Background: The coronavirus disease 2019 (COVID-19) pandemic has dramatically altered how clinicians care for hospitalized patients in the setting of a highly contagious respiratory disease. Changes seen across hospitals include implementation of medical distancing guidelines (i.e. reduced in-person patient contact) and creation of respiratory isolation units (RIUs) for patients with COVID-19. While medical distancing has been recommended, no study to date has used objective measures, such as changes in patient room entries, to quantify the degree to which clinicians followed medical distancing guidelines during the pandemic and between an RIU and regular floor units.

Methods: Daily room entries in an RIU and general medicine units were collected using body heat sensors from an existing hospital hand hygiene monitoring system before and during the COVID-19 pandemic from January 2020 to August 2020. These room entries served as an objective proxy for clinician medical distancing. During the pandemic, clinicians were instructed to reduce room entries to limit exposure. While general medicine units had patients under investigation (PUIs) in addition to patients admitted for non-COVID-19 related reasons, the RIU only had patients with confirmed COVID-19. PUIs who tested positive for COVID-19 were moved to the RIU. Interrupted time series analyses were used to compare changes in room entries with various policies in both unit types, including the start and stop of the RIU and state stay-at-home order.

Results: There were no significant differences in age over 65 years (46.6% vs 49.8%, p=0.07), sex (52.2% vs 48.3% female, p=0.08), Black/African American race (82.1% vs 82.7%, p=0.76), and mean length of stay (5.54 vs 6.78 days, p=0.06) between pre-pandemic and pandemic patient populations, respectively. Before the pandemic, the RIU was a general medicine unit and averaged 41.9 entries per room per day. Initially, the RIU experienced a 56% reduction in room entries (95% CI: 50.7%, 61.1%, p<0.001). Following decommission back to a general medicine unit, room entries increased by an average of 0.081entries per day (95% CI: 0.055, 0.108, p<0.001) and reached 68% of pre-pandemic levels in August 2020 (95% CI: 67.2%, 67.7%, p<0.001), which corresponded to 28.6 daily room entries. Before the pandemic, general medicine units averaged 36.6 entries per room per day. These units experienced a short-lived 11% reduction in room entries (95% CI: 10%, 11.1%, p=0.29) before increasing less than two weeks later and reaching 96% of pre-pandemic levels in August 2020 (95% CI: 95.5%, 96%, p<0.001), which corresponded to an average of 36 daily room entries.

Conclusions: Cohorting patients on RIUs was associated with more successful adherence to medical distancing. Furthermore, changes in room entries in the RIU tracked with RIU conversion and decommission timeline rather than statewide stay-at-home orders, suggesting that awareness of patients with COVID-19 within the unit had a greater impact on clinician medical distancing than state policy. Because PUIs were in general medicine units, this suggests the need for reinforcement of medical distancing for regular staff. As the number of hospitalized patients with COVID-19 decreased, 24-hour room entries in the RIU increased toward the pre-pandemic baseline. This work suggests that medical distancing is difficult to sustain and may require reminders and reinforcement. Objective data such as these could assist hospitals in assessing adherence to workplace safety during a surge.

IMAGE 1: Respiratory Isolation Unit Average 24-hour Room Entries with COVID-19 Timeline

IMAGE 2: General Medicine Units Average 24-hour Room Entries with COVID-19 Timeline