A novel cohorting and isolation strategy for suspected COVID-19 cases during a pandemic.
Aged
Aged, 80 and over
Betacoronavirus
/ isolation & purification
COVID-19
Cohort Studies
Coronavirus Infections
/ diagnosis
Cross Infection
/ prevention & control
Female
Guidelines as Topic
Humans
London
Male
Middle Aged
Pandemics
/ prevention & control
Pneumonia, Viral
/ diagnosis
SARS-CoV-2
Triage
/ standards
COVID-19
Cohorting
Infection prevention and control
Pandemic
Risk stratification
Triage
Journal
The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
05
05
2020
accepted:
26
05
2020
pubmed:
3
6
2020
medline:
22
8
2020
entrez:
3
6
2020
Statut:
ppublish
Résumé
The COVID-19 pandemic presents a significant infection prevention and control challenge. The admission of large numbers of patients with suspected COVID-19 disease risks overwhelming the capacity to protect other patients from exposure. The delay between clinical suspicion and confirmatory testing adds to the complexity of the problem. We implemented a triage tool aimed at minimizing hospital-acquired COVID-19 particularly in patients at risk of severe disease. Patients were allocated to triage categories defined by likelihood of COVID-19 and risk of a poor outcome. Category A (low-likelihood; high-risk), B (high-likelihood; high-risk), C (high-likelihood; low-risk) and D (low-likelihood; low-risk). This determined the order of priority for isolation in single-occupancy rooms with Category A the highest. Patients in other groups were cohorted when isolation capacity was limited with additional interventions to reduce transmission. Ninety-three patients were evaluated with 79 (85%) receiving a COVID-19 diagnosis during their admission. Of those without a COVID-19 diagnosis: 10 were initially triaged to Category A; 0 to B; 1 to C and 4 to D. All high-risk patients requiring isolation were, therefore, admitted to single-occupancy rooms and protected from exposure. Twenty-eight (30%) suspected COVID-19 patients were evaluated to be low risk (groups C and D) and eligible for cohorting. No symptomatic hospital-acquired infections were detected in the cohorted patients. Application of a clinical triage tool to guide isolation and cohorting decisions may reduce the risk of hospital-acquired transmission of COVID-19 especially to individuals at the greatest of risk of severe disease.
Sections du résumé
BACKGROUND
BACKGROUND
The COVID-19 pandemic presents a significant infection prevention and control challenge. The admission of large numbers of patients with suspected COVID-19 disease risks overwhelming the capacity to protect other patients from exposure. The delay between clinical suspicion and confirmatory testing adds to the complexity of the problem.
METHODS
METHODS
We implemented a triage tool aimed at minimizing hospital-acquired COVID-19 particularly in patients at risk of severe disease. Patients were allocated to triage categories defined by likelihood of COVID-19 and risk of a poor outcome. Category A (low-likelihood; high-risk), B (high-likelihood; high-risk), C (high-likelihood; low-risk) and D (low-likelihood; low-risk). This determined the order of priority for isolation in single-occupancy rooms with Category A the highest. Patients in other groups were cohorted when isolation capacity was limited with additional interventions to reduce transmission.
RESULTS
RESULTS
Ninety-three patients were evaluated with 79 (85%) receiving a COVID-19 diagnosis during their admission. Of those without a COVID-19 diagnosis: 10 were initially triaged to Category A; 0 to B; 1 to C and 4 to D. All high-risk patients requiring isolation were, therefore, admitted to single-occupancy rooms and protected from exposure. Twenty-eight (30%) suspected COVID-19 patients were evaluated to be low risk (groups C and D) and eligible for cohorting. No symptomatic hospital-acquired infections were detected in the cohorted patients.
DISCUSSION
CONCLUSIONS
Application of a clinical triage tool to guide isolation and cohorting decisions may reduce the risk of hospital-acquired transmission of COVID-19 especially to individuals at the greatest of risk of severe disease.
Identifiants
pubmed: 32485197
pii: S0195-6701(20)30275-9
doi: 10.1016/j.jhin.2020.05.035
pmc: PMC7261079
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
632-637Informations de copyright
Copyright © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Références
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N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Nat Med. 2020 May;26(5):672-675
pubmed: 32296168