Infection control;

What’s the connection between break rooms and transmission of Covid-19 in health care settings?

FA Manian MD, MPH, , , , , , , , , , Leave a comment

Emerging data suggest that healthcare workers (HCWs) may be at increased risk of Covid-19 in break rooms when consuming food or when in the presence of others without a mask.1-4

In a study of over 700 HCWs screened for SARS-CoV-2 by PCR at a university hospital, staying in the same personnel break room as an HCW without a medical mask for more than 15 min and consuming food within 1 meter of an HCW were significantly associated with SARS-CoV-2 infection.1 Consumption of food in break rooms by personnel was thereafter “forbidden” in this facility. Interestingly, 28% of infected personnel in this study lacked symptoms at the time of testing.

A recent outbreak at a Boston hospital involving both patients and HCWs months after institution of strict infection control measures (including universal masking of visitors and HCWs and PCR testing of all patients on admission) traced the outbreak to a variety of factors, including HCWs eating in crowded work rooms.2,3

A CDC study of risk factors among adults 18 years or older with Covid-19 in the community identified dining at a restaurant as significant risk factors for Covid-19.4

Transmission of SARS-CoV-2 during eating or drinking is not surprising because masks cannot be effectively worn during food consumption. Combine eating or drinking with talking, laughing and suboptimal ventilation system and we have all the elements of perfect storm for transmission of Covid-19 during food breaks.

Bonus Pearl: Did you know that, in addition to dining at a restaurant, patients with Covid-19 without known close contact with infected persons have reported higher likelihood of going to bar/coffee shop? 4

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References

 

  1. Celebi G, Piskin N, Beklevic AC, et al. Specific risk factors for SARS-CoV-2 transmission among health care workers in a university hospital. Am J Infect Control 2020;48:1225-30. https://pubmed.ncbi.nlm.nih.gov/32771498/
  2. Freyer FJ. Brigham and Women’s hospital completes investigation of coronavirus outbreak. Boston Globe, October 19, 2020. https://www.bostonglobe.com/2020/10/19/metro/brigham-womens-hospital-completes-investigation-coronavirus-outbreak/
  3. Freyer FJ. At the Brigham, “battle-weary” staff may have allowed virus to slip in. Boston Globe, September 24, 2020. https://www.bostonglobe.com/2020/09/24/metro/brigham-womens-hospital-reports-cluster-10-covid-19-cases/
  4. Fisher KA, Tenforde MW, Felstein LR, et al. Community and close contact exposures associated with COVID-19 among symptomatic adults ≥18 years in 11 outpatient health care facilities—United States, July 2020. MMWR 2020;69:1258-64. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499837/

Disclosures: The listed questions and answers are solely the responsibility of the author and do not necessarily represent the official views of Mercy Hospital-St. Louis or its affiliates. Although every effort has been made to provide accurate information, the author is far from being perfect. The reader is urged to verify the content of the material with other sources as deemed appropriate and exercise clinical judgment in the interpretation and application of the information provided herein. No responsibility for an adverse outcome or guarantees for a favorable clinical result is assumed by the author. Thank you!

 

 

What’s the connection between break rooms and transmission of Covid-19 in health care settings?

Can I use fist bump when I greet my patients or coworkers in the hospital?

FA Manian MD, MPH, , , , , , Leave a comment

Fist bump may be a safer practice than handshake with respect to transfer of potential pathogens but should not be considered a “safe”’ alternative. Studies to date have demonstrated transfer of bacteria even with fist bump, albeit often at lower counts. 1-3

In an experimental study involving healthcare workers in a hospital,1 fist bump was still associated with bacterial colonization, albeit at levels 4 times less than that of palmar surfaces following handshakes. Smaller contact surface area and reduced total contact time were thought to contribute to lower risk of bacterial transfer via fist bump.

In another experiment involving E. coli, fist bump was associated with ~75% less transfer of bacteria relative to “moderate handshake”.2

Interestingly, in a 2020 study of 50 methicillin-resistant Staphylococcus aureus (MRSA)-colonized patients,3 the rate of MRSA isolated from the fist after a fist bump was not significantly lower than that of the dorsal surface of the hand after a handshake (16% vs 22%, P=0.6).  

In contrast, “cruise tap”, defined as contact between 2 knuckles alone, may be safer than fist bump. In the MRSA study above, cruise tap was associated with significantly lower rate of bacterial transfer compared to handshakes (8% vs 22%, P=0.02).3

Even a safer alternative is to avoid skin-to-skin contact altogether by using elbow bump, or no “bump” at all, particularly in the Covid-19 era!

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References

  1. Ghareeb PA, Bourlai T, Dutton W, et al. Reducing pathogen transmission in a hospital setting. Handshake verses fist bump: a pilot study. https://pubmed.ncbi.nlm.nih.gov/24144553/
  2. Mela S, Withworth DE. The fist bump: A more hygienic alternative to the handshake. Am J Infect Control 2014;42:916-7. http://www.apic.org/Resource_/TinyMceFileManager/Fist_bump_article_AJIC_August_2014.pdf
  3. Pinto-Herrera NC, Jones LD, Ha W, et al. Transfer of methicillin-resistant Staphylococcus aureus by first bump versus handshake. Infect Control Hospital Epidemiology 2020;41:962-64. https://pubmed.ncbi.nlm.nih.gov/32456719/

 

Disclosures: The listed questions and answers are solely the responsibility of the author and do not necessarily represent the official views of Massachusetts General Hospital, Harvard Catalyst, Harvard University, its affiliate academic healthcare centers, or its contributors. Although every effort has been made to provide accurate information, the author is far from being perfect. The reader is urged to verify the content of the material with other sources as deemed appropriate and exercise clinical judgment in the interpretation and application of the information provided herein. No responsibility for an adverse outcome or guarantees for a favorable clinical result is assumed by the author. Thank you!

Can I use fist bump when I greet my patients or coworkers in the hospital?