Skip to main content
Top
Published in: Antimicrobial Resistance & Infection Control 1/2020

Open Access 01-12-2020 | SARS-CoV-2 | Research

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

Authors: Sandra Schneider, Brar Piening, Pauline Assina Nouri-Pasovsky, Anne Caroline Krüger, Petra Gastmeier, Seven Johannes Sam Aghdassi

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2020

Login to get access

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.
Literature
1.
go back to reference The 2019-nCoV Outbreak Joint Field Epidemiology Investigation Team, Li Q. Notes from the field: an outbreak of NCIP (2019-nCoV) infection in China—Wuhan, Hubei Province, 2019–2020. China CDC Wkly. 2020;2(5):79–80.CrossRef The 2019-nCoV Outbreak Joint Field Epidemiology Investigation Team, Li Q. Notes from the field: an outbreak of NCIP (2019-nCoV) infection in China—Wuhan, Hubei Province, 2019–2020. China CDC Wkly. 2020;2(5):79–80.CrossRef
2.
go back to reference Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199–207.CrossRef Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199–207.CrossRef
3.
go back to reference Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–44.CrossRef Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–44.CrossRef
5.
go back to reference Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med. 2020;382(10):970–1.CrossRef Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med. 2020;382(10):970–1.CrossRef
9.
go back to reference Yu P, Zhu J, Zhang Z, Han Y, Huang L. A familial cluster of infection associated with the 2019 novel coronavirus indicating potential person-to-person transmission during the incubation period. J Infect Dis. 2020;221(11):1757–61.CrossRef Yu P, Zhu J, Zhang Z, Han Y, Huang L. A familial cluster of infection associated with the 2019 novel coronavirus indicating potential person-to-person transmission during the incubation period. J Infect Dis. 2020;221(11):1757–61.CrossRef
10.
go back to reference Danzmann L, Gastmeier P, Schwab F, Vonberg RP. Health care workers causing large nosocomial outbreaks: a systematic review. BMC Infect Dis. 2013;13:98.CrossRef Danzmann L, Gastmeier P, Schwab F, Vonberg RP. Health care workers causing large nosocomial outbreaks: a systematic review. BMC Infect Dis. 2013;13:98.CrossRef
11.
go back to reference Vonberg RP, Stamm-Balderjahn S, Hansen S, Zuschneid I, Ruden H, Behnke M, et al. How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation. Infect Control Hosp Epidemiol. 2006;27(10):1123–7.CrossRef Vonberg RP, Stamm-Balderjahn S, Hansen S, Zuschneid I, Ruden H, Behnke M, et al. How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation. Infect Control Hosp Epidemiol. 2006;27(10):1123–7.CrossRef
12.
go back to reference Jorstad OK, Moe MC, Eriksen K, Petrovski G, Bragadottir R. Coronavirus disease 2019 (COVID-19) outbreak at the Department of Ophthalmology, Oslo University Hospital, Norway. Acta Ophthalmol. 2020;98(3):e388–9.CrossRef Jorstad OK, Moe MC, Eriksen K, Petrovski G, Bragadottir R. Coronavirus disease 2019 (COVID-19) outbreak at the Department of Ophthalmology, Oslo University Hospital, Norway. Acta Ophthalmol. 2020;98(3):e388–9.CrossRef
13.
go back to reference McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epidemiology of Covid-19 in a long-term care facility in King County, Washington. N Engl J Med. 2020;382(21):2005–11.CrossRef McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epidemiology of Covid-19 in a long-term care facility in King County, Washington. N Engl J Med. 2020;382(21):2005–11.CrossRef
14.
go back to reference Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet. 2020;395(10234):1418–20.CrossRef Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet. 2020;395(10234):1418–20.CrossRef
15.
go back to reference Schwierzeck V, Correa-Martinez CL, Schneider KN, Mellmann A, Hennies MT, Hafezi W, et al. SARS-CoV-2 in the employees of a large university hospital. Dtsch Arztebl Int. 2020;117(19):344–5.PubMedPubMedCentral Schwierzeck V, Correa-Martinez CL, Schneider KN, Mellmann A, Hennies MT, Hafezi W, et al. SARS-CoV-2 in the employees of a large university hospital. Dtsch Arztebl Int. 2020;117(19):344–5.PubMedPubMedCentral
17.
go back to reference Kerwat K, Just M, Wulf H. The German Protection against Infection Act (Infektionsschutzgesetz (IfSG)). Anasthesiol Intensivmed Notfallmed Schmerzther. 2009;44(3):182–3.CrossRef Kerwat K, Just M, Wulf H. The German Protection against Infection Act (Infektionsschutzgesetz (IfSG)). Anasthesiol Intensivmed Notfallmed Schmerzther. 2009;44(3):182–3.CrossRef
18.
go back to reference Rosen MA, DiazGranados D, Dietz AS, Benishek LE, Thompson D, Pronovost PJ, et al. Teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol. 2018;73(4):433–50.CrossRef Rosen MA, DiazGranados D, Dietz AS, Benishek LE, Thompson D, Pronovost PJ, et al. Teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol. 2018;73(4):433–50.CrossRef
19.
go back to reference Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med. 2020;27(2):20.CrossRef Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med. 2020;27(2):20.CrossRef
20.
go back to reference Bell DM. World Health Organization Working Group on Prevention of International and Community Transmission of SARS. Public Health Interventions and SARS Spread, 2003. Emerg Infect Dis. 2004;10(11):1900–6.CrossRef Bell DM. World Health Organization Working Group on Prevention of International and Community Transmission of SARS. Public Health Interventions and SARS Spread, 2003. Emerg Infect Dis. 2004;10(11):1900–6.CrossRef
21.
go back to reference Lewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect Dis. 2020;20(6):631–3.CrossRef Lewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect Dis. 2020;20(6):631–3.CrossRef
22.
go back to reference Cowling BJ, Zhou Y, Ip DK, Leung GM, Aiello AE. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiol Infect. 2010;138(4):449–56.CrossRef Cowling BJ, Zhou Y, Ip DK, Leung GM, Aiello AE. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiol Infect. 2010;138(4):449–56.CrossRef
23.
go back to reference MacIntyre CR, Cauchemez S, Dwyer DE, Seale H, Cheung P, Browne G, et al. Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis. 2009;15(2):233–41.CrossRef MacIntyre CR, Cauchemez S, Dwyer DE, Seale H, Cheung P, Browne G, et al. Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis. 2009;15(2):233–41.CrossRef
24.
go back to reference Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med. 2020;8(5):434–6.CrossRef Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med. 2020;8(5):434–6.CrossRef
Metadata
Title
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
Authors
Sandra Schneider
Brar Piening
Pauline Assina Nouri-Pasovsky
Anne Caroline Krüger
Petra Gastmeier
Seven Johannes Sam Aghdassi
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2020
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-020-00848-w

Other articles of this Issue 1/2020

Antimicrobial Resistance & Infection Control 1/2020 Go to the issue