sickness surveillance, and more rigorous management of contacts of COVID-19 cases, were likely to have reduced nosocomial transmission amid the Delta variant.
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Affiliation(s)
- Rachel Hui Fen Lim
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Htet Lin Htun
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Anthony Lianjie Li
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Huiling Guo
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Win Mar Kyaw
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Aung Aung Hein
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Brenda Ang
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore; Department of Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | - Angela Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore; Saw Swee Hock School of Public Health, National University of Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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7
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Asokkumar R, Seow I, Chin Hong L, Chang J, Tan D, Salazar E. Rostered routine testing for severe acute respiratory coronavirus virus 2 infection among healthcare workers: Do we detect more? J Gastroenterol Hepatol 2022; 37:404-405. [PMID: 34694645 PMCID: PMC8656364 DOI: 10.1111/jgh.15720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Affiliation(s)
- R Asokkumar
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - I Seow
- Department of Colorectal SurgerySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - L Chin Hong
- Department of Upper Gastrointestinal and Bariatric SurgerySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - J Chang
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - D Tan
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
| | - E Salazar
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore,Duke‐NUS Graduate Medical SchoolSingapore
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Tan SY, How CH, Poon BH, Tan TY, Siau C. Rostered Routine Testing: A Necessary Evil? Open Forum Infect Dis 2022; 9:ofab549. [PMID: 35024370 PMCID: PMC8689919 DOI: 10.1093/ofid/ofab549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
We report our institution’s experience of detecting a staff member who was infected with severe acute respiratory syndrome coronavirus 2 while he was asymptomatic, as part of a rostered routine testing program, and how the institution was able to undertake measures to curb the spread, hence reducing the impact on the daily operations of our institution.
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Affiliation(s)
- Seow Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore
| | - Choon How How
- Department of Care and Health Integration, Changi General Hospital, Singapore
| | - Beng Hoong Poon
- Chairman Medical Board Office, Changi General Hospital, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Chuin Siau
- Department of Respiratory & Critical Care Medicine, Changi General Hospital, Singapore
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9
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Lim WY, Tan GSE, Htun HL, Phua HP, Kyaw WM, Guo H, Cui L, Mak TM, Poh BF, Wong JCC, Setoh YX, Ang BSP, Chow ALP. The first nosocomial cluster of COVID-19 due to the Delta variant in a major acute-care hospital in Singapore - investigations and outbreak response. J Hosp Infect 2021; 122:27-34. [PMID: 34942201 PMCID: PMC8687717 DOI: 10.1016/j.jhin.2021.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The first large nosocomial cluster of COVID-19 in Singapore in April 2021 led to partial closure of a major acute-care hospital. We report our investigations and evaluate the effectiveness of the BNT162.b2 and mRNA1273 vaccines against the Delta variant. METHODS Close contacts of COVID-19 patients and the affected ward were identified and underwent surveillance for SARS-CoV-2 infection. Patient, staff and visitor cohorts were constructed and factors associated with infection evaluated. Phylogenetic analysis of patient samples was performed. Ward air exhaust filters were tested for SARS-CoV-2 virus. RESULTS There were 47 cases in total, comprising 29 patients, 9 staff, 6 ward visitors and 3 household contacts. All infections were of the Delta variant. Ventilation studies showed turbulent airflow and swabs from air exhaust filters were positive for SARS-Cov2. Vaccine breakthrough infections were seen in both patients and staff. Among patients, vaccination was associated with a 79% lower odds of infection with COVID-19 (adjusted OR =0.21, 95%CI 0.05-0.95) CONCLUSIONS: This cluster occurred despite an enhancement in infection control measures that the hospital had undertaken at the onset of this pandemic, but it was rapidly brought under control through case isolation, extensive contact tracing and quarantine measures, and led to enhancements in hospital personal protective equipment (PPE) use, introduction of routine rostered testing of inpatients and staff, and hospital infrastructure changes to improve ventilation within the general ward.
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Affiliation(s)
- Wei-Yen Lim
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | | | - Htet Lin Htun
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Hwee Pin Phua
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Win Mar Kyaw
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Huiling Guo
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Lin Cui
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Tze Minn Mak
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Bee Fong Poh
- Department of Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | | | - Yin Xiang Setoh
- Environmental Health Institute, National Environment Agency, Singapore
| | - Brenda Sze Peng Ang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Angela Li Ping Chow
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Rostered routine testing for healthcare workers and universal inpatient screening: The role of expanded hospital surveillance during an outbreak of coronavirus disease 2019 (COVID-19) in the surrounding community. Infect Control Hosp Epidemiol 2021; 43:1747-1749. [PMID: 34353387 PMCID: PMC8410743 DOI: 10.1017/ice.2021.366] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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