Multipronged infection control strategy to achieve zero nosocomial coronavirus disease 2019 (COVID-19) cases among Hong Kong healthcare workers in the first 300 days of the pandemic

Abstract

Background: Nosocomial outbreaks leading to healthcare workers (HCWs) infection and death have been increasingly reported during the coronavirus disease 2019 (COVID-19) pandemic. An effective intervention is urgently needed to reduce nosocomial acquisition. Methods: We summarized our experience of multi-pronged infection control (IC) strategy in the first 300 days (December 31, 2019 to October 25, 2020) of COVID-19 era under the governance of Hospital Authority in Hong Kong. Results: Of 5,296 COVID-19 patients, 4,808 (90.8%) were diagnosed in the first (142 cases), second (896 cases), and third wave (3,770 cases) of COVID-19 in Hong Kong. Except for one patient who died before admission, all COVID-19 patients were admitted to public healthcare system which culminated to 78,834 COVID-19 patient-days. The median length of stay was 13 days (ranged, 1-128). Of 81,955 HCWs, thirty-eight (0.05%) HCWs [13 professional (2 doctors, 11 nurses) and 25 non-professional staff], had COVID-19. Except for 5 of 38 (13.2%) infected by HCW-to-HCW transmission in the non-clinical settings, no HCW had documented transmission from COVID-19 patients in the hospitals. The incidence of COVID-19 among HCWs was significantly lower than that of our general population (0.46 per 1,000 HCWs vs 0.71 per 1,000 population, p=0.008). The incidence of COVID-19 among professional staff was significantly lower than that of non-professional staff (0.30 vs 0.66 per 1,000 FTE, p=0.022). Conclusion: Hospital-based approach spared our healthcare service from being overloaded. No nosocomial COVID-19 in HCWs was found in the first 300 days of COVID-19 era in Hong Kong with our multi-pronged IC strategy.