Toronto Western struggles to contain outbreak
Staff attempt to find out why some hospitals are hit harder than others
The COVID-19 ward at Toronto Western Hospital has temporarily closed to new admissions, and is being relocated to a new floor in an attempt to get an outbreak under control.
It’s the sixth outbreak since April for the Dundas and Bathurst hospital, with 38 patients and 68 staff infected overall.
The unit, on the eighth floor, is adjacent to another unit where patients without COVID were being treated for general medical problems that don’t need surgery. So far, three of them have been infected, along with seven staff members. An eighth staff member tested positive Monday, but it’s not clear yet if they are connected to the outbreak, said Dr. Susy Hota, medical director of infection prevention and control at the University Health Network.
“We want to make sure that we have the COVID unit separated from other units,” she said, adding that the two areas were connected by a hallway, and staff shared a locker room. “Definitely having the two units close together, 8A and 8B, and the way that the staffing model has worked, it’s probably not a good way of doing it.”
New patients have been diverted to nearby Toronto General Hospital, also part of the University Health Network, in the meantime.
They’re also now trying hard to keep staffing “as dedicated as possible,” Hota said.
The decision was made shortly after the outbreak was declared on Oct. 15, she added.
The 8A unit, which had the COVID patients, has been “thoroughly cleaned,” and the new unit will eventually be opened up on a different floor. The few remaining COVIDpositive patients there have been moved into 8B until the new unit is ready, but they’re separated from the other patients, she said.
The idea behind having the two attached units was that if the first one was overwhelmed, staff could expand easily into the second. They also didn’t want to put too many COVID patients in the same room because of the “theoretical disadvantage in terms of transmission risk if you have a huge burden of COVID in one physical area.”
There were COVID patients in 8B during the first wave, Hota noted, but so far that has not been needed in the second. The team did also look at ventilation, but in this case “it’s more traditional outbreak I think, than anything weird and wonderful that we hadn’t thought of before,” she said.
There was also an outbreak at both 8A and 8B in late April, and it was declared over in midMay. There have been four other outbreaks at the Western, including one in the emergency department, but they were all declared over by June. There haven’t been any at the Toronto General Hospital.
A hospital outbreak is declared when there are two or more cases within 14 days and there’s reasonable concern that the infections happened within the hospital.
It’s “bizarre” how some hospitals, such as Toronto Western, which has had the second most outbreaks overall in Toronto, after St. Joseph’s Health Centre with seven, are seeing more outbreaks than others, Hota said.
While she said there have been more COVID-19 patients overall at Toronto Western (180 in-patients, including 30 ICU patients over the course of the pandemic), there have been periods of time where there have been more at Toronto General, “so that can’t be all of it.”
It could have to do with hospital culture, or physical layout, hence the move of the ward.
“We’re doing our due diligence with everything because we’re very aware of the fact that we’ve had outbreaks in the past at Toronto Western and here we are with another one,” Hota said. “Of course we’re doing what we normally would do, and then whatever else we can think of that could be contributing to it, we’re trying to look at as well.”
At St. Joseph’s Health Centre there are now two units with active outbreaks, said spokesperson Hayley Mick in an email. There are four patients with COVID connected to the outbreak, and one staff member. Two other outbreaks there were declared over on Oct. 23.
“St. Joseph’s remains a safe place to receive care and emergency services,” Mick said. “We have taken many measures to ensure this, including closing affected units to new admissions, further enhancing infection control procedures and adding the additional precaution of mandatory use of face shields at all times in clinical spaces.”
North York General Hospital is postponing non-emergency surgery after an outbreak was declared Sunday. “There are two staff members who tested positive for COVID-19 that appear to be linked,” the hospital said in a statement Monday. “There have not been any patient cases identified to date.” An investigation and contract tracing are underway, the hospital said.
The public should remember, Hota added, that while the word outbreak can sound scary, it only takes two cases within two weeks to declare one.