Is COVID-19 in hospital employees automatically an occupational disease? SARS-COV-2 acquisition modes and rates among employees in a long-term care facility (LTCF) during the first pandemic wave

Introduction: Inhalation therapy allows conveying drugs directly into the airways while minimizing the systemic exposure. Nebulizers can be used by patients unable to use metered-dose inhalers or other inhalers. However, this procedure generates aerosol and causes environmental contamination or disease transmission. Thus, the usage of inhalation therapy should be cautious, especially in the current COVID- 19 pandemic. Besides, the device can also be a reservoir for pathogens and lead to further infection. The use of nebulizers also requires disassembly and cleaning of after each dose. Objectives: This survey aimed to evaluate the compliance of hospital policy regarding the use of inhalation therapy. Methods: This survey was conducted as a part of infection prevention and control program in a 2600-bed teaching hospital. Infection control personnel designed a structured questionnaire and visited the in-patient services during Dec. 1, 2020 to Dec. 31, 2020. The survey included the environment control (single room, close door, or close curtain if more than one bed), cleaning methods after use, and who handle the procedure. Results: A total of 84 wards were audited. 38% of the wards did not close the door and 33% did not close the curtain while performing nebulization. To clean the devise after use, the use of tap water flowed by boiled water was most common (32%), followed by sterile water (21%) and 6% used tap water only. The cleaning procedure was performed by nurses (30%) or family/care givers (19%). After the survey, Center for Infection Control had made a consensus with Department of Integrated Diagnostics & Therapeutics and Department of Nursing. The main guidance include: 1) suggest use nebulization in single room only and close the door, if not feasible, suggest close the curtain around the patient area;2) sterile water or boiled water should be used as the last step in cleaning;3) the cleansing procedure should be performed by nurse and trained family/ caregiver. Conclusion: In the era of COVID-19 pandemic, nebulization therapy may carry the risk of inducing aerosol and increase the risk of disease transmission. Through the survey, we notice the infection control practice of nebulization in the hospital should be strengthen. Isolation methods (door/curtain) and cleaning procedure are the two key points need improvement.