Table 1 Context-specific IPC challenges and coping strategies due to COVID-19 at the Vienna General Hospital

PPE shortages

• Conditional re-use of masks (no visible contamination, person-related, etc.)

• Use of medical face masks instead of N95 respirators (both patient and HCW equipped with a medical face mask)

• Strategy for re-processing masks via steam-sterilization (never came into effect)

Shortages of disinfectants

• In-house production of hand disinfectant by the hospital’s pharmacy

• Purchase of products with a comparable activity spectrum for surface disinfection

Several COVID-19 waves

Limited isolation capacities for suspected cases at the emergency department: only one separate room available for the assessment/management of cases presenting with respiratory symptoms

• Prioritization of PCR test analysis at the laboratory to quickly obtain a result

• Universal N95 mask mandate for all patients (whenever possible)

Few isolation options in outpatient departments

• Blocking of seats in waiting areas to ensure enough space between waiting patients

• Universal N95 mask mandate

Limited single room capacities

• Extensive testing strategy (screening of patients prior to admission, routine re-testing during hospitalization)

Doors to patient rooms could not be kept closed at all times due to agitated and/or confused patients or lack of monitoring equipment for unstable patients

• Universal N95 mask requirements for healthcare personnel

• Frequent testing of patients

Lack of sufficient airborne infection isolation rooms (AIIRs) for confirmed cases

• Doors should remain closed

Labor-intensity of entire PPE change between COVID-19 patients – only plastic apron was changed

• Continued surveillance and heightened vigilance regarding outbreaks from patients colonized/infected with multidrug resistant organisms on COVID-19 wards

Adherence issues regarding universal respirator use among hospital staff (e.g. masks removed by HCWs in recreational areas)

• Regular reminders to adhere to the in-house regulations

• Frequent SARS-CoV-2 screening of HCWs

Low compliance with universal N95 respirator mandate among visitors

• Visitor restrictions

• Requirement to show proof of a low transmission risk upon entry (e.g. prior vaccination/infection/recent negative test result)

Introduction of combined screening tests for Influenza/SARS-CoV-2/RSV. How to proceed with incidental findings, e.g. asymptomatic RSV positive patients?

• Isolation of RSV positive cases in high-risk areas (obstetrics, neonatal, pediatrics departments)

The spread of Omicron

Staff shortages due to sick leave

• Shortening of quarantine to five days with a negative SARS-CoV-2 test result (or Ct-value > 30) and no COVID-19 related symptoms

Overburdened contact tracing task force

• Daily PCR screening of HCWs, accompanied by an omission of contact tracing among HCWs

• Nota bene: Patients exposed to COVID-19 cases were still traced and isolated