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Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case-control study.
Leal, Jenine; O'Grady, Heidi M; Armstrong, Logan; Dixit, Devika; Khawaja, Zoha; Snedeker, Kate; Ellison, Jennifer; Erebor, Joyce; Jamieson, Peter; Weiss, Amanda; Salcedo, Daniel; Roberts, Kimberley; Wiens, Karen; Croxen, Matthew A; Berenger, Byron M; Pabbaraju, Kanti; Lin, Yi-Chan; Evans, David; Conly, John M.
  • Leal J; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.
  • O'Grady HM; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Armstrong L; O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
  • Dixit D; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.
  • Khawaja Z; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.
  • Snedeker K; Infection Prevention and Control, Alberta Health Services, Edmonton, AB, Canada.
  • Ellison J; Department of Pediatrics, Division of Infectious Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
  • Erebor J; W21C, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Jamieson P; Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada.
  • Weiss A; Infection Prevention and Control, Alberta Health Services, Lethbridge, AB, Canada.
  • Salcedo D; Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.
  • Roberts K; Department of Family Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
  • Wiens K; Cardiac Sciences, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada.
  • Croxen MA; Cardiac Sciences, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada.
  • Berenger BM; Cardiac Sciences, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada.
  • Pabbaraju K; Cardiac Sciences, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada.
  • Lin YC; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada.
  • Evans D; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
  • Conly JM; Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
Antimicrob Resist Infect Control ; 12(1): 21, 2023 03 22.
Article in English | MEDLINE | ID: covidwho-2268145
ABSTRACT

BACKGROUND:

Risk factors for nosocomial COVID-19 outbreaks continue to evolve. The aim of this study was to investigate a multi-ward nosocomial outbreak of COVID-19 between 1st September and 15th November 2020, occurring in a setting without vaccination for any healthcare workers or patients.

METHODS:

Outbreak report and retrospective, matched case-control study using incidence density sampling in three cardiac wards in an 1100-bed tertiary teaching hospital in Calgary, Alberta, Canada. Patients were confirmed/probable COVID-19 cases and contemporaneous control patients without COVID-19. COVID-19 outbreak definitions were based on Public Health guidelines. Clinical and environmental specimens were tested by RT-PCR and as applicable quantitative viral cultures and whole genome sequencing were conducted. Controls were inpatients on the cardiac wards during the study period confirmed to be without COVID-19, matched to outbreak cases by time of symptom onset dates, age within ± 15 years and were admitted in hospital for at least 2 days. Demographics, Braden Score, baseline medications, laboratory measures, co-morbidities, and hospitalization characteristics were collected on cases and controls. Univariate and multivariate conditional logistical regression was used to identify independent risk factors for nosocomial COVID-19.

RESULTS:

The outbreak involved 42 healthcare workers and 39 patients. The strongest independent risk factor for nosocomial COVID-19 (IRR 3.21, 95% CI 1.47-7.02) was exposure in a multi-bedded room. Of 45 strains successfully sequenced, 44 (97.8%) were B.1.128 and differed from the most common circulating community lineages. SARS-CoV-2 positive cultures were detected in 56.7% (34/60) of clinical and environmental specimens. The multidisciplinary outbreak team observed eleven contributing events to transmission during the outbreak.

CONCLUSIONS:

Transmission routes of SARS-CoV-2 in hospital outbreaks are complex; however multi-bedded rooms play a significant role in the transmission of SARS-CoV-2.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Topics: Vaccines Limits: Humans Country/Region as subject: North America Language: English Journal: Antimicrob Resist Infect Control Year: 2023 Document Type: Article Affiliation country: S13756-023-01215-1

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Topics: Vaccines Limits: Humans Country/Region as subject: North America Language: English Journal: Antimicrob Resist Infect Control Year: 2023 Document Type: Article Affiliation country: S13756-023-01215-1