Successfully addressing non-compliance with behavioral and social infection control measures is a critical component in management of healthcare worker COVID-19 outbreaks: learning outcomes from the first staff outbreak in the main maternity hospital in Qatar

Hawabibee Petkar^1*Bonnie George²Eman Mostafa²Imelda Caseres-Chiuco²Mahmoud Mohamed³Andrew Jeremijenko⁴Peter Coyle¹Hebah Al Khatib⁵Fatiha M Benslimane⁵Meryem Bensaad⁶Bayan Al-Barghouthi⁶Zaid Mahir Petkar⁷Jameela Al-Ajmi⁸Hilal Al Rifai³Huda Saleh²

• ¹Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
• ²Department of Quality and Patient Safety, Womens Wellness and Research Center, Doha, Qatar
• ³Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
• ⁴Staff Medical Center, Hamad Medical Corporation, Doha, Qatar
• ⁵Biomedical Research Center, Qatar University, Doha, Qatar
• ⁶Genomics Core, Weill Cornell Medicine-Qatar, Doha, Qatar
• ⁷Independent Researcher, London, United Kingdom
• ⁸Corporate Infection Control, Hamad Medical Corporation, Doha, Qatar

Background: Nosocomial healthcare worker (HCW) SARS-CoV-2 outbreaks are well recognized. Contact tracing, use of surgical masks, hand hygiene and social distancing can prevent spread. Social and behavioral factors play an important role in outbreal control. We provide an integrated report on management of our first outbreak and lessons learned.an. Methods: Demographic and test result information was extracted from the outbreak report. Infection control practices were audited using a standardized behavior assessment tool.. Exposure risk was ascertained using World Health Organization definitions. Cases were identified by reverse transcriptase polymerase chain reaction (RT-PCR) or by seroconversion. Whole genome sequencing was performed on RT-PCR positive cases. . Statistical analyses were performed in RStudio. Incidence rates and relative risk were used as measures of effectResults: Almost 10% of HCWs developed infection; high risk exposures had a statistically higher risk. All isolates were clade 20C. Consistent with the hypothesis, the epidemiological curve showed a mixed outbreak, initially common source, with subsequent sporadic cases possibly from environmental contamination. Interventions: focused on contact tracing and strict compliance with social distancing, PPE use, hand hygiene and environmental cleaning, supported by rigorous audits. Lessons learned: root cause was a symptomatic HCW reporting to work in breach of policy.. Contributing factors:failure to challenge the breach,, lax managerial oversight,, lounge overcrowding and insufficient cleaning staff . Discussion: Management required a multi-pronged approach. Full delineation of the outbreak required contact tracing, and correlation of epidemiological information with Ct values, whole genome sequencing and serology. Strategies to address social and behavioral factors should be devised considering the local institutional culture Good leadership, 'speaking up' for patient safety and linking individual IPC practices to annual evaluations are effective measures.