Multi-pronged infection control strategy to achieve zero nosocomial COVID-19 infection among Hong Kong healthcare workers in the first 300 days of combat.

Background Nosocomial outbreaks leading to healthcare workers (HCWs) infection and death have been increasingly reported during the coronavirus disease 2019 (COVID-19) pandemic. An effective intervention is urgently needed to reduce nosocomial acquisition. Methods We summarized our experience of multi-pronged infection control (IC) strategy in the first 300 days (December 31, 2019 to October 25, 2020) of COVID-19 era under the governance of Hospital Authority in Hong Kong. Results Of 5,296 COVID-19 patients, 4,808 (90.8%) were diagnosed in the first (142 cases), second (896 cases), and third wave (3,770 cases) of COVID-19 in Hong Kong. Except for one patient who died before admission, all COVID-19 patients were admitted to public healthcare system which culminated to 78,834 COVID-19 patient-days. The median length of stay was 13 days (ranged, 1-128). Of 81,955 HCWs, thirty-eight (0.05%) HCWs [13 professional (2 doctors, 11 nurses) and 25 non-professional staff], had COVID-19. Except for 5 of 38 (13.2%) infected by HCW-to-HCW transmission in the non-clinical settings, no HCW had documented transmission from COVID-19 patients in the hospitals. The incidence of COVID-19 among HCWs was significantly lower than that of our general population (0.46 per 1,000 HCWs vs 0.71 per 1,000 population, p=0.008). The incidence of COVID-19 among professional staff was significantly lower than that of non-professional staff (0.30 vs 0.66 per 1,000 FTE, p=0.022). Conclusion Hospital-based approach spared our healthcare service from being overloaded. No nosocomial COVID-19 in HCWs was found in the first 300 days of COVID-19 era in Hong Kong with our multi-pronged IC strategy.