Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-17T21:27:57.561Z Has data issue: false hasContentIssue false
  • English
  • Français

Coronavirus disease 2019 (COVID-19) admission screening and assessment of infectiousness at an academic medical center in Iowa, 2020

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  24 June 2021

Mohammed A. Alsuhaibani Open the ORCID record for Mohammed A. Alsuhaibani [Opens in a new window] ,
Takaaki Kobayashi ,
Alexandra Trannel ,
Stephanie Holley ,
Oluchi J. Abosi ,
Kyle E. Jenn ,
Holly Meacham ,
Lorinda Sheeler ,
William Etienne  and
Angelique Dains
...Show all authors
Mohammed A. Alsuhaibani*
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia
Takaaki Kobayashi
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Alexandra Trannel
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Stephanie Holley
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Oluchi J. Abosi
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Kyle E. Jenn
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Holly Meacham
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Lorinda Sheeler
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
William Etienne
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Angelique Dains
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Mary E. Kukla
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Emily Ward
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Bradley Ford
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Michael B. Edmond
Affiliation:
Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, United States
Melanie Wellington
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Daniel J. Diekema
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
Jorge L. Salinas*
Affiliation:
University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
*
Author for correspondence: Mohammed A. Alsuhaibani, E-mail: moa.alsuhaibani@qu.edu.sa Or Jorge L. Salinas, E-mail: Jorge-salinas@uiowa.edu
Author for correspondence: Mohammed A. Alsuhaibani, E-mail: moa.alsuhaibani@qu.edu.sa Or Jorge L. Salinas, E-mail: Jorge-salinas@uiowa.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Patients admitted to the hospital may unknowingly carry severe acute respiratory coronavirus virus 2 (SARS-CoV-2), and hospitals have implemented SARS-CoV-2 admission screening. However, because SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) assays may remain positive for months after infection, positive results may represent active or past infection. We determined the prevalence and infectiousness of patients who were admitted for reasons unrelated to COVID-19 but tested positive for SARS-CoV-2 on admission screening.

Methods:

We conducted an observational study at the University of Iowa Hospitals & Clinics from July 7 to October 25, 2020. All patients admitted without suspicion of COVID-19 were included, and medical records of those with a positive admission screening test were reviewed. Infectiousness was determined using patient history, PCR cycle threshold (Ct) value, and serology.

Results:

In total, 5,913 patients were screened and admitted for reasons unrelated to COVID-19. Of these, 101 had positive admission RT-PCR results; 36 of these patients were excluded because they had respiratory signs/symptoms on admission on chart review. Also, 65 patients (1.1%) did not have respiratory symptoms. Finally, 55 patients had Ct values available and were included in this analysis. The median age of the final cohort was 56 years and 51% were male. Our assessment revealed that 23 patients (42%) were likely infectious. The median duration of in-hospital isolation was 5 days for those likely infectious and 2 days for those deemed noninfectious.

Conclusions:

SARS-CoV-2 was infrequent among patients admitted for reasons unrelated to COVID-19. An assessment of the likelihood of infectiousness using clinical history, RT-PCR Ct values, and serology may help in making the determination to discontinue isolation and conserve resources.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 8 , August 2022 , pp. 974 - 978
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Healthcare facilities: managing operations during the COVID-19 Pandemic. Centers for Disease Control and prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html. Published 2021. Accessed March 20, 2021.Google Scholar
Johansson, MA, Quandelacy, TM, Kada, S, et al. SARS-CoV-2 transmission from people without COVID-19 symptoms. JAMA Netw Open 2021;4:e2035057.CrossRefGoogle ScholarPubMed
Kimball, A, Hatfield, KM, Arons, M, et al. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility—King County, Washington, March 2020. Morbid Mortal Wkly Rep 2020;69:377–381.CrossRefGoogle Scholar
Kobayashi, T, Trannel, A, Holley, SA, et al. COVID-19 serial testing among hospitalized patients in a Midwest tertiary medical center, July–September 2020. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1630.Google Scholar
Sutton, D, Fuchs, K, D’Alton, M, Goffman, D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020;382:2163–2164.CrossRefGoogle ScholarPubMed
Guan, W-J, Ni, Z-Y, Hu, Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–1720.CrossRefGoogle ScholarPubMed
Li, Q, Guan, X, Wu, P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199–1207.CrossRefGoogle ScholarPubMed
Lauer, SA, Grantz, KH, Bi, Q, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020;172:577–582.CrossRefGoogle ScholarPubMed
Rhee, C, Kanjilal, S, Baker, M, Klompas, M. Duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity: when is it safe to discontinue isolation? Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1249.Google Scholar
He, X, Lau, EHY, Wu, P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020;26:672–675.CrossRefGoogle ScholarPubMed
Tahamtan, A, Ardebili, A. Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert Rev Mol Diagn 2020;20:453–454.CrossRefGoogle ScholarPubMed
Tom, MR, Mina, MJ. To interpret the SARS-CoV-2 test, consider the cycle threshold value. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa619.CrossRefGoogle ScholarPubMed
Rogers, AA, Baumann, RE, Borillo, GA, et al. Evaluation of transport media and specimen transport conditions for the detection of SARS-CoV-2 by use of real-time reverse transcription-PCR. J Clin Microbiol 2020;58(8):e0070820.CrossRefGoogle ScholarPubMed
Binnicker, MJ. Can the severe acute respiratory syndrome coronavirus 2 polymerase chain reaction cycle threshold value and time from symptom onset to testing predict infectivity? Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1607.CrossRefGoogle ScholarPubMed
Bullard, J, Dust, K, Funk, D, et al. Predicting infectious SARS-CoV-2 from diagnostic samples. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa638.CrossRefGoogle ScholarPubMed
Gniazdowski, V, Morris, CP, Wohl, S, et al. Repeat COVID-19 molecular testing: correlation of SARS-CoV-2 culture with molecular assays and cycle thresholds. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1616.Google Scholar
Mowrer, CT, Creager, H, Cawcutt, K, et al. Evaluation of cycle threshold values at deisolation. Infect Control Hosp Epidemiol 2021. doi: 10.1017/ice.2021.132.Google ScholarPubMed
Aslam, A, Singh, J, Robilotti, E, et al. SARS CoV-2 surveillance and exposure in the perioperative setting with universal testing and personal protective equipment (PPE) policies. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1607.Google Scholar
Krüger, S, Leskien, M, Schuller, P, et al. Performance and feasibility of universal PCR admission screening for SARS-CoV-2 in a German tertiary-care hospital. J Med Virol 2021;93:2890–2898.CrossRefGoogle Scholar
TaqPath COVID-19 Combo Kit and TaqPath COVID-19 Combo Kit Advanced instructions for use. Thermo Fisher Website. https://assets.thermofisher.com/TFSAssets/LSG/manuals/MAN0019181_TaqPath_COVID-19_IFU_EUA.pdf. Published 2021. Accessed June 3,2021.Google Scholar
Risk of inaccurate results with Thermo Fisher Scientific TaqPath COVID-19 Combo Kit—letter to clinical laboratory staff and health care providers. US Food and Drug Administration website. https://www.fda.gov/medical-devices/letters-health-care-providers/risk-inaccurate-results-thermo-fisher-scientific-taqpath-covid-19-combo-kit-letter-clinical. Published 2020. Accessed June 3, 2021.Google Scholar
Young, BE, Ong, SWX, Ng, LFP, et al. Viral dynamics and immune correlates of coronavirus disease 2019 (COVID-19) severity. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1280.Google Scholar
Kim, M-C, Cui, C, Shin, K-R, et al. Duration of culturable SARS-CoV-2 in hospitalized patients with COVID-19. N Engl J Med 2021;384:671–673.CrossRefGoogle ScholarPubMed
Discontinuation of transmission-based precautions and disposition of patients with SARS-CoV-2 infection in healthcare settings. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html. Published 2021. Accessed May 30,2021Google Scholar
Scheier, T, Schibli, A, Eich, G, et al. Universal admission screening for SARS-CoV-2 infections among hospitalized patients, Switzerland, 2020. Emerg Infect Dis 2021;27:404–410.CrossRefGoogle Scholar
Sastry, SR, Pryor, R, Raybould, JE, et al. Universal screening for the SARS-CoV-2 virus on hospital admission in an area with low COVID-19 prevalence. Infect Control Hosp Epidemiol. 2020;41:1231–1233.CrossRefGoogle Scholar
Perera, R, Tso, E, Tsang, OTY, et al. SARS-CoV-2 virus culture and subgenomic RNA for respiratory specimens from patients with mild coronavirus disease. Emerg Infect Dis. 2020;26:2701–2704.CrossRefGoogle ScholarPubMed
Klompas, M, Baker, MA, Rhee, C, et al. A SARS-CoV-2 cluster in an acute-care hospital. Ann Intern Med. 2021;174:794–802.CrossRefGoogle Scholar
Rickman, HM, Rampling, T, Shaw, K, et al. Nosocomial transmission of COVID-19: a retrospective study of 66 hospital-acquired cases in a London teaching hospital. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa816.Google Scholar
Carter, B, Collins, JT, Barlow-Pay, F, et al. Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople). J Hosp Infect 2020;106:376–384.CrossRefGoogle Scholar
Cohen, CC, Cohen, B, Shang, J. Effectiveness of contact precautions against multidrug-resistant organism transmission in acute care: a systematic review of the literature. J Hosp Infect 2015;90:275–284.CrossRefGoogle ScholarPubMed
Rhoads, D, Peaper, DR, She, RC, et al. College of American Pathologists (CAP) Microbiology Committee Perspective: caution must be used in interpreting the cycle threshold (Ct) value. Clin Infect Dis 2021;72:e685–e686.CrossRefGoogle ScholarPubMed
Kwan, W-M, Mok, C-K, Kwok, Y-T, et al. Bundled interventions for consumption management and monitoring of personal protective equipment in COVID-19 pandemic in Hong Kong local hospitals. BMJ Open Qual 2020;9(4):e000990.CrossRefGoogle Scholar
Ranney, ML, Griffeth, V, Jha, AK. Critical supply shortages—the need for ventilators and personal protective equipment during the COVID-19 pandemic. N Engl J Med 2020;382(18):e41.CrossRefGoogle Scholar
Implementing filtering facepiece respirator (FFR) reuse, including reuse after decontamination, when there are known shortages of N95 respirators. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html. Published 2020. Accessed March 10, 2021.Google Scholar
Poon, K-S, Wen-Sim Tee, N. Caveats of reporting cycle threshold values from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) qualitative polymerase chain reaction assays: a molecular diagnostic laboratory perspective. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa1399.Google Scholar