A hospital-wide response to multiple outbreaks of COVID-19 in Health Care Workers Lessons learned from the field

Objective

To describe COVID-19 infections amongst healthcare workers at the Royal Melbourne Hospital from 1 ^st July to 31 ^st August 2020

Design

Prospective observational study

Setting

A 550 bed tertiary referral hospital in metropolitan Melbourne

Participants

All healthcare workers identified with COVID-19 infection in the period of interest

Results

262 healthcare worker infections were identified over 9 weeks. 68.3% of infected healthcare workers were nurses and the most affected locations were the geriatric and rehabilitation wards. Clusters of infection occurred in staff working in wards with patients known to have COVID-19 infection. Staff infections peaked when COVID-19 infected inpatient numbers were highest, and density of patients and certain patient behaviours were noted by staff to be linked to possible transmission events. Three small outbreaks on other wards occurred but all were recognised and brought under control. Availability of rapid turn-around staff testing, and regular review of local data and obtaining feedback from staff helped identify useful interventions which were iteratively implemented. Attention to staff wellbeing was critical to the response and a comprehensive support service was implemented.

Conclusion(s)

A comprehensive multimodal approach to containment was instituted with iterative refinement based on frontline workers observations and ongoing analysis of local data in real time.

The known: Healthcare workers are a group recognized to be at risk of acquisition of infection in the workplace during the current COVID-19 pandemic

The new: This describes the experience of the largest Australian outbreak to date of COVID- 19 infection amongst healthcare workers in a hospital environment

The implications: This paper should assist healthcare services to prepare for surges in COVID-19 infection to help limit future transmissions to healthcare workers