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

Lawton, Tom; Butler, Matt; Peters, Christine

doi:10.1016/j.jhin.2021.11.018

Cited by 18 publications

(17 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…56 Finally, PHA definition will need to be revised since including patients who became positive after 7 days is likely to underestimate COVID-19 variants with shorter incubation period. 24 CPAP is a valuable non-invasive respiratory support to treat acute hypoxic respiratory failure associated with COVID-19, however, delaying invasive ventilation in nonresponders to CPAP may increase mortality. 57 Further studies need to identify measures to predict CPAP and CPAP length efficacy on patients or which specific noninvasive treatment could be better for a patient.…”

Section: Discussionmentioning

confidence: 99%

“…27 28 It was estimated that 6000 additional patients caught COVID-19 in NHS hospital trusts with non-respiratory protective equipment. 24 Staff were less likely to initiate hospital transmission chains in wave 2, accounting for 31.3% of index cases compared with 50.6% in wave 1. 21 Apart from occasional exceptions, most of the published studies on CPAP are based on small/medium sample size (up to 400 patients).…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 96%

“… 23 Hospital-acquired COVID-19 reduced to 4% after summer 2021, corresponding with the rollout of vaccines in the UK. 24 The causes lay in building design, ventilation of rooms, huge pressure on overcrowded beds, short staffed and overwhelmed clinical teams, a lack of testing and inadequate patient and public involvement in the early months of the COVID-19 pandemic. 25 26 Major deficiencies in compliance with Public Health England’s guidance on good practice in preventing nosocomial COVID-19 transmission were also found, such as routine allocation of patients to beds before negative tests were confirmed, not testing clinical staff regularly and not using protective screens between patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

et al. 2022

View full text Add to dashboard Cite

ObjectiveTo estimate continuous positive airway pressure (CPAP) length of treatment effect on survival of hospitalised COVID-19 patients in a medium-sized UK Hospital, and how this effect changes according to the patient’s comorbidity and COVID-19 route of acquisition (community or nosocomial) during the two waves in 2020.SettingThe acute inpatient unit in Wrightington, Wigan and Leigh Teaching Hospitals National Health Service (NHS) Foundation Trust (WWL), a medium-sized NHS Trust in north-west of England.DesignRetrospective cohort of all confirmed COVID-19 patients admitted in WWL during 2020.Participants1830 patients (568 first wave, 1262 s wave) with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 (first confirmed COVID-19 case) and 31 December 2020.Outcome measureCOVID-19 survival rate in all patients and survival rate in potentially hospital-acquired COVID-19 (PHA) patients were modelled using a predictor set which include comorbidities (eg, obesity, diabetes, chronic ischaemic heart disease (IHD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD)), wave, age, sex and care home residency, and interventions (remdesivir, dexamethasone, CPAP, intensive care unit (ICU), intubation). Secondary outcome measure was CPAP length, which was modelled using the same predictors of the survival rate.ResultsMortality rate in the second wave was significantly lower than in the first wave (43.4% vs 28.1%, p<0.001), although for PHA COVID-19 patients mortality did not reduce, remaining at very high levels independently of wave and CPAP length. For all cohort, statistical modelling identified CPAP length (HR 95% CI 0.86 to 0.96) and women (HR 95% CI 0.71 to 0.81) were associated with improved survival, while being older age (HR 95% CI 1.02 to 1.03) admitted from care homes (HR 95% CI 2.22 to 2.39), IHD (HR 95% CI 1.13 to 1.24), CKD (HR 95% CI 1.14 to 1.25), obesity (HR 95% CI 1.18 to 1.28) and COPD-emphysema (HR 95% CI 1.18 to 1.57) were associated with reduced survival. Despite the detrimental effect of comorbidities, patients with CKD (95% CI 16% to 30% improvement in survival), IHD (95% CI 1% to 10% improvement in survival) and asthma (95% CI 8% to 30% improvement in survival) benefitted most from CPAP length, while no significant survival difference was found for obese and patients with diabetes.ConclusionsThe experience of an Acute Trust during the COVID-19 outbreak of 2020 is documented and indicates the importance of care home and hospitals in disease acquisition. Death rates fell between the first and second wave only for community-acquired COVID-19 patients. The fall was associated to CPAP length, especially for some comorbidities. While uncovering some risk and protective factors of mortality in COVID-19 studies, the study also unravels how little is known about PHA COVID-19 and the interaction between CPAP and some comorbidities.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of This Studymentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…There was insufficient data reported, however, to know if the differences in infection rates were due to increased use of respirators or other factors that may have confounded this observation. 118…”

Section: Maskingmentioning

confidence: 99%

New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses

Klompas

2022

Semin Respir Crit Care Med

View full text Add to dashboard Cite

A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.

show abstract

Preventing SARS-CoV-2 Transmission in Health Care Settings in the Context of the Omicron Variant

Karan

2022

JAMA

View full text Add to dashboard Cite

The world is in the midst of an unprecedented surge in SARS-CoV-2 cases attributable to the Omicron variant. This new variant is 2 to 3 times more contagious than the Delta variant. According to a report from the UK, 1109 of 14 606 non-household contacts of individuals with the Omicron variant developed infection vs 2922 of 102 997 non-household contacts of individuals with the Delta variant (7.6% vs 2.8%, respectively; adjusted odds ratio [OR], 2.63 [95% CI,). 1 The increased contagiousness of the Omicron variant is not only leading to a surge in community infections but it is also leading to more transmissions in hospitals. During the last week of December 2021 in England, for example, 2525 of 12 424 (20.3%) patients hospitalized with SARS-CoV-2 were first diagnosed more than 7 days after hospital admission. By comparison, the analogous figures for the first week of November 2021 were 434 of 5208 (8.3%) patients.The increase in hospital-onset infections associated with the Omicron variant belies the fact that nosocomial transmission of SARS-CoV-2 has been part of the COVID-19 pandemic from the beginning. The frequency of hospital-based transmission, however, is likely unappreciated. This is because few hospitals systematically test patients throughout and following their hospital stays. Most hospitals only test patients for SARS-CoV-2 at the time of admission and therefore may miss some infections acquired after admission, especially because approximately 40% of SARS-CoV-2 infections are mild or asymptomatic and thus do not trigger repeat testing. Furthermore, hospital stays for many non-COVID-19-related conditions are short, so some infections will only develop after discharge and will be missed or misattributed to posthospital exposures. Some jurisdictions have gone to great lengths to discern the true frequency of hospital-acquired SARS-CoV-2. This is best done using whole-genome sequencing of the virus to demonstrate relatedness to the infections of other patients and staff as well as to eliminate spurious temporal and spatial associations. In a study from the University of Oxford that evaluated 803 inpatients and 329 staff members from 4 hospitals who were diagnosed with SARS-CoV-2 during a 7-week period in late 2020, an estimated 188 of 803 (23.4%) patient infections were deemed to potentially be nosocomial. 2 Whole-genome sequencing helped identify multiple cases that were potentially acquired at the hospital despite receiving care on different wards (suggesting unidentified staff intermediaries) or being diagnosed at admission (suggesting exposure during a prior admission).Most hospitals have already implemented multifaceted infection control programs to prevent nosocomial SARS-CoV-2 transmission. These typically include uni-VIEWPOINT

show abstract

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

Cited by 18 publications

References 9 publications

Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses

Preventing SARS-CoV-2 Transmission in Health Care Settings in the Context of the Omicron Variant

Contact Info

Product

Resources

About