Healthcare-associated COVID-19 in England: A national data linkage study

Bhattacharya, Alex; Collin, Simon M.; Stimson, James A.; Thelwall, Simon; Nsonwu, Olisaeloka; Gerver, Sarah; Robotham, Julie V.; Wilcox, Mark H.; Hopkins, Susan; Hope, Russell

doi:10.1016/j.jinf.2021.08.039

Cited by 53 publications

(54 citation statements)

References 23 publications

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“…Hospital attendances (including admissions) was defined as any hospital attendance, including admissions and attendances at accident and emergency departments, 0–14 days after the first specimen date of the most recent infection episode. Hospital attendances (including admissions and diagnoses during hospital stay) was defined in the same way as hospital attendances (including admissions), but additionally included cases with a first specimen date occurring during their hospital stay (hospital-onset cases 27 ), to approximately match the definition used in NHS COVID-19 hospitalisation statistics. 28 The mortality outcome was defined as death occurring 0–28 days after the first positive specimen date of the most recent infection episode, again matching the definition used in routine UK government reporting.…”

Section: Methodsmentioning

confidence: 99%

Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study

Nyberg

Ferguson

Nash³

et al. 2022

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Section: Methodsmentioning

confidence: 99%

Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study

Nyberg

Ferguson

Nash³

et al. 2022

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“…Nosocomial transmission and outbreaks of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have been frequently reported in various healthcare settings since the beginning of the pandemic [ 1 – 6 ]. Reported proportions of hospitalised Coronavirus Disease 2019 (COVID-19) patients suspected to have acquired SARS-CoV-2 in the hospitals vary widely, ranging from < 1% to 20% [ 7 – 10 ], and a national data linkage study in England estimated that 15% of laboratory-confirmed cases among hospital patients were healthcare-associated [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Transmission of community- and hospital-acquired SARS-CoV-2 in hospital settings in the UK: A cohort study

Eyre

Lumley

et al. 2021

PLoS Med

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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.

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“…NHSE and PHE define a healthcare-associated case as any patient who tests positive for SARS-CoV-2 for the first time ≥8 days post admission to hospital. 6 , 18 Over the course of the first wave (1 March 2020 to 31 August 2020), one-third of all laboratory-confirmed cases in England were linked to a record of hospital attendance, 15.4% of which (∼5.3% of all confirmed cases) were suspected to be healthcare-associated, 19 although this figure is likely biased by the increased likelihood of a case being detected in hospital inpatients compared with those in the general community. From the analysis data from acute NHSE trusts over an extended time period from weeks 10–48 (1 March 2020 to 1 December 2020), the number of non-COVID-19 admissions per week ranged from 140 000–290 000 and the number of patients who developed a nosocomial infection in a single week peaked at ∼2000 ( Figure 2A–C ).…”

Section: Resultsmentioning

confidence: 99%

Quantifying the contribution of pathways of nosocomial acquisition of COVID-19 in English hospitals

Evans¹,

Stimson²,

Pople³

et al. 2021

International Journal of Epidemiology

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Background Despite evidence of the nosocomial transmission of novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in hospitals worldwide, the contributions of the pathways of transmission are poorly quantified. Methods We analysed national records of hospital admissions and discharges, linked to data on SARS-CoV-2 testing, using an individual-based model that considers patient-to-patient, patient-to-healthcare worker (HCW), HCW-to-patient and HCW-to-HCW transmission. Results Between 1 March 2020 and 31 December 2020, SARS-CoV-2 infections that were classified as nosocomial were identified in 0.5% (0.34–0.74) of patients admitted to an acute National Health Service trust. We found that the most likely route of nosocomial transmission to patients was indirect transmission from other infected patients, e.g. through HCWs acting as vectors or contaminated fomites, followed by direct transmission between patients in the same bay. The risk of transmission to patients from HCWs over this time period is low, but can contribute significantly when the number of infected inpatients is low. Further, the risk of a HCW acquiring SARS-CoV-2 in hospital is approximately equal to that in the community, thereby doubling their overall risk of infection. The most likely route of transmission to HCWs is transmission from other infected HCWs. Conclusions Current control strategies have successfully reduced the transmission of SARS-CoV-2 between patients and HCWs. In order to reduce the burden of nosocomial COVID-19 infections on health services, stricter measures should be enforced that would inhibit the spread of the virus between bays or wards in the hospital. There should also be a focus on inhibiting the spread of SARS-CoV-2 between HCWs. The findings have important implications for infection-control procedures in hospitals.

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Healthcare-associated COVID-19 in England: A national data linkage study

Cited by 53 publications

References 23 publications

Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study

Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study

Transmission of community- and hospital-acquired SARS-CoV-2 in hospital settings in the UK: A cohort study

Quantifying the contribution of pathways of nosocomial acquisition of COVID-19 in English hospitals

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