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Infection control efforts in Hong Kong hospital prevented H7N9 transmission
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A bundle approach to infection control in a Hong Kong health care system was a significant factor in preventing the spread of influenza A(H7N9), even among health care workers with unprotected exposure to the virus, according to study results published in Infection Control and Hospital Epidemiology.
“The emergence of A(H7N9) influenza in March 2013 posed a public health threat both locally and internationally because of the risk for airborne transmission,” study researcher K.Y. Yuen, MD, of Queen Mary Hospital in Hong Kong, said in a press release. “Despite the delay in airborne precaution implementation, we suspect that high hand hygiene compliance, as a result of continuous implementation of proactive control measures against various viruses and multidrug-resistant organisms, protected frontline health care workers against many challenges of emerging infectious diseases.”
K. Y. Yuen
Yuen and colleagues assessed the effectiveness of specific proactive infection control measures established at the hospital in April 2013. These included:
- active and enhanced surveillance to identify suspected cases of H7N9 presenting to the hospital;
- early segregation of patients in an airborne infection isolation facility;
- rapid molecular diagnostic testing;
- and extensive contact tracing for exposed HCWs who were not wearing N95 respirators during aerosol-generating procedures.
From April 2013 through May 2014, 163,456 patients were admitted to the hospital. Of these, 126 were tested for H7N9 by reverse-transcription PCR, and two patients tested positive for the infection — one of whom was referred from a regional hospital.
Seventy of 130 HCWs in the study had unprotected exposure, but the majority wore surgical masks and practiced hand hygiene after patient care. Of those with unprotected exposure, 22.9% were involved with high-risk patient contacts. Most unprotected HCWs with high-risk patient contacts received oseltamivir (Tamiflu, Genentech) prophylaxis (P=.088) and had paired sera collected for H7 antibody testing (P<.001).
Although 14.3% of HCWs with unprotected exposure developed influenza-like illness, none tested positive for H7N9 infection.
Yuen and colleagues noted that the lack of nosocomial transmission of H7N9 may represent the “intrinsic characteristic of the virus” and not the intervention. The researchers believe, however, their hospital is now better prepared for emerging or unknown diseases than in 1997 during the influenza A(H5N1) outbreak.
“As we look at lessons learned from this outbreak, the high false-positive screening rate and other delays in diagnosis may have resulted in unprotected exposure of frontline staff,” Yuen said. “However, enhanced surveillance methods appeared to be an important safety net for the detection of [H7N9].”
Disclosure: The researchers report no relevant financial disclosures.
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