Netcare has welcomed the findings of an investigation into St Augustine's Hospital in KwaZulu-Natal following 119 confirmed Covid-19 cases among staff and patients.The investigation, instigated by the Department of Health and Ministerial Advisory Committee (MAC), found that between 9 March and 30 April, 39 patients and 80 staff members at the hospital were infected, with 15 patients dying.The investigation was led by Dr Richard Lessells, Professor Yunus Moosa and Professor Tulio de Oliveira who are experts in infectious diseases, epidemiology and viral genomics, respectively.It found the 80 staff cases represented about 5% of all staff members who were tested for the virus. Fourteen staff members required hospital admission but none were admitted to intensive care and none died.The majority of infections were among nurses and student nurses, while a few cases were found among staff members who were not involved in direct patient care.According to De Oliveira, it was estimated the outbreak and spread accounted for 14% of all Covid-19 cases in KwaZulu-Natal up to 30 April. According to their report, the outbreak within the hospital was likely started by a single introduction of the virus to the hospital in early March from a patient being assessed for Covid-19 in the emergency department.READ | How one Covid-19 case at St Augustine’s Hospital led to 135 infections within 51 daysIt is likely this patient passed the virus on to another one who had been admitted for a suspected stroke at the same time."The virus then spread widely through the hospital, involving patients and healthcare workers in at least five different wards," the investigation found.NetcareIn its response to the report, Netcare's regional director, Craig Murphy, said recommendations and interventions that came out of the investigation had been fully implemented, while others were already in place and had been strengthened."In early March, we were rapidly learning about the nature of Covid-19 as many national policy guidelines were being changed and refined as the pandemic unfolded in South Africa," Murphy added, saying many lessons had been learnt by the entire health sector.He said Covid-19 presented particular challenges as it was still highly infectious even though patients might not exhibit any symptoms. "Despite the presence of extensive and effective infection prevention measures, such as those in place within Netcare facilities, any workplace or gathering of people poses a potential risk for infection."We wish to reiterate our sincere gratitude to all our healthcare workers, nurses and doctors, and their families for their incredible efforts under these trying and challenging circumstances," Murphy added.FindingsThrough an analysis of timelines, including identifying which wards patients were in, when their symptoms started and when they were tested positive, a chain of events that was most likely was constructed.Lessells said the initial spread of the virus was not recognised at the time because the first patient, who was potentially infected in the emergency department, was not suspected of having Covid-19 at the time."She did not have any of the typical risk factors and only presented with a single episode of fever without cough or other respiratory symptoms."By the time she was diagnosed with Covid-19 and the hospital began responding to the outbreak, several other patients and healthcare workers had already been infected."ALSO READ | Third Tygerberg Hospital nurse dies of Covid-19He added the investigation highlighted how quickly and easily Covid-19 could spread through a hospital.It also found the outbreak had led to clusters of infections in a local nursing home, affecting four residents as well as in an outpatient dialysis unit operated by National Renal Care on the hospital campus that affected nine patients and eight staff."This highlights the risk that outbreaks like this become what we call amplifiers of transmission, that is they fuel transmission in the wider community," De Oliveira said.RecommendationsThe recommendations were aimed at reducing the risk of similar outbreaks by strengthening infection prevention and control practices in all hospital and health facilities, Moosa said.These include establishing separate zones for people confirmed to have Covid-19, suspected cases and those who are unlikely to be infected, vigilance in these areas, limiting non-essential movement between patients and wards, Covid-19 training, hand hygiene, cleaning practices, physical distancing and considering weekly testing of frontline staff.