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COVID-19 outbreak and genomic investigation in an inpatient behavioral health unit
Estefany Rios-Guzman1,2, Alina G Stancovici3, Lacy M Simons1,2
1Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Insights
During the Omicron surge, a COVID-19 outbreak in a behavioral health unit (BHU) involved 35 healthcare workers and 8 inpatients. Mitigation strategies, including testing and reduced socialization, helped control transmission and minimize patient care disruptions.
Area of Science:
- Infectious Disease Epidemiology
- Public Health
- Healthcare Management
Background:
- Inpatient behavioral health units (BHUs) face unique challenges in mitigating COVID-19 transmission due to social interactions.
- Understanding transmission routes and intervention efficacy is crucial for controlling outbreaks in these settings.
Purpose of the Study:
- To identify SARS-CoV-2 transmission routes during an inpatient BHU outbreak.
- To evaluate the effectiveness of mitigation strategies implemented during the Omicron surge (December 2021-January 2022).
Main Methods:
- Conducted an outbreak investigation following the identification of COVID-19 cases.
- Implemented weekly point prevalence testing for inpatients, healthcare workers (HCWs), and staff.
- Utilized whole-genome sequencing for phylogenetic analysis to trace transmission sources and employed molecular surveillance.
Main Results:
- Identified 35 HCWs and 8 inpatients with COVID-19 between December 16, 2021, and January 17, 2022.
- Phylogenetic analysis revealed three distinct SARS-CoV-2 transmission clusters, suggesting multiple introductions and inpatient spread in communal areas.
- Outbreaks were linked to staff and an inpatient visitor.
Conclusions:
- Multiple SARS-CoV-2 introductions and transmission in communal settings likely fueled the outbreak.
- Implemented control measures, including enhanced PPE, limited socialization, and molecular surveillance, effectively minimized patient care disruptions.
- The developed outbreak control plan serves as a model for future pandemic preparedness in BHUs.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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