Video Greatly Enhances Contact Tracing

Contact tracing might be one of the more challenging parts of an infection preventionist’s job. Still, it’s a must, especially in the era of coronavirus disease 2019 (COVID-19), and IPs manage to contact trace despite how time intensive it can be. Video surveillance isn’t available in most healthcare settings, at least not the sort of video surveillance employed at a juvenile detention center. The use of video surveillance greatly increased the ability of administrators and medical personnel to contact trace at the Cook County Juvenile Temporary Detention Center (JTDC) in Chicago, according to a preprint study in the American Journal of Infection Control.

“We created a COVID-19 outbreak management protocol which included the formation of an outbreak management team (OMT) and enhanced infection control practices using video surveillance,” the study states. “Currently, our institution’s positivity rate remains low for both staff and residents largely because of the OMT. Video technology combined with enhanced infection control practices can be a useful technique to reduce COVID-19 infections in custodial settings.”

In reaction to the COVID-19 pandemic, the detention center formed the OMT in early March, which enhanced infection protection protocols throughout the facility and monitored contacts via video surveillance. They based their program on one developed by the Irish Prison System.

Investigators with the John H. Stronger Jr. Hospital of Cook County noted that the creation of the OMT and enhancement of IP protocols grew out of an appreciation of just how such institutions can be breeding grounds for something like COVID. Internal and external factors put such institutions are risk. Those factors “include poor ventilation, lack of negative pressure rooms, outdated environmental engineering designs, and difficulties maintaining social distancing,” the study states. “The odds of a viral outbreak, including SARS-CoV-2, in custodial settings is high and is often introduced into these settings by employees, contractors, and visitors.”

The JDTC is the largest juvenile detention center in the nation with about 600 employees and a rolling average population of about 180 minors. It also has about 700 digital cameras stationed nearly everywhere in the facility except offices and washrooms. The OMT’s first order of business, according to the study, was training employees in the proper use of personal protective equipment (PPE). IP protocols included universal masking, daily temperature checks for workers upon entrance and exit of the facility, and social distancing methods, such as allowing only 3 people on an elevator at one time.

“When one of the residential units had a cluster of infections, the team was able to identify the source by reviewing video footage,” the study states. “By using contact tracing, the team was able to identify any employees who had close contacts with residents. All residents exposed to an infected employee were tested to determine the secondary attack rate.”

Infected employees (602) and residents (314) were quarantined for 14 days. The COVID positivity rates are now low for both residents and staff “largely because of the OMT.”

Video review proved to be time consuming, but the investigators argue that it’s worth it.

The study states: “The advantages of video review include the following: (1) Immediate identification of close contacts allowing recommendations for immediate testing, medical isolation, and quarantine; (2) Three hundred sixty degree video angles of the route and location of the individual for up to 30 days prior to identification; (3) Identification of the details of each exposure incident, including observation of whether employees adhered to the recommended infection control practices, and quantification of the duration of exposure using the video timestamp; (4) supplementation of the oral interview in cases where the narrative regarding activities or contacts was unclear. Video review helped improve compliance with infection control protocols because it revealed unidentified issues and areas in need of improvement, such as, appropriate masking and enforcement of social distancing. It also allowed the OMT to implement changes such as requiring floor nurses to wear face shields, and installation of sneeze guards on nursing carts.”