New outbreak at Toronto Western affects ER staff,
Latest infections cluster found after hospital widened testing of staff
“What is important is that people know that we are being very, very honest with them.”
DR. ERIN O’CONNOR DEPUTY MEDICAL DIRECTOR, UHN EMERGENCY DEPARTMENT
Toronto Western Hospital is declaring a fifth outbreak after five health-care workers from its emergency room tested positive for COVID-19, with the first case dating to three weeks ago, hospital officials have confirmed.
University Health Network, which includes Toronto Western, is using the newly published provincial definition for a COVID hospital outbreak, defined as at least two cases within a 14-day period where both could have “reasonably” acquired their infections in the hospital. There are more than a dozen active hospital outbreaks in the city now, but this is the first to involve emergency room staff, according to Toronto Public Health.
Dr. Erin O’Connor, deputy medical director for UHN’s emergency department, learned of the five ER cases Tuesday night, a day after she stressed to the Star that her ER was a safe place for patients, despite outbreaks in other parts of the hospital.
She said she still believes this to be true because of stringent controls that protect patients from health workers who could be infected. But the news that five of her colleagues have tested positive has been difficult to absorb.
“These are our colleagues and our friends and it’s certainly a worry for everyone,” O’Connor said Wednesday. “It really hits home when it’s your direct colleagues and people you see every day.
“It’s been a pretty upsetting 12 hours or so.”
In a memo sent to staff on Wednesday night, UHN said there is now mandatory testing for all emergency department staff, with employees who worked between April 20 and May 13 asked to go to a “rapid swabbing clinic.”
The memo said that although it is not always necessary to fully close a unit during an outbreak, measures being put into place include decluttering, enhanced cleaning, restricted traffic, and “PPE coaches” who will help staff with donning and doffing their personal protective equipment, physical distancing and “proper mask etiquette.”
The five ER cases include a mix of clinical and nonclinical staff, said Dr. Susy Hota, UHN’s medical director of infection prevention and control. Hota would not specify their exact roles, citing privacy concerns. O’Connor said none were among the 89 doctors or four physician’s assistants who report directly to her, though her department is also staffed by more than 130 employees including nurses and personal support workers.
Hota said she learned of the cluster Tuesday afternoon after it was flagged by the occupational health and safety department — even though the first case was during the week of April 20. Until last week, Hota had served as lead medical consultant to the occupational health team but said that department is now undergoing restructuring.
The employee tested negative for COVID despite having symptoms, Hota said. Retested later, as a part of broad screening efforts implemented by UHN in the wake of the recent COVID outbreaks, the employee was found to be positive.
The other cases were subsequently identified, with the most recent one turning up last week, Hota said. She declined to share specific dates for when each person was tested or when their individual results were confirmed, citing concerns it could identify them to their coworkers.
But she acknowledged the three-week lag between the first case and when hospital officials identified the cluster. “That’s quite a span of time of positive results coming in and I can’t really answer why it is that the delay occurred,” she said. “I’m not really sure why it played out the way it did and that’s being explored right now.”
Hota said at least four health workers were symptomatic when they tested positive, with investigations still underway for the fifth. One person was hospitalized but has since been discharged, she said.
Investigators are also looking into whether any patients may have been infected. But Hota said the risk to them is “quite low” because staff would have been wearing both a mask and face shield during patient interactions, in addition to practising other infection-control measures.
UHN believes it is now doing more staff testing than any other hospital, including of asymptomatic staff, so officials do expect to find more cases as long as COVID is circulating in the community.
So far, 3,743 staff tests have been performed at UHN with 97 of them — or 2.3 per cent — turning up positive.
Investigators are looking into possible connection between the outbreaks, Hota said.
As of Tuesday, 73 hospital outbreaks have been reported in the province, involving about a quarter of Ontario’s 225 hospital sites.
IPAC experts say outbreaks tend to occur when there are breakdowns in protocols — a risk almost certainly heightened during an unprecedented pandemic, when staff are tired and new protocols have been introduced around PPE, which is in limited supply.
And despite practising vigilance around patients, hospital staff still need to rest, drink and eat — all moments that might involve them co-mingling or removing their masks.
According to a Toronto Western health-care worker, who asked not to be identified because they weren’t authorized to speak on the record, a place where “staff might be exposed to each other without appropriate PPE is in the lunch room,” a space described as being roughly the size of a master bedroom in an average-sized Toronto home.
O’Connor said the lunch room had already been redesigned to promote physical distancing but since these new cases were announced, a second lunch room has been opened up, with clearly marked spots for where people can safely sit and eat.
She said the fact UHN is now doing broad testing of employees, including those who are asymptomatic, should serve to reassure the public because it means the hospital is taking steps to identify issues that would otherwise be missed.
O’Connor said she can understand people’s concerns about outbreaks at Toronto Western. But she hopes people will still seek help from hospitals whenever they find themselves in need of care.
“What is important is that people know that we are being very, very honest with them and that we are giving information when we have it,” she said.