Isolation Precautions Associated with COVID-19 Infections Among Immunocompromised Populations: A Multi-Center Study of Nine National Cancer Institute-Designated Comprehensive Cancer Centers.

Abstract

Background: Nine Comprehensive Cancer Centers sought to understand COVID-19 infection management experiences through the pandemic to improve future immunocompromised host guideline development.

Methods: Volunteers from Comprehensive Cancer Center Infection Prevention and Control (C3IC) completed two surveys on COVID-19 practices from March 2020 to December 2023. Three reviewers independently validated qualitative analysis of findings. Virtual meetings were leveraged to review information gathered, discuss findings, and identify themes among respondents.

Results: 100% (9/9) of respondents changed in COVID-19-associated isolation discontinuation guidance at least once. All (9/9) included patient immune status as criterion. All (9/9) required PCR clearance testing at some point in the pandemic, 6 of 9 (66%) continued to require clearance testing at the time of the survey; Only 1 of 9 (11%) allowed antigen testing to meet criteria. Cycle threshold (CT) values were inconsistently referenced and considered related to isolation management. Seven isolation titles were noted across 9 institutions, despite near agreement on measures employed.

Discussion: Variability existed in COVID-19 management among study participants despite serving similar populations, which may stem from limited data supporting understanding of viral transmissibility in immunocompromised hosts.

Conclusions: Guideline development for immunocompromised hosts, potential drivers for viral evolution, can lack clarity for consistent management of the population. Engaging subject matters in these populations in future guideline development will improve infection prevention in healthcare settings.