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COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services (25 January 2020-15 November 2020)

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COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services (25 January 2020-15 November 2020) COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services (25 January 2020-15 November 2020) Full report OFFICIAL 2 | COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services - June 2021 COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services (25 January 2020-15 November 2020) Full report OFFICIAL 3 | COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services - June 2021 To receive this document in another format, phone +61 (03) 9096 0000, using the National Relay Service 13 36 77 if required, or email the Victorian Department of Health <[email protected]>. Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Australia, Department of Health, June 2021. Except where otherwise indicated, the images in this document show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. This document may contain images of deceased Aboriginal and Torres Strait Islander peoples. In this document, ‘Aboriginal’ refers to both Aboriginal and Torres Strait Islander people. ‘Indigenous’ or ‘Koori/Koorie’ is retained when part of the title of a report, program or quotation. ISBN 978-1-76096-455-9 (pdf/online/MS word) Available at the Victorian COVID-19 Website <https://www.coronavirus.vic.gov.au/additional-covid-19- case-data#cases-in-hospital> OFFICIAL 4 | COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services - June 2021 Suggested citation: Veale, H. J.1, Dale, K. 1, Ampt, F. 1,10, Kalman, T. 1, Kaufman, C. 1, Gibson, E. 1,6,9, Carville, K. 1,5, Harper, C.1,12, Ahmed, H. 1, Pehm, M. 1,13, Bull, A. 2, Brett, J. 2, Worth, L. 2, Sherry, N. L. 3,11, Leeb, K. 1, Cheng, A.1,7,8, Rowe., S. L. 1 (2021). COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services (25 January 2020- 15 November 2020). Victorian Department of Health. * Authors Veale and Dale contributed equally to this report. This work was guided by the COVID-19 Hospital-Acquired Infections Working Group: Prof Brett Sutton1 Prof Allen Cheng1, 7, 8 Nicola Quin1 Ben Fielding1 Kira Leeb1 Dr Frances Ampt1, 10 Stacey Rowe1 Tali Kalman1 Hilary Veale1 Kylie Carville1,5 Claire Boardman1,7 Judy Sutherland1 Dr Ann Bull2 Judy Brett2 A/Prof Leon Worth2 Dr Norelle Sherry3,11 Angela Nolan4 Affiliations: 1 Victorian Department of Health, Melbourne, Australia 2 Victorian Healthcare Associated Infections Surveillance System, Melbourne, Australia 3 Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne 4 St Vincent’s Hospital, Melbourne, Australia 5 Doherty Institute for Immunity and Infection, Melbourne, Australia 6 Geelong Centre for Emerging Infectious Disease, Geelong, Australia 7 Monash University, Melbourne, Australia 8 Alfred Health, Melbourne, Australia 9 Deakin University, Geelong, Australia 10 Burnet Institute, Melbourne, Australia 11 Austin Health, Melbourne, Australia 12 Queensland University of Technology, Queensland, Australia 13 The Royal Women’s Hospital, Melbourne, Australia OFFICIAL 5 | COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services - June 2021 Contents Abbreviations & Acronyms .................................................................................................................... 7 Key Findings ......................................................................................................................................... 8 Introduction ........................................................................................................................................... 9 Purpose ............................................................................................................................................... 10 Methods............................................................................................................................................... 10 Results ................................................................................................................................................ 14 Case study 1: The risk of ‘unrecognised cases’ ................................................................................. 37 Case study 2: PPE use is not always perfect ..................................................................................... 38 Discussion ........................................................................................................................................... 39 Conclusion .......................................................................................................................................... 43 Acknowledgements ............................................................................................................................. 44 References .......................................................................................................................................... 45 Appendix 1: Definitions of C19-HAIs diagnosed during hospital stay ................................................ 49 Appendix 2: Definitions of C19-HAIs diagnosed post-discharge ........................................................ 50 Appendix 3: Facilitated discussion attendee brief .............................................................................. 52 Appendix 4: Victorian Hospitals with C19-HAIs .................................................................................. 55 OFFICIAL 6 | COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services - June 2021 List of figures Figure 1: Selection process for patients with definite and probable C19-HAIs ........................................... 15 Figure 2: Timeline of COVID-19 cases in Victoria (25 January 2020- 15 November 2020), stratified by hospitalisation and healthcare acquisition .................................................................................................. 17 Figure 3: Age distribution of COVID- 19 cases, by hospitalisation and C19-HAI status ............................ 18 Figure 4: Prevalence of COVID-19 infections per 100,000 people/km2 and location of hospitals with C19- HAIs in metropolitan Melbourne .................................................................................................................. 22 Figure 5: C19-HAI cases by genomic cluster and hospital* ........................................................................ 26 List of tables Table 1: Results of assessment process for patients with C19-HAIs diagnosed between 25 January 2020 and 15 November 2020 ............................................................................................................................... 16 Table 2: C19-HAIs by hospitalisation status and timing of diagnosis ......................................................... 16 Table 3: Demographic characteristics and outcomes of patients with C19-HAIs and patients hospitalised with community-acquired COVID-19; number (column per cent) unless specified .................................... 19 Table 4: Definite and probable C19-HAIs in patients, by hospital and health service (25 January to 15 November 2020; ordered by number of C19-HAI cases per health service). ............................................. 21 Table 5: Definite and probable C19-HAIs, by Department of Health region and hospital type, 25 January 2020 to 15 November 2020......................................................................................................................... 22 Table 6: Characteristics of hospitals unaffected, affected and highly affected by C19-HAIs, Victoria 2020; median (range) unless specified. ................................................................................................................ 23 Table 7: Genomic clustering for C19-HAI patients, by hospital (25 January to 15 November 2020) ......... 25 Table 8: Examples of possible chains of transmission for C19-HAI patients ............................................. 27 Table 9: Patient factors relevant to C19-HAIs............................................................................................. 30 Table 10: Infrastructure limitations relevant to C19-HAIs ........................................................................... 32 Table 11: Resource/technology factors relevant to C19-HAIs .................................................................... 33 Table 12: Staff factors ................................................................................................................................. 34 Table 13: Broader pandemic, social and political context ........................................................................... 35 Table 14: Summary of instrumental strategies and 'lessons learnt' by participating health services ......... 36 Table 15: Summary of suggestions by health services for improvement in State responses .................... 36 OFFICIAL 7 | COVID-19 Hospital-Acquired Infections Among Patients in Victorian Health Services - June 2021 Abbreviations & Acronyms AGB Aerosol Generating Behaviours AV Ambulance Victoria C19-HAI COVID-19 Hospital- Acquired Infections CALD Culturally and Linguistically Diverse CHO Chief Health Officer COVID-19 Coronavirus Disease 2019 (viral disease caused by SARS-CoV-2) CQV COVID-19 Quarantine Victoria The
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