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Interventions to control nosocomial transmission of SARS-CoV-2: a modelling study.
Pham, Thi Mui; Tahir, Hannan; van de Wijgert, Janneke H H M; Van der Roest, Bastiaan R; Ellerbroek, Pauline; Bonten, Marc J M; Bootsma, Martin C J; Kretzschmar, Mirjam E.
  • Pham TM; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Utrecht, The Netherlands. t.m.pham-2@umcutrecht.nl.
  • Tahir H; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Utrecht, The Netherlands.
  • van de Wijgert JHHM; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Utrecht, The Netherlands.
  • Van der Roest BR; Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK.
  • Ellerbroek P; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Utrecht, The Netherlands.
  • Bonten MJM; Department of Internal Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
  • Bootsma MCJ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Utrecht, The Netherlands.
  • Kretzschmar ME; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
BMC Med ; 19(1): 211, 2021 08 27.
Article in English | MEDLINE | ID: covidwho-1470617
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ABSTRACT

BACKGROUND:

Emergence of more transmissible SARS-CoV-2 variants requires more efficient control measures to limit nosocomial transmission and maintain healthcare capacities during pandemic waves. Yet the relative importance of different strategies is unknown.

METHODS:

We developed an agent-based model and compared the impact of personal protective equipment (PPE), screening of healthcare workers (HCWs), contact tracing of symptomatic HCWs and restricting HCWs from working in multiple units (HCW cohorting) on nosocomial SARS-CoV-2 transmission. The model was fit on hospital data from the first wave in the Netherlands (February until August 2020) and assumed that HCWs used 90% effective PPE in COVID-19 wards and self-isolated at home for 7 days immediately upon symptom onset. Intervention effects on the effective reproduction number (RE), HCW absenteeism and the proportion of infected individuals among tested individuals (positivity rate) were estimated for a more transmissible variant.

RESULTS:

Introduction of a variant with 56% higher transmissibility increased - all other variables kept constant - RE from 0.4 to 0.65 (+ 63%) and nosocomial transmissions by 303%, mainly because of more transmissions caused by pre-symptomatic patients and HCWs. Compared to baseline, PPE use in all hospital wards (assuming 90% effectiveness) reduced RE by 85% and absenteeism by 57%. Screening HCWs every 3 days with perfect test sensitivity reduced RE by 67%, yielding a maximum test positivity rate of 5%. Screening HCWs every 3 or 7 days assuming time-varying test sensitivities reduced RE by 9% and 3%, respectively. Contact tracing reduced RE by at least 32% and achieved higher test positivity rates than screening interventions. HCW cohorting reduced RE by 5%. Sensitivity analyses show that our findings do not change significantly for 70% PPE effectiveness. For low PPE effectiveness of 50%, PPE use in all wards is less effective than screening every 3 days with perfect sensitivity but still more effective than all other interventions.

CONCLUSIONS:

In response to the emergence of more transmissible SARS-CoV-2 variants, PPE use in all hospital wards might still be most effective in preventing nosocomial transmission. Regular screening and contact tracing of HCWs are also effective interventions but critically depend on the sensitivity of the diagnostic test used.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Variants Limits: Humans Country/Region as subject: Europa Language: English Journal: BMC Med Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: S12916-021-02060-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Variants Limits: Humans Country/Region as subject: Europa Language: English Journal: BMC Med Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: S12916-021-02060-y