Abstract
Objective: To understand the transmission dynamics of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in a hospital outbreak to inform infection control actions.
Design: Retrospective cohort study.
Setting: General medical and elderly inpatient wards in a hospital in England.
Methods: Coronavirus disease 2019 (COVID-19) patients were classified as community or healthcare associated by time from admission to onset or positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, nonrespiratory, or respiratory. Infectiousness was calculated from 2 days prior to 14 days after symptom onset or positive test. Cases were defined as healthcare-associated COVID-19 when infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aORs) were calculated from univariable and multivariable logistic regression.
Results: Of 153 patients, 65 were COVID-19 patients and 45 of these were healthcare-associated cases. Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR, 3.81; 95% CI, 1.6.3-8.87). Nonrespiratory exposure was only significant within 2.5 m (aOR, 5.21; 95% CI, 1.15-23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95% CI, 0.99-4.22) to 2.36 (95% CI, 1.44-3.88).
Conclusions: Respiratory exposure anywhere within a 4-bed bay was a risk, whereas nonrespiratory exposure required bed distance ≤2.5 m. Standard infection control measures required beds to be >2 m apart. Our findings suggest that this may be insufficient to stop SARS-CoV-2 transmission. We recommend improving cohorting and further studies into bed distance and transmission factors.
| Original language | English |
|---|---|
| Pages (from-to) | 1618-1624 |
| Number of pages | 7 |
| Journal | Infection Control and Hospital Epidemiology |
| Volume | 43 |
| Issue number | 11 |
| Early online date | 22 Nov 2021 |
| DOIs | |
| Publication status | Published - 22 Nov 2022 |
Bibliographical note
Funding Information: No funding information available.Open Access: No open Access licence.
Publisher Copyright: © The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Citation: Leeman, D., Ma, T., Pathiraja, M., Taylor, J., Adnan, T., Baltas, I., . . . Balasegaram, S. (2022). Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nosocomial transmission dynamics, a retrospective cohort study of two healthcare-associated coronavirus disease 2019 (COVID-19) clusters in a district hospital in England during March and April 2020. Infection Control & Hospital Epidemiology, 43(11), 1618-1624. doi:10.1017/ice.2021.483
DOI: 10.1017/ice.2021.483
