Background. In parallel with public health responses, health systems have had to rapidly implement infection control strategies during the SARS-CoV-2 (COVID-19) pandemic. Various technologies, such as digital contact tracing (DCT), have been implemented to enhance case investigations among healthcare workers' (HCWs). Currently, little attention has focused on the perspectives of those who have implemented DCT innovations and those who have adopted such technologies within a healthcare environment. -- Objective. This study aimed to describe the implementation, acceptance, and outcomes of a web-based DCT tool used extensively at a specialized pediatric acute-care hospital in Ontario during the COVID-19 pandemic from the perspective of key stakeholders. -- Methods. Using an exploratory qualitative design, this research involved 21 semi-structured interviews with healthcare administrators (n=6; 29%), occupational health specialists (n=8; 38%), and healthcare workers (n=7; 33/%) at the Children's Hospital of Eastern Ontario. Interview protocols and analysis were guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The interviews lasted on average 33.6 minutes in length and were audio-recorded. Verbatim transcripts were subjected to thematic analysis using NVivo software. -- Results. The implementation of DCT during the COVID-19 pandemic was viable and well-received among stakeholders. End-users cited that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk-assessment consequences and access concerns were present as barriers (reach). Stakeholders commonly agreed that the DCT tool exerted a positive outcome on the hospital's capacity to meet the demands of COVID-19, notably through the facilitation of timely case investigations and by informing decision-making processes (effectiveness). Implementors and occupational specialists conveyed staffing impacts, and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a technology that was human-centered were crucial factors driving staff adoption. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs standard practices, alongside the evolving perspectives of COVID-19. Some end-users expressed an initial disconnect towards the DCT tool, raising questions about the fidelity of the implementation. However, stakeholders collectively agreed on the viability of the DCT approach and its applicability to infectious disease practices (maintenance). -- Conclusion. Stakeholders reported DCT in the hospital context to be acceptable and efficient in meeting the demands of the COVID-19 pandemic. Recommendations for optimized DCT use include education and training for relevant personnel, improved access and usability, and integration into clinical systems. The findings contribute to evidence-based practices and guide future scale-up initiatives focused on digital surveillance in the hospital context.

Abstract Background Data about the effectiveness of digital contact tracing are based on studies conducted in countries with predominantly high- or middle-income settings. Up to now, little research is done to identify specific problems for the implementation of such technique in low-income countries. Methods A Bluetooth-assisted GPS location-based digital contact tracing (DCT) app was tested by 141 participants during 14 days in a hospital in Monrovia, Liberia in February 2020. The DCT app was compared to a paper-based reference system. Hits between participants and 10 designated infected participants were recorded simultaneously by both methods. Additional data about GPS and Bluetooth adherence were gathered and surveys to estimate battery consumption and app adherence were conducted. DCT apps accuracy was evaluated in different settings. Results GPS coordinates from 101/141 (71.6%) participants were received. The number of hours recorded by the participants during the study period, true Hours Recorded (tHR), was 496.3 h (1.1% of maximum Hours recordable) during the study period. With the paper-based method 1075 hits and with the DCT app five hits of designated infected participants with other participants have been listed. Differences between true and maximum recording times were due to failed permission settings (45%), data transmission issues (11.3%), of the participants 10.1% switched off GPS and 32.5% experienced other technical or compliance problems. In buildings, use of Bluetooth increased the accuracy of the DCT app (GPS + BT 22.9 m ± 21.6 SD vs. GPS 60.9 m ± 34.7 SD; p = 0.004). GPS accuracy in public transportation was 10.3 m ± 10.05 SD with a significant (p = 0.007) correlation between precision and phone brand. GPS resolution outdoors was 10.4 m ± 4.2 SD. Conclusion In our study several limitations of the DCT together with the impairment of GPS accuracy in urban settings impede the solely use of a DCT app. It could be feasible as a supplement to traditional manual contact tracing. DKRS, DRKS0 00293 27. Registered 20 June 2020 - Retrospectively registered.

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