Nosocomial transmission of SARS-CoV-2 is a key concern, and evaluating the effect of testing and infection prevention and control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical English hospital, we estimate that between 9 March 2020 and 17 July 2020 approximately 20% of infections in inpatients, and 73% of infections in healthcare workers (HCWs) were due to nosocomial transmission. Model results suggest that placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 35%. Periodic testing of HCWs has a smaller effect on the number of hospital-acquired COVID-19 cases in patients, but reduces infection in HCWs by as much as 37% and results in only a small proportion of staff absences (approx. 0.3% per day). This is considerably less than the 20–25% of staff that have been reported to be absent from work owing to suspected COVID-19 and self-isolation. Model-based evaluations of interventions, informed by data collected so far, can help to inform policy as the pandemic progresses and help prevent transmission in the vulnerable hospital population. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.

BackgroundAs part of the 2014 European Antibiotic Awareness Day plans, a new campaign called Antibiotic Guardian (AG) was launched in the United Kingdom, including an online pledge system to increase commitment from healthcare professionals and members of the public to reduce antimicrobial resistance (AMR). The aim of this evaluation was to determine the impact of the campaign on self-reported knowledge and behaviour around AMR.MethodsAn online survey was sent to 9016 Antibiotic Guardians (AGs) to assess changes in self-reported knowledge and behaviour (outcomes) following the campaign. Logistic regression models, adjusted for variables including age, sex and pledge group (pledging as member of public or as healthcare professional), were used to estimate associations between outcomes and AG characteristics.Results2478 AGs responded to the survey (27.5 % response rate) of whom 1696 (68.4 %) pledged as healthcare professionals and 782 (31.6 %) as members of public (similar proportions to the total number of AGs). 96.3 % of all AGs who responded had prior knowledge of AMR. 73.5 % of participants were female and participants were most commonly between 45 and 54 years old.Two thirds (63.4 %) of participants reported always acting according to their pledge. Members of the public were more likely to act in line with their pledge than professionals (Odds Ratio (OR) =3.60, 95 % Confidence Interval (CI): 2.88-4.51). Approximately half of participants (44.5 %) (both healthcare professionals and members of public) reported that they acquired more knowledge about AMR post-campaign. People that were confused about AMR prior to the campaign acquired more knowledge after the campaign (OR = 3.10, 95 % CI: 1.36-7.09). More participants reported a sense of personal responsibility towards tackling AMR post-campaign, increasing from 58.3 % of participants pre-campaign to 70.5 % post-campaign.ConclusionThis study demonstrated that the campaign increased commitment to tackling AMR in both healthcare professional and member of the public, increased self-reported knowledge and changed self-reported behaviour particularly among people with prior AMR awareness. Online pledge schemes can be an effective and inexpensive way to engage people with the problem of AMR especially among those with prior awareness of the topic.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3057-2) contains supplementary material, which is available to authorized users.

Objectives : Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. Methods : Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test <14 days pre-admission, up to day 2 of admission; hospital-onset indeterminate healthcare-associated, first positive on day 3-7; hospital-onset probable healthcare-associated, first positive on day 8-14; hospital-onset definite healthcare-associated, first positive from day 15 of admission until discharge; community-onset possible healthcare-associated, first positive test ≤14 days post-discharge. Results : One-third (34.4%, 100,859/293,204) of all laboratory-confirmed COVID-19 cases were linked to a hospital record. Hospital-onset probable and definite cases represented 5.3% (15,564/293,204) of all laboratory-confirmed cases and 15.4% (15,564/100,859) of laboratory-confirmed cases among hospital patients. Community-onset community-acquired and community-onset possible healthcare-associated cases represented 86.5% (253,582/293,204) and 5.1% (14,913/293,204) of all laboratory-confirmed cases, respectively. Conclusions : Up to 1 in 6 SARS-CoV-2 infections among hospitalised patients with COVID-19 in England during the first 6 months of the pandemic could be attributed to nosocomial transmission, but these represent less than 1% of the estimated 3 million COVID-19 cases in this period.

BackgroundThe Antibiotic Guardian Campaign was developed to increase commitment to reducing Antimicrobial Resistance (AMR), change behaviour and increase knowledge through an online pledge system for healthcare professionals and members of the public to become Antibiotic Guardians (AG). This qualitative evaluation aimed to understand AG experiences of the campaign and perceived impact on behaviour.MethodsNinety-four AGs (48 via a survey and 46 who had agreed to future contact) were invited to participate in a telephone semi-structured interview. The sample was based on self-identification as a healthcare professional or a member of the public, pledge group (e.g. adults, primary care prescribers etc.), pledge and gender. Interviews explored how participants became aware of the campaign, reasons for joining, pledge choices, responses to joining and views about the campaign’s implementation. Interviews were analysed using the Framework Method.ResultsTwenty-two AGs (10 healthcare professionals and 12 members of the public) were interviewed. AGs became aware of the campaign through professional networks and social media, and were motivated to join by personal and professional concern for AMR. Choice of pledge group and pledge were attributed to relevance and potential impact on AMR and the behaviour of others through pledge enactment and promotion of the campaign. Most AGs could not recall their pledge unprompted. Most felt they fulfilled their pledge, although this reflected either behaviour change or the pledge reinforcing pre-existing behaviour. The campaign triggered AGs to reflect on AMR related behaviour and reinforced pre-existing beliefs. Several AGs promoted the campaign to others. Responding collectively as part of the campaign was thought to have a greater impact than individual action. However, limited campaign visibility was observed and the campaign was perceived to have restricted ability to reach those unaware of AMR.ConclusionsAGs were motivated to reduce AMR and most felt they fulfilled their pledges although for many this appeared to be through reinforcement of existing behaviours. We recommend that the campaign engages those without pre-existing knowledge of AMR by increasing its visibility, capitalising on the diffusion of its message and including more awareness-raising content for those with limited AMR knowledge.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4552-9) contains supplementary material, which is available to authorized users.

The majority of healthcare organizations review national AMS toolkits; however, implementation of the toolkits, through the development of action plans to deliver AMS interventions, requires improvement. For the first time, we report the extent of cross-sector and multidisciplinary collaboration to deliver AMS interventions in both primary and secondary care sectors in England. Results highlight that further qualitative and quantitative work is required to explore mutual benefits and promote best practice. Antimicrobial pharmacists remain leaders for implementing AMS interventions across both primary and secondary healthcare sectors.