COVID-19 infection prevention and control in a cardiology and heart surgery center: an integrated strategy

Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) is a novel coronavirus that emerged in late 2019 in China and it is the causal agent of an acute respiratory disease, named ‘coronavirus disease 2019’ (COVID-19). SARS COV-2 is highly transmissible and pathogenic, and lead to a global pandemic that is posing a major threat for human health and public safety. The response to the pandemic lead to unprecedented societal responses (such as national lockdowns) and scientific efforts both in terms of comprehension of viral biology and development of diagnostic, therapeutic and preventive tools. Hospital environment, as happened for previous coronaviruses, is at high-risk of nosocomial outbreaks and numerous cases of in-hospital transmission have been reported, leading to disruption of healthcare services. For these reason national and international agencies have issued infection and prevention control (IPC) guidelines to prevent nosocomial transmission. Fondazione Toscana Gabriele Monasterio (FTGM) is a public tertiary-level cardiology and heart surgery center with two sites in Pisa and Massa, that has been designed as Non-COVID hub for cardiologic and heart surgery emergencies for USL Tuscany Northwest. Since the beginning of the epidemic FTGM issued an integrated COVID-19 IPC strategy including: - General IPC and administrative measures (e.g. hand hygiene, physical distancing, universal use of surgical masks, and triage at entrance for fever, respiratory symptoms, and history of exposure to the virus. limiting visitor access, reduction of elective activities, promotion of remote work and telemedicine) -Environmental measures (e.g. enhanced surface cleaning, control of indoor air, proper linen, laundry, and waste management) - Patient management measures (e.g. dedicated pathways and isolation wards for patients with fever and respiratory symptoms and universal SARS-CoV-2 screening for inpatients) - Personnel protection measures (e.g. consistent use of adequate PPE, epidemiological surveillance of symptoms and contacts, serological screening for SARS-CoV 2 antibodies, promotion of influenza vaccination) This thesis will report the ongoing and planned activities for COVID-19 IPC at FTGM until October 2020 in the light of the rapidly evolving epidemiological situation, legislative framework and scientific evidence