![]() A team of federal, state health department, and county health department staff including infection preventionists, an industrial hygienist, medical officers, and epidemiologists conducted 2 onsite observations of clinical and nonclinical work areas and interviewed unit managers, infection preventionist, occupational health manager, facilities manager, and the facility’s management team. The survey assessed potential exposures during their December 25 shift, previous exposures during December, observations on shifts between December 18 and December 25, and COVID-19 vaccination status. The hospital IPC team conducted a survey between January 5 and January 11 of all ED and ED-linked HCP who had worked on December 25. Using staffing rosters, we determined dates when infected ED HCP had worked between December 11 and January 9 and were infectious, defined as during 2 days prior to symptom onset and within 10 days after symptom onset. The Santa Clara County public health laboratory performed WGS. and were not admitted were offered SARS-CoV-2 testing after identification of the outbreak. Patients who presented to the ED on December 25 between 9:00 a.m. All patients admitted for inpatient treatment were tested for SARS-CoV-2 on admission, and those who were in the ED between December 25 and December 30 additionally received serial testing every 3 days during their hospitalization. All hospital HCP, including ED HCP who did not work on December 25, were encouraged to undergo testing for SARS-CoV-2. Following outbreak identification, hospital A offered PCR testing every 3 days between January 1 and February 28 to all HCP who were in the ED on December 25. Prior to the identification of this cluster, hospital A had been offering voluntary weekly PCR testing to asymptomatic HCP with low uptake. We reviewed California Reportable Disease Information Exchange (CalREDIE), California Connected system (CalCONNECT), and testing records of hospital A to identify SARS-CoV-2 infections among HCP and ED patients. ![]() Confirmed cases met the probable case criteria and had a SARS-CoV-2 isolate that matched the outbreak sequence that is, they differed by ≤3 single nucleotide polymorphisms (SNPs) according to whole-genome sequencing (WGS). Notably, this date range represents a full incubation period (14 days) before and after December 25. A probable case was defined as a positive SARS-CoV-2 test by polymerase chain reaction (PCR) occurring in (1) hospital A HCP assigned to the ED (referred to as ED HCP), (2) HCP (referred to as ED-linked HCP) or patient (referred to as ED patient) who spent at least 15 minutes in the ED in the 14-day period prior to infection (symptom onset date or positive SARS-CoV-2 test specimen collection date, if asymptomatic), or (3) HCP or patient with an epidemiologic link to a confirmed case (eg, present on the same unit at the same time) provided the timing of the infection fell between and including December 11, 2020, and January 9, 2021. ![]()
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