LAUSR

Despite strict infection control efforts, hospital-acquired coronavirus disease 2019 (COVID-19) was reported [1–3]. The Emergency Department (ED), which serves as a gatekeeper for hospitals, is expected to be the most exposed area to COVID-19 and it can become the epicenter of a hospitalassociated outbreak [4]. The aim of our study is to evaluate the burden of EDacquired COVID-19 (EDAC) in patients discharged from a reorganized Italian ED during COVID-19 outbreak. This was an observational prospective study approved by the ethical committee conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national). Informed consent was obtained from study patients. Before the outbreak of COVID-19, the hospital reorganized ED in two areas: suspected COVID-19 and nosuspected COVID-19 area. Patients with respiratory symptoms, fever, or close contact with a COVID-19 case were assigned by the pre-triage staff to the suspected COVID-19 area, while all the others to the no-suspected COVID-19 area. If suspicion of COVID-19 was raised from a more thorough history or test results in patients assigned to the no-suspected-COVID area, those patients were transferred to the suspected COVID-19 area. Real-time reverse transcription-polymerase chain reaction nasopharyngeal swab was performed immediately after ED physician evaluation on COVID-19-suspected patients and on patients potentially needing observation or hospital admission. During the stay in the suspected COVID-19 area, patients wore surgical masks and gloves and were distanced from each other by at least 2 m in two open bays, whereas those in the no-suspected-COVID area wore surgical masks and were distanced from each other by at least 1 m in three open bays. Patients with a negative result of the nasopharyngeal swab who needed observation, were transferred to the noCOVID-19 Observation Unit and attended in shared rooms keeping 1 m of distance from each other and wore surgical masks. Healthcare professionals working in the suspected COVID-19 area wore FFP2 masks, disposable gown/apron/ TNT suit/gloves and protective goggles as well as FFP3 masks and visors when aerosol procedures were performed. Healthcare professionals working in the no-suspected COVID-19 area wore non-woven gowns, surgical masks and disposable gloves. Consecutive patients evaluated in ED from 7 to 30 April, 2020, were considered for the study. Inclusion criteria were: