494 - COVID-19 Outbreak: A Tale of Two Psych Units

Background: COVID infections in inpatient psychiatry units present unique challenges during the pandemic, including behavioral characteristics of the patients, structural aspect of the unit, type of therapy for the patients.  We present COVID outbreaks in psychiatry units in two hospitals in our medical center in Bronx, NY, and describe our mitigation strategies.Table: Infection Control Strategies Implemented during the Outbreak


Methods: Hosp A:  In the early period of the pandemic in NY, 2 patients in the inpatient psychiatry unit tested positive for SARS-CoV-2 PCR. The unit was temporarily closed to new admissions. Hosp B: On 4/1, one of the patients in a 22 bed Psych unit, admitted since 3/10/20, developed fever, cough and tested positive for COVID-19 PCR. Two of her close contacts tested positive for SARS-COV-2 PCR.

Results: Hospital A:  In total, 5 of the 29 patients (17.2%) in the unit were SARS-CoV-2 positive, all of whom were asymptomatic. Hospital B:  Testing of the remaining patients showed positive PCR in 10/14. PCR tests of healthcare workers (HCW) were positive in 13/46. Except for the index patient, all the patients were asymptomatic but 32/46 HCW reported symptoms.  One negative patient subsequently turned positive.
Infection control and prevention strategies instituted in both hospitals were the same with subtle differences due to dissimilar burden of infection and structure of the units.  Table 1 shows the timing of the outbreak and the rapid institution of preventive measures in each of the hospitals.
There was still difficulty with patients regarding adherence.  Some of the patients refused to stay in isolation and would roam.  Compliance with masking and hand hygiene was problematic.   
Communication was of paramount importance.  Multiple meetings were held between the Psychiatry staff, Infection Control and Prevention team, executive leadership of the hospital.  Environmental Services and Engineering were also involved.  Communications with the NY State Department of Health occurred frequently. 

Conclusion: Strategies for management of COVID-19 patients in inpatient psychiatric units depends on the density of infected patients in the hospital and in the community.  The implementation of practice change may need to be rapidly adjusted depending on the situation and available resources. Contingency plans should be formulated early on.