Despite infection control guidance, sporadic nosocomial coronavirus disease 2019 (COVID-19) outbreaks occur. We describe a complex severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cluster with interfacility spread during the SARS-CoV-2 δ (delta) pandemic surge in the Midwest.

This study was conducted in (1) a hematology-oncology ward in a regional academic medical center and (2) a geographically distant acute rehabilitation hospital.

We conducted contact tracing for each COVID-19 case to identify healthcare exposures within 14 days prior to diagnosis. Liberal testing was performed for asymptomatic carriage for patients and staff. Whole-genome sequencing was conducted for all available clinical isolates from patients and healthcare workers (HCWs) to identify transmission clusters.

In the immunosuppressed ward, 19 cases (4 patients, 15 HCWs) shared a genetically related SARS-CoV-2 isolate. Of these 4 patients, 3 died in the hospital or within 1 week of discharge. The suspected index case was a patient with new dyspnea, diagnosed during preprocedure screening. In the rehabilitation hospital, 20 cases (5 patients and 15 HCWs) positive for COVID-19, of whom 2 patients and 3 HCWs had an isolate genetically related to the above cluster. The suspected index case was a patient from the immune suppressed ward whose positive status was not detected at admission to the rehabilitation facility. Our response to this cluster included the following interventions in both settings: restricting visitors, restricting learners, restricting overflow admissions, enforcing strict compliance with escalated PPE, access to on-site free and frequent testing for staff, and testing all patients prior to hospital discharge and transfer to other facilities.

Stringent infection control measures can prevent nosocomial COVID-19 transmission in healthcare facilities with high-risk patients during pandemic surges. These interventions were successful in ending these outbreaks.

尽管有感染控制指导，2019 年院内冠状病毒病 (COVID-19) 仍出现零星暴发。我们描述了一个复杂的严重急性呼吸道冠状病毒 2 (SARS-CoV-2) 簇，在中西部 SARS-CoV-2 δ (delta) 大流行期间具有跨设施传播。

这项研究是在（1）地区学术医疗中心的血液肿瘤病房和（2）地理位置较远的急性康复医院进行的。

我们对每个 COVID-19 病例进行了接触者追踪，以确定诊断前 14 天内的医疗暴露情况。对患者和工作人员的无症状携带进行了自由检测。对患者和医护人员 (HCW) 的所有可用临床分离株进行全基因组测序，以识别传播簇。

在免疫抑制病房中，19 例患者（4 名患者，15 名医护人员）共享一种遗传相关的 SARS-CoV-2 分离株。这4名患者中，有3人在医院或出院后1周内死亡。疑似指标病例是一名在术前筛查期间诊断出新发呼吸困难的患者。在康复医院，有 20 例（5 名患者和 15 名医务人员）COVID-19 呈阳性，其中 2 名患者和 3 名医务人员携带与上述集群基因相关的分离株。疑似指示病例是一名来自免疫抑制病房的患者，其在进入康复机构时未检测到阳性状态。我们对这一集群的应对措施包括在两种情况下采取以下干预措施：限制访客、限制学习者、限制超额入院、严格遵守升级的个人防护装备、为工作人员提供现场免费和频繁的检测，以及在出院前对所有患者进行检测并转移到其他设施。

严格的感染控制措施可以防止在大流行高峰期间高危患者所在医疗机构内发生 COVID-19 院内传播。这些干预措施成功地结束了这些疫情的爆发。