Table 1 Infection control measures

Formation of a local Corona Task Force

January 2020

To ensure effective management and functioning of the hospital and to link strategic and operational leaders with each other.

Enablers: Early formation of an informal team of specialists, already planning ahead.

Barriers: Meetings tied up human resources that were needed in patient care.

Mid-January 2020: First informal meeting took place that comprised specialists for infectious diseases, hospital hygiene and intensive care as well as virologists. This was followed by the nomination of a leading physician of the Corona Task Force by the hospital medical board. Meetings with all relevant hospital stakeholders were called daily to weekly.

Guidelines and standard operating procedures by local Corona task force

January 2020

To ensure a rapid and consistent implementation of infection control measures adapted to local conditions

Enablers: Local availability of an electronic platform for guidelines and standard operating procedures.

Electronic guidelines accessible by all hospital staff. Regular adaptation to current situation. Contents: Local infection control measures, test strategy, isolation criteria, management of COVID-19 patients, visitor rules, vaccination for staff, and others.

Enhanced communication

January 2020

To ensure easy access and adherence of health care staff to local guidelines

Enablers: Local availability of a mailing system accessed by all hospital staff

Communication of the local situation and decisions of the task force was assigned to one hospital quality manager. Email updates were circulated among all staff daily to weekly in the first months of the pandemic. Implementation of an email address for questions and suggestions of staff and an emergency phone number for urgent inquiries.

Triage at hospital entry and isolation area in pediatric ED

Mid-February 2020

To prevent transmission of SARS-CoV-2 from patients in waiting areas and outpatient departments. To facilitate early testing of patients and their caregivers

Enablers: Availability of a separate access to the pediatric ED.

Barriers: Previously, admission control during daytime had never been implemented. Lack of staff for triage at all access points. A separation area in the pediatric ED did not exist.

Recruitment of new staff to control patients’ and visitors’ access to the hospital. Closure of all access points apart from the main entrance. Screening for symptoms compatible with COVID-19, measurement of body temperature. Suspected cases were directly sent to a separate waiting area or examination room in the pediatric ED.

Visitor restrictions

Mid-March 2020

To prevent transmission of SARS-CoV-2 from visitors to patients and hospital staff

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Restriction of accompanying persons to one parent or caregiver per patient. Complete restriction of visitors.

Cancellation of non-urgent treatments

Mid-March to End of June 2020;

End of December 2020

To prevent crowding, re-allocate consultation and ward rooms for potential COVID-19 patients and preserve medical staff to maintain routine-care

Barriers: Lack of infrastructure for telemedical care in most pediatric departments.

Cancellation or postponement of: consultations because of long-term symptoms, day case surgeries (e.g. inguinal hernias, metal removal after osteosynthesis), follow up visits, referrals for second opinion and others.

Mandatory face masks for staff, parents and patients

End of March 2020 (FFP2-masks from February 2021)

To prevent SARS-CoV-2 transmission between patients, caregivers and staff

Barriers: Massive shortage of medical face masks (FFP1 and FFP2) during the first months of the pandemic. Uncertainty about their future availability.

Mandatory FFP1 masks in the entire hospital for staff, accompanying persons and patients ≥6 years of age. Only exception: inside ward rooms. Later in the pandemic, respirators (FFP2 or N95) became the obligatory standard.

Respiratory infection ward/Isolation area on regular ward

End of March 2020

/End of June 2020

To prevent virus transmission from admitted children with suspected or confirmed COVID-19. To facilitate specific care for COVID-19 patients by assigned health care staff

Enablers: Availability of additional ward rooms and health care staff from pediatric surgery due to the cancellation of scheduled non-urgent operations. Rapid building of interior walls to separate areas within wards was possible.

Barriers: No pre-existing infection or isolation ward. Negative-pressure rooms not existing.

Dedicated ward for suspected or confirmed pediatric COVID-19 cases with a capacity of ten beds. Later, the ward was closed and replaced by an isolation area on another ward with a flexible capacity of three to five beds. Additionally, a flexible isolation area of max. Four beds was available on the PICU. Both areas were separated by installing additional doors and walls.

Outpatient fever clinic

End of March to Mid-April 2020

To minimize the risk of virus transmission from children seeking medical care for mild respiratory illness

Enablers: Effective collaboration with local authorities and rescue services

Outpatient fever clinic for children with suspected COVID-19 at another place in town, away from the hospital.

Acquisition of local tools for SARS-CoV-2 testing

End of February 2020

To provide quick and reliable tests in sufficient quantity

Enablers: Supportive local virology laboratory

Local SARS-CoV-2 tests available from February 2020. Increase of the monthly test capacity by more than four-fold between March and June 2020. Point-of-care polymerase chain reaction (PCR) testing available by November 2020. A detailed overview over the SARS-CoV-2 diagnostic test procedures used, their time of implementation, turnaround time and test capacity is given in Additional File 1.

Implementation and regular adaptation of the local SARS-CoV-2 test strategy

End of February 2020

Early detection of SARS-CoV-2 infection in symptomatic and asymptomatic patients and visitors

Enablers: Availability and updates of nation-wide guidelines on SARS-CoV-2 testing by the German public health authorities

Barriers: Insufficiency of laboratory resources and long turnaround times for SARS-CoV-2 PCR testing during the first months of the pandemic

Shift of the indication for SARS-CoV-2 testing:

- Mid-February: symptomatic travelers from risk areas and contact persons

- Early-March: Symptomatic travelers from risk areas, any patients with pneumonia

- Early-April: all patients admitted with symptoms compatible with COVID-19. All patients undergoing HSCT

- Early-May: Routine-screening for patient admitted from ED, admitted to the PICU, patients in need of intubation or sedation, high-risk patients

Mid-November: Point-of-care (POC)-PCR testing for all admissions from the pediatric ED; SARS-CoV-2 antigen tests for caregivers (on admission) and screening of staff once weekly.