SARS-Coronavirus-2 cases in healthcare workers may not regularly originate from patient care: lessons from a university hospital on the underestimated risk of healthcare worker to healthcare worker transmission

• Published in: Antimicrobial resistance & infection control Vol. 9; no. 1; pp. 192 - 7
• Main Authors: Schneider, Sandra, Piening, Brar, Nouri-Pasovsky, Pauline Assina, Krüger, Anne Caroline, Gastmeier, Petra, Aghdassi, Seven Johannes Sam
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07-12-2020; BioMed Central; BMC
• Subjects: Aerosols; Asymptomatic; Care and treatment; Contact tracing; Coronaviruses; COVID-19; COVID-19 - prevention & control; COVID-19 - transmission; Dialysis; Disease control; Disease Outbreaks; Disease transmission; Drug resistance; Employees; Epidemics; Epidemiology; Health aspects; Health care; Health facilities; Health Personnel; Health risks; Healthcare-associated infection; Hospitalization; Hospitals; Hospitals, University; Humans; Infection control; Infections; Infectious Disease Transmission, Patient-to-Professional - prevention & control; Laboratories; Masks; Medical personnel; Medical supplies; Nosocomial infections; Occupational health; Outbreak; Outbreaks; Pathogens; Patients; Personal Protective Equipment; Protective equipment; SARS-Coronavirus-2; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Surveillance; Viruses; Workers; Germany; China; COVID-19; Occupational health; SARS-Coronavirus-2; Healthcare-associated infection; Outbreak; Infection control
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-020-00848-w

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents an unprecedented healthcare challenge. Various SARS-CoV-2 outbreaks in healthcare facilities have been reported. Healthcare workers (HCWs) may play a critical role in the spread of the virus, particularly when asymptomatic. We examined four healthcare-associated outbreaks of SARS-CoV-2 infections that occurred at a university hospital in Berlin, Germany. We aimed to describe and analyze the spread of the virus in order to draw conclusions for effective containment of SARS-CoV-2 in healthcare facilities.
Healthcare-associated outbreaks of SARS-CoV-2 infections were defined as two or more laboratory confirmed infections with SARS-CoV-2 where an epidemiological link within the healthcare setting appeared likely. We focused our analysis on one of three sites of the Charité-University Medicine hospital within a 2 month period (March and April 2020).
We observed four healthcare-associated outbreaks of SARS-CoV-2 infections, with a total of 24 infected persons (23 HCWs and one patient). The outbreaks were detected in the departments of nephrology and dialysis (n = 9), anesthesiology (n = 8), surgical pediatrics (n = 4), and neurology (n = 3). Each outbreak showed multiple unprotected contacts between infected HCWs. A combination of contact tracing, testing, physical distancing and mandatory continuous wearing of face masks by all HCWs was able to contain all four outbreaks.
HCW to HCW transmission represented the likely source of the four outbreaks. Ensuring proper physical distancing measures and wearing of protective equipment, also when interacting with colleagues, must be a key aspect of fighting COVID-19 in healthcare facilities.