At the Brigham, ‘battle-weary’ staff may have allowed virus to slip in

'Desperately trying to contain’ an outbreak, the hospital is testing staffers, patients, and their contacts, and limiting visits.

Signs promoting hand hygiene and social distancing can be seen throughout Brigham and Women's Hospital.Craig F. Walker/Globe Staff

Brigham and Women’s Hospital revealed Thursday that it is working to contain a cluster of COVID-19 cases in two of its medical-surgical units, an unusual outbreak that apparently occurred as “battle-weary” staffers let their guard down.

Hospital officials believe the outbreak was triggered by either a patient or an employee who interacted last week. The employee came to work while “presymptomatic” — infected but not yet showing symptoms. The employee tested positive on Sunday and the patient on Monday.

The patient went on to spread the virus to other patients and employees, who in turn spread it to others, possibly aided by a series of lapses in infection-control protocols, hospital officials said.

By Thursday afternoon, the Boston hospital had identified eight patients and 11 employees infected in the cluster, and said it expects that number to grow as contact tracing continues. But Brigham and Women’s emphasized in a statement posted on its website Thursday evening that it believes the cluster has been limited to the two units, 16A and 14CD in the Braunwald Tower, in the Longwood medical area.

The Brigham has tested 98 employees and 50 patients so far, and has 445 people “in the process of being tested," according to the statement. The hospital is continuing to identify and test others who may have been exposed, including patients discharged from the affected units. The hospital has also cleaned the affected area, closed 16A for a deep clean and to evaluate the ventilation system, and moved patients who tested positive to a COVID-19 unit. And it has limited visitors to “certain areas.”

“They’re desperately trying to contain it,” said Trish Powers, a trauma nurse and chairwoman of the Massachusetts Nurses Association’s unit at the Brigham. “It has the potential to be something really huge. . . . We’re all hoping and praying that this stays contained somewhat and does not spread like wildfire.”

At least two nurses were among those who tested positive, and both had symptoms, Powers said. One is isolating in her bedroom while her children and husband are at home, attending school and working remotely.

Since long before this week’s cluster, hospital staff and visitors have all been wearing masks, although sometimes visitors need reminders to cover their noses, Powers said. The N95 masks with the highest level of protection are reserved for staffers treating COVID-19 patients.

“This just shows that even here where 99 percent of the people all the time have their mask on correctly and there’s Purell everywhere, that these things can happen,” Powers said. The union represents 3,400 nurses at the hospital.

Dr. Mike Klompas, the hospital epidemiologist, told employees Thursday afternoon that the staff member who came to work unaware of being infected “did nothing wrong,” according to a recording of an online employee forum.

The staffer, who tested positive for COVID-19 on Sunday, had cared for a patient on the 14th floor of the Braunwald Tower. The patient had tested negative twice upon admission, but after symptoms worsened was diagnosed with COVID-19 on Monday.

The patient was transferred to the 16th floor, and in both units the virus spread to other patients and staffers, who in turn infected others, Klompas told employees.

Klompas listed a series of lapses that contributed to the spread, including patients' failure to wear masks during care, providers' inconsistent use of eye protection, providers eating in crowded work rooms, and people working while symptomatic. Those workers had mild symptoms — scratchy throat, runny nose — that they “understandably” attributed to their usual seasonal allergies, he said.

The first patient was coughing a great deal and receiving medications through a nebulizer, likely spewing a lot of the virus into the air. Another infected patient frequently came to the nursing station without a mask, Klompas said, according to the recording of the forum.

All those factors, he told employees, were like holes in slices of Swiss cheese that happened to line up, letting the virus pass through.

Prior to the outbreak, Klompas said, the Brigham had a pristine record at preventing the spread of coronavirus within its walls, by adhering to “a package of protections.”

Now, after months of contending with the pandemic, he told the employees, “We’re all battle-weary. Maybe some of us are letting down our guard a bit.”

In its statement, the hospital said: “The Brigham is committed to creating and maintaining a safe care environment by testing all patients admitted to the hospital, requiring staff to attest to their health daily before working, requiring all staff, patients and visitors to wear hospital-issued masks while on campus, insisting on frequent hand hygiene, frequently cleaning the environment, and enforcing appropriate physical distancing.”

Asked whether people should be scared to go to hospitals now, Governor Charlie Baker noted at a news conference Thursday that huge numbers of people have sought care for COVID-19 in recent months in hospitals, doctors' offices, and other locations. Even so, he said, “the number of outbreaks that we’ve seen in Massachusetts hospitals over that period of time has been pretty small, which is a big statement about the work that’s been done by our hospital community, and our health care community generally, to do a really good job.”

Baker said that the Brigham notified the state Department of Public Health as soon as the cluster was recognized, and that the state will “work with them and with their infectious disease specialist to chase down any additional cases . . . to make sure that the outbreak is contained.”

Additionally, health officials said, the state Public Health Lab is assisting with genetic sequencing to help identify patterns of transmission.

Anne Marie Pettis, president-elect of the Association for Professionals in Infection Control and Epidemiology, said in-hospital spread of coronavirus appears to be uncommon, based on her conversations with colleagues, but there’s no national database tracking such events.

“After a while people get tired out, and there’s that fatigue that comes along with having to do all of this, what I like to call the new abnormal,” Pettis said. The key, she said, is “constant auditing and monitoring” to make sure protocols are followed. “We cannot let our guard down,” she said.

Just two weeks ago, Brigham researchers published a study showing virtually no transmission of the virus within the hospital over a 12-week period. Only two patients among more than 9,000 came down with COVID-19 while in the hospital; one apparently was infected by a spouse and the other had no known hospital exposure.

But hospital infections have occurred. In July, an employee of BayState Medical Center in Springfield traveled to a hot spot outside the state and apparently spread the virus to colleagues who were lax about mask-wearing in the break room, leading to a cluster of cases among workers and patients that eventually involved 55 people, according to news reports.

Hospitals in Massachusetts have been treating a steady but low number of COVID-19 patients for the past two months. On Tuesday, there were 361 people with COVID-19 in hospitals statewide, according to state data, down from nearly 4,000 at the pandemic’s peak in April. But hospitals are readying for a likely spike in cases in the fall and winter as people move indoors and respiratory illnesses of all types increase.

Victoria McGrane of the Globe staff contributed to this report.