{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:05:16Z","timestamp":1787681116256,"version":"build-2784847793"},"reference-count":27,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X20014373_as1\"><jats:title>Objective:<\/jats:title><jats:p>We sought to contain a healthcare-associated coronavirus disease 2019 (COVID-19) outbreak, to evaluate contributory factors, and to prevent future outbreaks.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20014373_as2\"><jats:title>Design:<\/jats:title><jats:p>Quasi-experimental cluster-control outbreak evaluation.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20014373_as3\"><jats:title>Methods:<\/jats:title><jats:p>All patients and staff on the outbreak ward (case cluster), and randomly selected patients and staff on COVID-19 wards (positive control cluster) and a non-COVID-19 wards (negative control cluster) underwent reverse-transcriptase polymerase chain reaction (RT-PCR) testing. Hand hygiene and personal protective equipment (PPE) compliance, detection of environmental SARS-COV-2 RNA, patient behavior, and SARS-CoV-2 IgG antibody prevalence were assessed.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20014373_as4\"><jats:title>Results:<\/jats:title><jats:p>In total, 145 staff and 26 patients were exposed, resulting in 24 secondary cases. Also, 4 of 14 (29%) staff and 7 of 10 (70%) patients were asymptomatic or presymptomatic. There was no difference in mean cycle threshold between asymptomatic or presymptomatic versus symptomatic individuals. None of 32 randomly selected staff from the control wards tested positive. Environmental RNA detection levels were higher on the COVID-19 ward than on the negative control ward (OR, 19.98; 95% CI, 2.63\u2013906.38; <jats:italic>P<\/jats:italic> &lt; .001). RNA levels on the COVID-19 ward (where there were no outbreaks) and the outbreak ward were similar (OR, 2.38; <jats:italic>P<\/jats:italic> = .18). Mean monthly hand hygiene compliance, based on 20,146 observations (over preceding year), was lower on the outbreak ward (<jats:italic>P<\/jats:italic> &lt; .006). Compared to both control wards, the proportion of staff with detectable antibodies was higher on the outbreak ward (OR, 3.78; 95% CI, 1.01\u201314.25; <jats:italic>P =<\/jats:italic> .008).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20014373_as5\"><jats:title>Conclusion:<\/jats:title><jats:p>Staff seroconversion was more likely during a short-term outbreak than from sustained duty on a COVID-19 ward. Environmental contamination and PPE use were similar on the outbreak and control wards. Patient noncompliance, decreased hand hygiene, and asymptomatic or presymptomatic transmission were more frequent on the outbreak ward.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2020.1437","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T22:51:29Z","timestamp":1610491889000},"page":"1333-1339","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":10,"title":["A cluster-control approach to a coronavirus disease 2019 (COVID-19) outbreak on a stroke ward with infection control considerations for dementia and vascular units"],"prefix":"10.1017","volume":"42","author":[{"given":"Emil P.","family":"Lesho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward E.","family":"Walsh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Gutowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Reno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Newhart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Bress","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa Z.","family":"Bronstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"S0899823X20014373_ref9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2008457"},{"key":"S0899823X20014373_ref8","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000000744"},{"key":"S0899823X20014373_ref20","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.151"},{"key":"S0899823X20014373_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30211-7"},{"key":"S0899823X20014373_ref24","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6919e6"},{"key":"S0899823X20014373_ref27","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1495"},{"key":"S0899823X20014373_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3"},{"key":"S0899823X20014373_ref5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1585"},{"key":"S0899823X20014373_ref21","doi-asserted-by":"publisher","DOI":"10.3201\/eid2606.200495"},{"key":"S0899823X20014373_ref25","doi-asserted-by":"publisher","DOI":"10.21037\/atm-20-3324"},{"key":"S0899823X20014373_ref17","doi-asserted-by":"publisher","DOI":"10.7326\/M20-3012"},{"key":"S0899823X20014373_ref13","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6914e1"},{"key":"S0899823X20014373_ref18","unstructured":"18. Interim US guidance for risk assessment and work restrictions for healthcare personnel with potential exposure to COVID-19. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/guidance-risk-assesment-hcp.html. Published 2020. Accessed October 20, 2020."},{"key":"S0899823X20014373_ref3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.6775"},{"key":"S0899823X20014373_ref15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2001801"},{"key":"S0899823X20014373_ref10","first-page":"377","article-title":"Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility\u2014King County, Washington, March 2020","volume":"2020","author":"Kimball","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0899823X20014373_ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.5394"},{"key":"S0899823X20014373_ref16","doi-asserted-by":"publisher","DOI":"10.3201\/eid2605.200198"},{"key":"S0899823X20014373_ref2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1966"},{"key":"S0899823X20014373_ref22","unstructured":"22. Kay, J. COVID-19 superspreader events in 28 countries: critical patterns and lessons. Quillette website. https:\/\/quillette.com\/2020\/04\/23\/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons\/. Published 2020. Accessed October 20, 2020."},{"key":"S0899823X20014373_ref11","first-page":"100533","article-title":"Investigation of SARS-CoV-2 outbreaks in six care homes in London, April 2020","volume":"26","author":"Ladhani","year":"2020","journal-title":"EClin Med"},{"key":"S0899823X20014373_ref19","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.231"},{"key":"S0899823X20014373_ref14","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0869-5"},{"key":"S0899823X20014373_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2020.04.037"},{"key":"S0899823X20014373_ref1","unstructured":"1. Vanhems, P. Multicenter study on nosocomial transmission of SARS-CoV-2 virus. National Institutes of Health website. https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04290780. Published 2020. Accessed October 20, 2020."},{"key":"S0899823X20014373_ref12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa491"},{"key":"S0899823X20014373_ref23","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1016\/S0140-6736(20)30462-1","article-title":"Secondary attack rate and superspreading events for SARS-CoV-2","volume":"395","author":"Lui","year":"2020","journal-title":"Lancet"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X20014373","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T13:51:23Z","timestamp":1636725083000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X20014373\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,11]]},"references-count":27,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["S0899823X20014373"],"URL":"https:\/\/doi.org\/10.1017\/ice.2020.1437","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,11]]},"assertion":[{"value":"\u00a9 The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}