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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.

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