Enhanced Infection Prevention Measures Including Universal N95 Usage and Daily Testing: The Impact on SARS-CoV-2 Transmission in Cohorted Hospital Cubicles Through Successive Delta and Omicron Waves

Wee, Liang En; Ko, Karrie Kwan Ki; Oo, Aung Myat; Yang, Yong; Arora, Shalvi; Venkatachalam, Indumathi

doi:10.1093/cid/ciac320

Cited by 5 publications

(7 citation statements)

References 7 publications

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“…The duration of time in a multi-bedded room was a major risk factor and the finding of a dose–response relationship adds epidemiologic strength of association to this finding. Another study from Singapore in a large cohort of nosocomial SARS-CoV-2 infections in patients housed in 5–6-bed cubicles, during time periods encompassing both SARS-CoV-2 Delta and Omicron variants found that sharing a common toilet with ≥ 1 cohorted cubicle was an independent risk factor for a transmission event (aOR, 1.92; 95% CI, 1.02–3.62) along with performance of aerosol-generating procedures and a cycle-threshold value of < 20 on RT-PCR testing [ 36 ]. This latter finding corroborates our finding of a 3.2-fold increased rate of acquiring SARS-CoV-2 with exposure to a multi-bedded room with a shared toilet and adds additional support given that it is irrespective of variant strain of SARS-CoV-2.…”

Section: Discussionmentioning

confidence: 99%

Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case–control study

Leal

O’Grady

Armstrong

et al. 2023

Antimicrob Resist Infect Control

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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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Section: Discussionmentioning

confidence: 99%

Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case–control study

Leal

O’Grady

Armstrong

et al. 2023

Antimicrob Resist Infect Control

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“…We performed a retrospective study on adult patients (≥18 years) with a history of HSCT at our center (Singapore General Hospital) who were diagnosed with COVID‐19 from May 2021 to May 2022. This period coincided with the emergence of community transmission attributed to the delta variant in April 2021, followed by the omicron variant in January 2022 4 . Before this, community transmission of SARS‐CoV‐2 was suppressed in Singapore through aggressive public‐health measures and no HSCT patients had COVID‐19 prior to April 2021.…”

Section: Methodsmentioning

confidence: 99%

“…Up to December 2021, prior to emergence of the omicron variant, whole‐genome sequencing for all COVID‐19 cases at our institution demonstrated that all cases were attributable to the SARS‐CoV‐2 delta variant 5 . In January 2022, during the shift from delta to omicron, S‐gene dropout on PCR testing using the TaqPath‐Combo PCR kit (Thermo Fisher Scientific) was taken to be indicative of the SARS‐CoV‐2 omicron variant 4 . By end‐January 2022, in‐hospital surveillance at our institution demonstrated S‐gene dropout on PCR testing in all surveillance cases, and COVID‐19 cases from February 2022 onward were attributed to the omicron variant.…”

Section: Methodsmentioning

confidence: 99%

“…This period coincided with the emergence of community transmission attributed to the delta variant in April 2021, followed by the omicron variant in January 2022. 4 Before this, community transmission of SARS-CoV-…”

Section: Data Curationmentioning

confidence: 99%

“…4 By end-January 2022, in-hospital surveillance at our institution demonstrated S-gene dropout on PCR testing in all…”

mentioning

confidence: 93%

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Favorable outcomes of COVID‐19 in vaccinated hematopoietic stem cell transplant recipients: A single‐center experience

Jinquan

Wee

Tan

et al. 2023

Transplant Infectious Dis

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Introduction A high incidence of mortality and severe COVID‐19 infection was reported in hematopoietic stem cell transplant (HSCT) recipients during the early phases of the COVID‐19 pandemic; however, outcomes with subsequent severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) variants, such as the omicron variant, have yet to be reported. Additionally, rollout of COVID‐19 vaccinations in subsequent pandemic waves may modify COVID‐19 disease severity and mortality in this immunocompromised population. We describe COVID‐19 outcomes among a highly vaccinated population of HSCT recipients at a single center during successive waves of community transmission arising from the SARS‐CoV‐2 delta and omicron variants. Methods We retrospectively reviewed medical records of all HSCT recipients at our institution who tested positive for SARS‐CoV‐2 from May 2021 to May 2022. Descriptive statistics were reported; the chi‐square test was utilized to identify factors associated with 90‐day all‐cause mortality and severity of COVID‐19 infection. Results Over the 1‐year study period, 77 HSCT recipients at our center contracted COVID‐19 (43 allogenic; 34 autologous). Twenty‐six (33.8%) patients were infected with the SARS‐CoV‐2 delta variant, while 51 (66.2%) had the SARS‐CoV‐2 omicron variant. Thirty‐nine (50.6%) patients required hospitalization. More than 80% had received prior COVID‐19 vaccination (57.1% with two doses, 27.3% with three doses). The majority (90.9%) had mild disease; only one (1.3%) patient required mechanical ventilation. Active hematological disease at time of COVID‐19 infection was associated with increased odds of mortality [odds ratio (OR) = 6.90, 95% confidence interval (CI) = 1.20–40]. The 90‐day all‐cause mortality was 7.8% (six patients). Infection with the omicron variant (vs. delta) was associated with less severe illness (OR = 0.05, 95% CI = 0.01–0.47) and decreased odds of mortality (OR = 0.08, 95% CI = 0.01–0.76). Being on immunosuppression (OR = 5.10, 95% CI = 1.10–23.60) and being unvaccinated at disease onset (OR = 14.76, 95% CI = 2.89–75.4) were associated with greater severity of COVID‐19 infection. Conclusion We observed favorable outcomes with COVID‐19 infection in a cohort of vaccinated HSCT patients. The SARS‐CoV‐2 omicron variant was associated with both less severe illness and decreased odds of mortality. As COVID‐19 moves toward endemicity, early access to treatment and encouraging vaccination uptake is crucial in mitigating the challenge of COVID‐19 management among HSCT recipients. Surveillance and assessment of clinical outcomes with new SARS‐CoV‐2 variants also remains important in this immunocompromised population.

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Relapsing COVID-19 infection as a manifestation of Good syndrome: a case report and literature review

Wee¹,

Jinquan²,

Oon³

et al. 2023

International Journal of Infectious Diseases

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Enhanced Infection Prevention Measures Including Universal N95 Usage and Daily Testing: The Impact on SARS-CoV-2 Transmission in Cohorted Hospital Cubicles Through Successive Delta and Omicron Waves

Cited by 5 publications

References 7 publications

Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case–control study

Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case–control study

Favorable outcomes of COVID‐19 in vaccinated hematopoietic stem cell transplant recipients: A single‐center experience

Relapsing COVID-19 infection as a manifestation of Good syndrome: a case report and literature review

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