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Transmission of community- and hospital-acquired SARS-CoV-2 in hospital settings in the UK: A cohort study.
Mo, Yin; Eyre, David W; Lumley, Sheila F; Walker, Timothy M; Shaw, Robert H; O'Donnell, Denise; Butcher, Lisa; Jeffery, Katie; Donnelly, Christl A; Cooper, Ben S.
  • Mo Y; Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
  • Eyre DW; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Lumley SF; Division of Infectious Disease, Department of Medicine, National University Hospital, Singapore.
  • Walker TM; Department of Medicine, National University of Singapore, Singapore.
  • Shaw RH; Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
  • O'Donnell D; Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.
  • Butcher L; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.
  • Jeffery K; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom.
  • Donnelly CA; Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.
  • Cooper BS; Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.
PLoS Med ; 18(10): e1003816, 2021 10.
Article in English | MEDLINE | ID: covidwho-1463303
ABSTRACT

BACKGROUND:

Nosocomial spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been widely reported, but the transmission pathways among patients and healthcare workers (HCWs) are unclear. Identifying the risk factors and drivers for these nosocomial transmissions is critical for infection prevention and control interventions. The main aim of our study was to quantify the relative importance of different transmission pathways of SARS-CoV-2 in the hospital setting. METHODS AND

FINDINGS:

This is an observational cohort study using data from 4 teaching hospitals in Oxfordshire, United Kingdom, from January to October 2020. Associations between infectious SARS-CoV-2 individuals and infection risk were quantified using logistic, generalised additive and linear mixed models. Cases were classified as community- or hospital-acquired using likely incubation periods of 3 to 7 days. Of 66,184 patients who were hospitalised during the study period, 920 had a positive SARS-CoV-2 PCR test within the same period (1.4%). The mean age was 67.9 (±20.7) years, 49.2% were females, and 68.5% were from the white ethnic group. Out of these, 571 patients had their first positive PCR tests while hospitalised (62.1%), and 97 of these occurred at least 7 days after admission (10.5%). Among the 5,596 HCWs, 615 (11.0%) tested positive during the study period using PCR or serological tests. The mean age was 39.5 (±11.1) years, 78.9% were females, and 49.8% were nurses. For susceptible patients, 1 day in the same ward with another patient with hospital-acquired SARS-CoV-2 was associated with an additional 7.5 infections per 1,000 susceptible patients (95% credible interval (CrI) 5.5 to 9.5/1,000 susceptible patients/day) per day. Exposure to an infectious patient with community-acquired Coronavirus Disease 2019 (COVID-19) or to an infectious HCW was associated with substantially lower infection risks (2.0/1,000 susceptible patients/day, 95% CrI 1.6 to 2.2). As for HCW infections, exposure to an infectious patient with hospital-acquired SARS-CoV-2 or to an infectious HCW were both associated with an additional 0.8 infection per 1,000 susceptible HCWs per day (95% CrI 0.3 to 1.6 and 0.6 to 1.0, respectively). Exposure to an infectious patient with community-acquired SARS-CoV-2 was associated with less than half this risk (0.2/1,000 susceptible HCWs/day, 95% CrI 0.2 to 0.2). These assumptions were tested in sensitivity analysis, which showed broadly similar results. The main limitations were that the symptom onset dates and HCW absence days were not available.

CONCLUSIONS:

In this study, we observed that exposure to patients with hospital-acquired SARS-CoV-2 is associated with a substantial infection risk to both HCWs and other hospitalised patients. Infection control measures to limit nosocomial transmission must be optimised to protect both staff and patients from SARS-CoV-2 infection.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / Health Personnel / Infectious Disease Transmission, Professional-to-Patient / Infectious Disease Transmission, Patient-to-Professional / Community-Acquired Infections / COVID-19 / Hospitals Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: PLoS Med Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pmed.1003816

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / Health Personnel / Infectious Disease Transmission, Professional-to-Patient / Infectious Disease Transmission, Patient-to-Professional / Community-Acquired Infections / COVID-19 / Hospitals Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: PLoS Med Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pmed.1003816