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Transmission of SARS-COV-2 in the hospital setting: Who is infecting whom?
Antimicrobial Resistance and Infection Control ; 10(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1448382
ABSTRACT

Introduction:

A better understanding of the relative importance of different transmission pathways of SARS-CoV-2 in hospital settings has the potential to help improve targeting of control measures aimed at reducing nosocomial spread.

Objectives:

To quantify the associations between risks of nosocomial SARS-CoV-2 infection and exposure on the same ward to infected healthcare workers (HCWs), to patients likely to have been infected nosocomially, and to patients with community onset COVID-19.

Methods:

Ward-level data were collected from four teaching hospitals in Oxfordshire, UK, over an 8 month period in 2020. SARS-CoV-2 infections were identified using both PCR results from symptomatic and asymptomatic testing and serological data coupled with symptom recall. A series of statistical models were used to quantify associations between exposures and probable hospital transmission events.

Results:

Risk to patients of probable nosocomial acquisition was most strongly associated with exposure to other patients with hospitalacquired SARS-CoV-2 (aOR, 1.76, 95%CI 1.51, 2.04), followed by the presence of an infected HCW on the same ward (aOR 1.45, 95%CI 1.22,1.71). The association with patients with community onset COVID- 19 was weaker (aOR 1.12, 95%CI 0.96,1.26). Transmission to HCWs was associated with exposure to other infectious HCWs and patients with hospital-acquired SARS-CoV-2 (aOR 1.66, 95%CI 1.55,1.78 and aOR 1.45, 95%CI 1.32,1.58 respectively). The introduction of more stringent infection prevention and control measures which included testing all patients for SARS-CoV-2 by PCR on admission and at weekly intervals was associated with substantial reduction in transmission risk to both patients (adjusted odds ratio, aOR 0.25, 95%CI 0.14, 0.42) and HCWs (aOR 0.43, 95%CI 0.34, 0.53).

Conclusion:

Patients who acquired SARS-CoV-2 in the hospital and, to a lesser degree, infectious HCWs likely working prior to the onset of symptoms, were the most strongly associated with increased risk of SARSCoV- 2 transmission. In contrast, exposure to patients who had acquired SARS-CoV-2 in the community was associated with, at most, modest increases in the daily risk of infection for both healthcare staff and the other patients.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Antimicrobial Resistance and Infection Control Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Antimicrobial Resistance and Infection Control Year: 2021 Document Type: Article