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Sarawak General Hospital, which is the only public access tertiary referral center in Sarawak State for all clinical specialties, was designated a hybrid hospital to treat both COVID-19 and non-COVID-19 patients. During the initial surge of patients admitted with COVID-19, there was also a corresponding increase in health-care workers (HCWs) detected with COVID-19 infection. The latter being isolated, and the large number of staff members that had come into contact with COVID-19 being quarantined from work, placed further strain on the health-care services. The staff mass screening strategy was a policy decision made by the hospital in response to infection among HCWs, and it aimed to reduce in-hospital transmission (particularly among asymptomatic staff), mitigate workforce depletion due to quarantining, and protect the health-care workforce. In this study, we assessed the detection rate of COVID-19 infection from staff mass testing over a five-week period, and described our experience of adopting this surveillance screening strategy alongside ongoing contact tracing and symptomatic screening strategies. Although it was thought that such periodic staff surveillance might be helpful in protecting the health-care workforce within a short period, the long-term implications, especially in settings with limited resources, is significant and therefore explored in this paper. Our findings might provide an evidence-based reference for the future planning of an optimal strategy with the least compromise in care for a larger proportion of non-COVID-19 patients amid efforts against COVID-19 in a large nonCOVID-designated hospital with hybrid status.

IntroductionIntroduction This study aimed to evaluate risk factors associated with SARS-CoV-2 infection among HCWs who had exposure from infected patients and HCWs in a recent outbreak in Sarawak General Hospital (SGH). Materials and Methods We included HCWs who were investigated during contact tracing of SARS-CoV-2 confirmed patients and HCWs in SGH. We analysed the risk factors including personal protective equipment (PPE) use, social distancing, contact duration, hand hygiene practice, and involvement in aerosol producing activities associated with HCW’s SARSCoV-2 infection risk, which was confirmed by using real-time polymerase chain reaction assay. Results We included 2104 HCWs: 62.2% were female with median age of 32 years old. Majority were nurses (45.3%) and doctors (29.8%). Fifty (2.4%) HCWs were later confirmed with SARS-CoV-2 infection. Among them, 12 had exposure from infected patient(s); 34 from infected HCW(s); and four had contacted both infected patient(s) and HCW(s). Discussion & Conclusion Aerosol-producing activities and hand hygiene were the significant risk factors associated with SARSCoV-2 infection risk in HCWs. The findings indicate indirect contact of contaminated surfaces or formite transmission as the possible transmission mode of SARS-CoV-2. Actions are needed to reinforce hand hygiene habits and practice while use of mask and PPEs should not be undermined in the effort of preventing nosocomial transmission of SARS-CoV-2. In univariable and multivariable analyses, in patient-HCW exposure, aerosol-producing activities was the only risk factor significantly associated with SARS-CoV-2 infection [OR=4.55, 95%CI=1.14-18.12], while in HCW-HCW exposure, hand hygiene was the sole significant risk factor (OR=2.21, 95%CI=1.13-4.31). Not wearing mask in HCW-HCW contact showed marginal significance level in univariable analysis (p=0.06, OR=6.98, 95%CI=0.93-50.03). Other risk factors were not found to significantly associated with SARS-CoV-2 infection risk in HCWs