Investigation of healthcare-associated SARS-CoV-2 infection: Learning outcomes from an investigative process in the initial phase of the pandemic

Isobel Ramsay; Katherine Sharrocks; Ben Warne; Nyarie Sithole; Pooja Ravji; Rachel Bousfield; Nick Jones; Clare E Leong; Mohamed Suliman; Rachel Tsui; Michelle S Toleman; Christine Moody; Richard Smith; James Whitehorn; Theodore Gouliouris; Florentina Penciu; Christian Hofling; Chris Cunningham; David A Enoch; Elinor Moore

doi:10.1177/17571774221092553

Investigation of healthcare-associated SARS-CoV-2 infection: Learning outcomes from an investigative process in the initial phase of the pandemic

J Infect Prev. 2022 Sep;23(5):197-205. doi: 10.1177/17571774221092553. Epub 2022 May 16.

Authors

Isobel Ramsay^{1

2}, Katherine Sharrocks², Ben Warne², Nyarie Sithole², Pooja Ravji^{1

2}, Rachel Bousfield^{1

2}, Nick Jones^{1

2}, Clare E Leong^{1

2}, Mohamed Suliman^{1

2}, Rachel Tsui¹, Michelle S Toleman¹, Christine Moody¹, Richard Smith¹, James Whitehorn^{1

2}, Theodore Gouliouris^{1

2}, Florentina Penciu¹, Christian Hofling³, Chris Cunningham², David A Enoch¹, Elinor Moore²

Affiliations

¹ Clinical Microbiology & Public Health Laboratory, Cambridge, UK.
² Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³ Infectious Diseases, Universidade Estadual de Campinas, Campinas, Brazil.

Abstract

Background: Healthcare-associated (HCA) SARS-CoV-2 infection is a significant contributor to the spread of the 2020 pandemic. Timely review of HCA cases is essential to identify learning to inform infection prevention and control (IPC) policies and organisational response.

Aim: To identify key areas for improvement through rapid investigation of HCA SARS-CoV-2 cases and to implement change.

Methods: Cases were identified based on date of first positive SARS-CoV-2 PCR sample in relation to date of hospital admission. Cases were reviewed using a structured gap analysis tool to identify key learning points. These were discussed in weekly multidisciplinary meetings to gain consensus on learning outcomes, level of harm incurred by the patient and required actions. Learning was then promptly fed back to individual teams and the organisation.

Findings: Of the 489 SARS-CoV-2 cases admitted between 10^th March and 23^rd June 2020, 114 suspected HCA cases (23.3%) were reviewed; 58/489 (11.8%) were ultimately deemed to be HCA. Five themes were identified: individual patient vulnerability, communication, IPC implementation, policy issues and organisational response. Adaptations to policies based on these reviews were completed within the course of the initial phase of the pandemic.

Conclusion: This approach enabled timely learning and implementation of control measures and policy development.

Keywords: COVID-19; gap analysis; healthcare-associated infection; infection prevention and control.