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Hospital-acquired coronavirus disease 2019 (COVID-19) among patients of two acute-care hospitals: Implications for surveillance

Published online by Cambridge University Press:  19 April 2022

William E. Trick*
Affiliation:
Health Research & Solutions, Cook County Health, Chicago, Illinois Department of Medicine, Rush University Medical Center, Chicago, Illinois
Carlos A. Q. Santos
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois
Sharon Welbel
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Cook County Health, Chicago, Illinois
Marion Tseng
Affiliation:
Medical Research Analytics and Informatics Alliance, Chicago, Illinois
Huiyuan Zhang
Affiliation:
Health Research & Solutions, Cook County Health, Chicago, Illinois
Onofre Donceras
Affiliation:
Division of Infectious Diseases, Cook County Health, Chicago, Illinois
Ashley I. Martinez
Affiliation:
Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
Michael Y. Lin
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois
*
Author for correspondence: William Trick, E-mail: wtrick@cookcountyhhs.org

Abstract

Objectives:

We quantified hospital-acquired coronavirus disease 2019 (COVID-19) during the early phases of the pandemic, and we evaluated solely temporal determinations of hospital acquisition.

Design:

Retrospective observational study during early phases of the COVID-19 pandemic, March 1–November 30, 2020. We identified laboratory-detected severe acute respiratory coronavirus virus 2 (SARS-CoV-2) from 30 days before admission through discharge. All cases detected after hospital day 5 were categorized by chart review as community or unlikely hospital-acquired cases, or possible or probable hospital-acquired cases.

Setting:

The study was conducted in 2 acute-care hospitals in Chicago, Illinois.

Patients:

The study included all hospitalized patients including an inpatient rehabilitation unit.

Interventions:

Each hospital implemented infection-control precautions soon after identifying COVID-19 cases, including patient and staff cohort protocols, universal masking, and restricted visitation policies.

Results:

Among 2,667 patients with SARS-CoV-2, detection before hospital day 6 was most common (n = 2,612; 98%); detection during hospital days 6–14 was uncommon (n = 43; 1.6%); and detection after hospital day 14 was rare (n = 16; 0.6%). By chart review, most cases after day 5 were categorized as community acquired, usually because SARS-CoV-2 had been detected at a prior healthcare facility (68% of cases on days 6–14 and 53% of cases after day 14). The incidence rates of possible and probable hospital-acquired cases per 10,000 patient days were similar for ICU- and non-ICU patients at hospital A (1.2 vs 1.3 difference, 0.1; 95% CI, −2.8 to 3.0) and hospital B (2.8 vs 1.2 difference, 1.6; 95% CI, −0.1 to 4.0).

Conclusions:

Most patients were protected by early and sustained application of infection-control precautions modified to reduce SARS-CoV-2 transmission. Using solely temporal criteria to discriminate hospital versus community acquisition would have misclassified many “late onset” SARS-CoV-2–positive cases.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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