Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-06-10T00:07:02.145Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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
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.)

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
Supplementary material: Image

Leeman et al. supplementary material

Leeman et al. supplementary material

Download Leeman et al. supplementary material(Image)
Image 22.9 KB