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Title: Use of a real-time locating system for contact tracing of health care workers during the COVID-19 pandemic at an infectious disease center in Singapore : validation study
Authors: Ho, Hanley J.
Zhang, Zoe Xiaozhu
Huang, Zhilian
Aung, Aung Hein
Lim, Wei-Yen
Chow, Angela
Keywords: Science::Medicine
Issue Date: 2020
Source: Ho, H. J., Zhang, Z. X., Huang, Z., Aung, A. H., Lim, W.-Y., & Chow, A. (2020). Use of a Real-Time Locating System for Contact Tracing of Health Care Workers During the COVID-19 Pandemic at an Infectious Disease Center in Singapore: Validation Study. Journal of Medical Internet Research, 22(5), e19437-. doi:10.2196/19437
Journal: Journal of medical Internet research 
Abstract: Background: In early 2020, coronavirus disease (COVID-19) emerged and spread by community and nosocomial transmission. Effective contact tracing of potentially exposed health care workers is crucial for the prevention and control of infectious disease outbreaks in the health care setting. Objective: This study aimed to evaluate the comparative effectiveness of contact tracing during the COVID-19 pandemic through the real-time locating system (RTLS) and review of the electronic medical record (EMR) at the designated hospital for COVID-19 response in Singapore. Methods: Over a 2-day study period, all admitted patients with COVID-19, their ward locations, and the health care workers rostered to each ward were identified to determine the total number of potential contacts between patients with COVID-19 and health care workers. The numbers of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR-based and RTLS-based contact tracing methods was further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by health care workers. Results: Of 796 potential staff-patient contacts (between 17 patients and 162 staff members), 104 (13.1%) were identified by both the RTLS and EMR, 54 (6.8%) by the RTLS alone, and 99 (12.4%) by the EMR alone; 539 (67.7%) were not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and a specificity of 77.9%, while the RTLS had a sensitivity of 72.2% and a specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either the RTLS or the EMR (sensitivity 77.8%, specificity 73.4%). Conclusions: RTLS-based contact tracing showed higher sensitivity and specificity than EMR review. Integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing of RTLS tags remain necessary.
ISSN: 1438-8871
DOI: 10.2196/19437
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Rights: © Hanley J Ho, Zoe Xiaozhu Zhang, Zhilian Huang, Aung Hein Aung, Wei-Yen Lim, Angela Chow. Originally published in the Journal of Medical Internet Research (, 26.05.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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