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Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nosocomial transmission dynamics, a retrospective cohort study of two healthcare-associated coronavirus disease 2019 (COVID-19) clusters in a district hospital in England during March and April 2020

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

Published online by Cambridge University Press:  22 November 2021

David S. Leeman Open the ORCID record for David S. Leeman [Opens in a new window] ,
Thomas S.-G. Ma ,
Melanie M. Pathiraja ,
Jennifer A. Taylor ,
Tahira Z. Adnan ,
Ioannis Baltas Open the ORCID record for Ioannis Baltas [Opens in a new window] ,
Adam Ioannou ,
Srikanth R. S. Iyengar ,
Rachel A. Mearkle  and
Thomas J. Stockdale
...Show all authors
David S. Leeman*
Affiliation:
Field Service South East and London, Health Protection Operations, UK Health Security Agency, London, United Kingdom
Thomas S.-G. Ma
Affiliation:
Field Service South East and London, Health Protection Operations, UK Health Security Agency, London, United Kingdom
Melanie M. Pathiraja
Affiliation:
Frimley Health NHS Foundation Trust, Berkshire, United Kingdom
Jennifer A. Taylor
Affiliation:
Field Service South East and London, Health Protection Operations, UK Health Security Agency, London, United Kingdom
Tahira Z. Adnan
Affiliation:
Imperial College London, London, United Kingdom
Ioannis Baltas
Affiliation:
Frimley Health NHS Foundation Trust, Berkshire, United Kingdom
Adam Ioannou
Affiliation:
Royal Free NHS Trust, London, United Kingdom
Srikanth R. S. Iyengar
Affiliation:
Frimley Health NHS Foundation Trust, Berkshire, United Kingdom
Rachel A. Mearkle
Affiliation:
South East Health Protection Team (Thames Valley), UK Health Security Agency, Oxfordshire, United Kingdom
Thomas J. Stockdale
Affiliation:
Frimley Health NHS Foundation Trust, Berkshire, United Kingdom
Koenraad Van Den Abbeele
Affiliation:
Frimley Health NHS Foundation Trust, Berkshire, United Kingdom
Sooria Balasegaram
Affiliation:
Field Service South East and London, Health Protection Operations, UK Health Security Agency, London, United Kingdom
*
Author for correspondence: David S. Leeman, E-mail: david.leeman@phe.gov.uk
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Abstract

Objective:

To understand the transmission dynamics of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in a hospital outbreak to inform infection control actions.

Design:

Retrospective cohort study.

Setting:

General medical and elderly inpatient wards in a hospital in England.

Methods:

Coronavirus disease 2019 (COVID-19) patients were classified as community or healthcare associated by time from admission to onset or positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, nonrespiratory, or respiratory. Infectiousness was calculated from 2 days prior to 14 days after symptom onset or positive test. Cases were defined as healthcare-associated COVID-19 when infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aORs) were calculated from univariable and multivariable logistic regression.

Results:

Of 153 patients, 65 were COVID-19 patients and 45 of these were healthcare-associated cases. Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR, 3.81; 95% CI, 1.6.3–8.87). Nonrespiratory exposure was only significant within 2.5 m (aOR, 5.21; 95% CI, 1.15–23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95% CI, 0.99–4.22) to 2.36 (95% CI, 1.44–3.88).

Conclusions:

Respiratory exposure anywhere within a 4-bed bay was a risk, whereas nonrespiratory exposure required bed distance ≤2.5 m. Standard infection control measures required beds to be >2 m apart. Our findings suggest that this may be insufficient to stop SARS-CoV-2 transmission. We recommend improving cohorting and further studies into bed distance and transmission factors.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 11 , November 2022 , pp. 1618 - 1624
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

References

Lu, R, Zhao, X, Li, J, Niu, P, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565–574.CrossRefGoogle ScholarPubMed
Wang, C, Horby, PW, Hayden, FG, Gao, GF. A novel coronavirus outbreak of global health concern. Lancet 2020;395:470–473.CrossRefGoogle ScholarPubMed
Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). World Health Organization website. https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov). Accessed August 20, 2020.Google Scholar
Transmission of SARS-CoV-2: implications for infection prevention precautions. World Health Organization website. https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions. Accessed August 20, 2020.Google Scholar
Haque, M, Sartelli, M, McKimm, J, Abu Bakar, M. Healthcare-associated infections—an overview. Infect Drug Resist 2018;11:2321–2333.CrossRefGoogle Scholar
Heinzerling, A, Stuckey, MJ, Scheuer, T, et al. Transmission of COVID-19 to healthcare personnel during exposures to a hospitalized patient—Solano County, California, February 2020. Morbid Mortal Wkly Rep 2020;69:472–476.CrossRefGoogle Scholar
Meredith, LW, Hamilton, WL, Warne, B, et al. Rapid implementation of SARS-CoV-2 sequencing to investigate cases of healthcare-associated COVID-19: a prospective genomic surveillance study. Lancet Infect Dis 2020;20:1263–1272.CrossRefGoogle Scholar
Gold, MS, Sehayek, D, Gabrielli, S, Zhang, X, McCusker, C, Ben-Shoshan, M. COVID-19 and comorbidities: a systematic review and meta-analysis. Postgrad Med 2020;132:749–755.CrossRefGoogle ScholarPubMed
Disparities in the risk and outcomes of COVID-19. Public Health England website. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdf. Accessed August 20, 2020.Google Scholar
Surveillance definitions for COVID-19. European Centre for Disease Prevention and Control website. https://www.ecdc.europa.eu/en/covid-19/surveillance/surveillance-definitions. Accessed July 27, 2020.Google Scholar
Admission and care of residents in a care home during COVID-19. Department for Health and Social Care website. https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes/coronavirus-covid-19-admission-and-care-of-people-in-care-homes#fnref:9. Accessed August 21, 2020.Google Scholar
Guidance for contacts of people with confirmed coronavirus (COVID-19) infection who do not live with the person. Public Health England website. https://www.gov.uk/government/publications/guidance-for-contacts-of-people-with-possible-or-confirmed-coronavirus-covid-19-infection-who-do-not-live-with-the-person/guidance-for-contacts-of-people-with-possible-or-confirmed-coronavirus-covid-19-infection-who-do-not-live-with-the-person. Accessed August 20, 2020.Google Scholar
Surveillance definitions for COVID-19. European Centre for Disease Prevention and Control website. https://www.ecdc.europa.eu/en/covid-19/surveillance/surveillance-definitions. Accessed August 20, 2020.Google Scholar
Asadi, S, Bouvier, N, Wexler, AS, Ristenpart, WD. The coronavirus pandemic and aerosols: does COVID-19 transmit via expiratory particles? Aerosol Sci Technol 2020. doi: 10.1080/02786826.2020.1749229.CrossRefGoogle Scholar
Liu, Y, Ning, Z, Chen, Y, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature 2020;582:557–560.CrossRefGoogle ScholarPubMed
Guo, Z, Wang, Z, Zhang, S, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis 2020;26:1583–1591.CrossRefGoogle Scholar
Morawska, L, Milton, DK. It is time to address airborne transmission of COVID-19 Clin Infect Dis 2020;ciaa939.CrossRefGoogle Scholar
Wilson, Nick, Corbett, Stephen, Tovey, Euan. Airborne transmission of COVID-19. BMJ 2020;370:m3206.CrossRefGoogle ScholarPubMed
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