Brigham and Women’s COVID-19 clusters present challenges in infection control

The lesson from Baystate is surprisingly similar to the emerging problem of the Brigham outbreak, which affected 19 employees and 9 patients as of Friday. They present the general challenges that hospitals face in controlling wise and unfamiliar enemies.

Springfield Hospitals have learned that the use of masks and eye protection needs to be carefully monitored to ensure that workers report even mild symptoms and have ample space for meals and gatherings without congestion. ..

“A big part of this is leadership and culture,” Salvador said.

The virus is spreading in conferences, weddings, churches, bars, prisons, homeless shelters, and more. However, despite being filled with sick and enthusiastic activities, outbreaks are rarely seen in hospitals and can usually occur quickly.

But such events clearly occur, including in Massachusetts.

In addition to Baystate and Brigham, small clusters occurred at Tufts Medical Center in the spring, but have not occurred since then. In addition, the Beth Israel Dicones Medical Center / Plymouth has a cluster affecting 12 patients and 16 staff this month, with no new cases since September 12. The New England Baptist Hospital is also competing with a recent cluster of 5 patients and 19 staff. No new cases have been seen since Wednesday.

“The hospital is a really safe place, especially compared to many places people go to,” said Dr. Shira I. Delon, an infectious disease doctor and hospital epidemiologist at Tufts Medical Center. The number of occurrences is “Millions and millions of people were admitted to hospitals during the pandemic process.”

Brigham’s cluster was recognized last week after employees and patients tested positive, and the infection spread among other patients and staff working in two units at the Braunwald Tower.

In Baystate, outbreaks began between groups of employees and then spread to patients. Just as Brigham and Women’s employees thought they had allergic symptoms, many of them began to work with mild symptoms caused by others.

“You need to change the culture of medicine. 150 years of doctors and nurses believed they couldn’t disappoint patients and colleagues. We’re always We have considered that virtue, “said Salvador.

Since the outbreak, Baystate said hospital officials have been pleased with the increase in the number of people calling due to illness.

so A series of tweets On Friday, Brigham resident Dr. Neharimei pointed out an employee’s disability.

“At many hospitals,” she wrote, “it can still take up to 72 hours to get test results. While waiting for results, I missed up to three days of work and told other members of the team. It can be burdensome and affect the care of the patient.

Another aspect of humanity that adversely affects infection control efforts, according to Salvador, is a phenomenon called “drift.” You may lose sight of the real risk because you avoid infection by following safe habits. A slight deviation from the infection control protocol will be normal, like driving 72 mph in a zone of 65 mph. “I drove 72, and I didn’t collide. Now I’m going to drive 90,” Salvador said.

By July, the COVID-19 surge in Massachusetts had eased. There are no COVID-19 patients in the hospital. “People made things a little more comfortable,” Salvador said. “Some infection control measures included wearing face masks and social distances.”

“I found it difficult to wear a mask all day on the shift,” he said. Sometimes people pushed them down and breathed.

This was an even bigger problem during meal breaks, and workers obviously had to remove their masks to eat, but they might not have always had room to be six feet away.

Baystate now requires managers to visit hospitals on a regular basis to record all observations and record them in the app. This will prompt the manager to fix the problem and allow the hospital to detect signs of “drift”.

“Most of this is vigilant. Did we live in that safe space or did we drift?” Salvador said.

According to Doron, Tufts unexpectedly tested outpatients positive for COVID-19. “We asked everyone in contact with the person if they wore masking and eye protection,” Delon said. When it became clear that everyone had done so, “everyone began to experience that sigh of relief,” strengthening the importance of those measures.

However, finding a space for employees to get together, hold meetings, and eat without getting too close was a big challenge.

Dr. Sharon Wright, Senior Medical Director for Infection Control and Hospital Epidemiology at Beth Israel Deaconess, said in an email.

Salvador said in Bay State that the administration sought “every corner and metamorphosis that could be used to free up more space for work and food.” Once the meeting is virtualized, the meeting room can be reused as a break room. The tent was set up outdoors for a break, but it cannot last until after November.

Hospital leaders use Tufts to tape measure from the break room to the break room, put a sign on the door, and put a sticker on the furniture.

Another difficult cultural change, says Dr. David Weber, an infectious disease specialist at the University of North Carolina and a board member of the American Healthcare Epidemiology Association, is that all employees monitor each other and point out revocation. This includes encouraging lower-level workers to warn their superiors, for example, allowing surgeons to warn senior surgeons that the face shield is on top.

“Maintaining 100% compliance in 100% of the time is very difficult,” Weber said, but hospital outbreaks remain uncommon. “Expecting perfection in a hospital that you can’t expect anywhere else is not fair to society.”

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Felice J. Freyer [email protected].. Follow her on Twitter Azuki