Rios-Guzman Estefany, Stancovici Alina G, Simons Lacy M, Barajas Grace, Glenn Katia, Weber Rachel T, Ozer Egon A, Lorenzo-Redondo Ramon, Hultquist Judd F, Bolon Maureen K
Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, USA.
Antimicrob Steward Healthc Epidemiol. 2024 Apr 29;4(1):e62. doi: 10.1017/ash.2024.40. eCollection 2024.
Inpatient behavioral health units (BHUs) had unique challenges in implementing interventions to mitigate coronavirus disease 2019 (COVID-19) transmission, in part due to socialization in BHU settings. The objective of this study was to identify the transmission routes and the efficacy of the mitigation strategies employed during a COVID-19 outbreak in an inpatient BHU during the Omicron surge from December 2021 to January 2022.
An outbreak investigation was performed after identifying 2 COVID-19-positive BHU inpatients on December 16 and 20, 2021. Mitigation measures involved weekly point prevalence testing for all inpatients, healthcare workers (HCWs), and staff, followed by infection prevention mitigation measures and molecular surveillance. Whole-genome sequencing on a subset of COVID-19-positive individuals was performed to identify the outbreak source. Finally, an outbreak control sustainability plan was formulated for future BHU outbreak resurgences.
We identified 35 HCWs and 8 inpatients who tested positive in the BHU between December 16, 2021, and January 17, 2022. We generated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) genomes from 15 HCWs and all inpatients. Phylogenetic analyses revealed 3 distinct but genetically related clusters: (1) an HCW and inpatient outbreak likely initiated by staff, (2) an HCW and inpatient outbreak likely initiated by an inpatient visitor, and (3) an HCW-only cluster initiated by staff.
Distinct transmission clusters are consistent with multiple, independent SARS-CoV-2 introductions with further inpatient transmission occurring in communal settings. The implemented outbreak control plan comprised of enhanced personal protective equipment requirements, limited socialization, and molecular surveillance likely minimized disruptions to patient care as a model for future pandemics.
住院行为健康单元（BHUs）在实施减轻2019冠状病毒病（COVID-19）传播的干预措施方面面临独特挑战，部分原因是BHUs环境中的社交活动。本研究的目的是确定2021年12月至2022年1月奥密克戎毒株激增期间，一家住院BHUs发生COVID-19疫情期间的传播途径以及所采用的缓解策略的效果。
在2021年12月16日和20日确定2名COVID-19呈阳性的BHUs住院患者后，进行了疫情调查。缓解措施包括对所有住院患者、医护人员（HCWs）和工作人员进行每周一次的现患率检测，随后采取感染预防缓解措施和分子监测。对一部分COVID-19呈阳性的个体进行全基因组测序，以确定疫情源头。最后，制定了疫情控制可持续性计划，以应对未来BHUs疫情的复发。
我们确定了在2021年12月16日至2022年1月17日期间，BHUs中有35名医护人员和8名住院患者检测呈阳性。我们从15名医护人员和所有住院患者中生成了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）基因组。系统发育分析揭示了3个不同但基因相关的集群：（1）一个可能由工作人员引发的医护人员和住院患者疫情，（2）一个可能由住院患者访客引发的医护人员和住院患者疫情，以及（3）一个由工作人员引发的仅医护人员集群。
不同的传播集群与多次独立的SARS-CoV-2引入一致，在公共环境中进一步发生住院患者传播。所实施的疫情控制计划包括加强个人防护装备要求、限制社交活动和分子监测，作为未来大流行的模型，可能将对患者护理的干扰降至最低。
