Superspreaders drive the largest outbreaks of hospital onset COVID-19 infections

Illingworth, Christopher J. R.; Hamilton, William L.; Warne, Ben; Routledge, Matthew; Popay, A.I.; Jackson, Chris; Fieldman, Tom; Meredith, Luke W.; Houldcroft, Charlotte J.; Hosmillo, Myra; Jahun, Aminu S.; Caller, Laura G; Caddy, Sarah; Yakovleva, Anna; Hall, Grant; Khokhar, Fahad; Feltwell, Theresa; Pinckert, Malte L.; Georgana, Iliana; Chaudhry, Yasmin; Curran, Martin D.; Parmar, Surendra; Sparkes, Dominic; Rivett, Lucy; Jones, Nick K; Sridhar, Sushmita; Forrest, Sally; Dymond, Tom; Grainger, Kayleigh; Workman, Christopher T.; Ferris, Mark; Gkrania‐Klotsas, Effrossyni; Brown, Nicholas M.; Weekes, Michael P.; Baker, Stephen J.; Peacock, Sharon J.; Goodfellow, Ian; Gouliouris, Theodore; Angelis, Daniela De; Török, M. Estée

doi:10.7554/elife.67308

Cited by 41 publications

(36 citation statements)

References 40 publications

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“…Other drivers of SARS-CoV-2 transmissions in the hospital setting not fully explained by infection pressures, which we did not capture in the analysis, may include variation in ward occupancy, community-acquired cases who did not develop symptoms until after hospitalisation, change in nature or frequency of SARS-CoV-2 exposures throughout hospitalisation, or could reflect frailties, i.e., those patients who have stayed 20 days and not been infected may be at lower risk of infection. However, recent work using detailed epidemiological and genomic data to infer transmission networks echoed our main finding that patients are more likely to be infected by other patients than by HCWs [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 74%

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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Section: Discussionmentioning

confidence: 74%

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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“…Airborne dissemination is likely an important transmission route for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [ 1 ], with SARS-CoV-2 RNA detected in air samples from coronavirus disease 2019 (COVID-19) wards [ 1 , 2 ]. Despite the use of personal protective equipment (PPE), there are multiple reports of patient-to-healthcare worker transmission of SARS-CoV-2 [ 3 ], potentially through the inhalation of viral particles [ 4 ]. There is a need to improve the safety for healthcare workers and patients by decreasing airborne transmission of SARS-CoV-2 [ 4 ].…”

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confidence: 99%

The Removal of Airborne Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Other Microbial Bioaerosols by Air Filtration on Coronavirus Disease 2019 (COVID-19) Surge Units

Morris

Sharrocks

Bousfield

et al. 2021

Clinical Infectious Diseases

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“…by preventing asymptomatically infected health care workers infecting patients, reported as 9%. 8 The data presented demonstrate that the measures associated with RPE implementation, likely involving improvements to ventilation and air filtration, are associated with a 21% and 33% relative reduction in odds of hospital-acquired COVID-19 for the Alpha and Delta waves respectively.…”

Section: Discussionmentioning

confidence: 80%

Airborne protection for staff is associated with reduced hospital-acquired COVID-19 in English NHS trusts

Lawton¹,

Butler

Peters

2022

Journal of Hospital Infection

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Superspreaders drive the largest outbreaks of hospital onset COVID-19 infections

Cited by 41 publications

References 40 publications

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

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

The Removal of Airborne Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Other Microbial Bioaerosols by Air Filtration on Coronavirus Disease 2019 (COVID-19) Surge Units

Airborne protection for staff is associated with reduced hospital-acquired COVID-19 in English NHS trusts

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