Characterising within-hospital SARS-CoV-2 transmission events using epidemiological and viral genomic data across two pandemic waves

Lindsey, Benjamin B.; Villabona-Arenas, Christian Julián; Campbell, Finlay; Keeley, Alexander J; Parker, Matthew; Shah, Dhruv R; Parsons, Paul J.; Zhang, Peijun; Kakkar, Nishchay; Gallis, Marta; Foulkes, Benjamin H.; Wolverson, Paige; Louka, Stavroula F.; Christou, Stella; State, Amy; Johnson, Katie; Raza, Mohammad; Hsu, Sharon; Jombart, Thibaut; Cori, Anne; Evans, Cariad; Partridge, David G; Atkins, Katherine E.; Hué, Stéphane; Silva, Thushan I. de

doi:10.1038/s41467-022-28291-y

Cited by 46 publications

(42 citation statements)

References 30 publications

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“…In addition, on AMU there were likely longer stays of asymptomatic/ paucisymptomatic cases prior to universal PPE use, more fomites (e.g. bedside tables, chairs), and more frequent interspeciality interactions resulting in transmission between HCWs 37 . In the event of a further wave or outbreak, infection prevention and control (IPC) interventions to reduce risk in these areas could include targeted IPC training and auditing (particularly of PPE use and break areas), serial staff testing, pop-up isolation units in bay areas and optimising staff-to-patient ratios.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for SARS-CoV-2 seroprevalence following the first pandemic wave in UK healthcare workers in a large NHS Foundation Trust

Colton

Hodgson²,

Hornsby³

et al. 2022

Wellcome Open Res

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Background: We aimed to measure SARS-CoV-2 seroprevalence in a cohort of healthcare workers (HCWs) during the first UK wave of the COVID-19 pandemic, explore risk factors associated with infection, and investigate the impact of antibody titres on assay sensitivity. Methods: HCWs at Sheffield Teaching Hospitals NHS Foundation Trust were prospectively enrolled and sampled at two time points. We developed an in-house ELISA for testing participant serum for SARS-CoV-2 IgG and IgA reactivity against Spike and Nucleoprotein. Data were analysed using three statistical models: a seroprevalence model, an antibody kinetics model, and a heterogeneous sensitivity model. Results: Our in-house assay had a sensitivity of 99·47% and specificity of 99·56%. We found that 24·4% (n=311/1275) of HCWs were seropositive as of 12th June 2020. Of these, 39·2% (n=122/311) were asymptomatic. The highest adjusted seroprevalence was measured in HCWs on the Acute Medical Unit (41·1%, 95% CrI 30·0–52·9) and in Physiotherapists and Occupational Therapists (39·2%, 95% CrI 24·4–56·5). Older age groups showed overall higher median antibody titres. Further modelling suggests that, for a serological assay with an overall sensitivity of 80%, antibody titres may be markedly affected by differences in age, with sensitivity estimates of 89% in those over 60 years but 61% in those ≤30 years. Conclusions: HCWs in acute medical units and those working closely with COVID-19 patients were at highest risk of infection, though whether these are infections acquired from patients or other staff is unknown. Current serological assays may underestimate seroprevalence in younger age groups if validated using sera from older and/or more severe COVID-19 cases.

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Section: Discussionmentioning

confidence: 99%

Risk factors for SARS-CoV-2 seroprevalence following the first pandemic wave in UK healthcare workers in a large NHS Foundation Trust

Colton

Hodgson²,

Hornsby³

et al. 2022

Wellcome Open Res

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“…Previous studies have found conflicting evidence on this point. Caring for COVID-19 patients was found not to increase risk of infection in 2 large studies conducted in the USA [4,19], whereas in the UK, those working in patient-facing roles during the pandemic have been shown to be at higher risk of infection [3,16], and occupational exposure to patients and colleagues with COVID-19 has been shown to increase the risk of HCW infection in UK settings [20,21]. It should be noted that there are different PPE standards recommended by the 2 countries.…”

Section: Plos Medicinementioning

confidence: 99%

Risk factors associated with SARS-CoV-2 infection in a multiethnic cohort of United Kingdom healthcare workers (UK-REACH): A cross-sectional analysis

et al. 2022

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Background Healthcare workers (HCWs), particularly those from ethnic minority groups, have been shown to be at disproportionately higher risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to the general population. However, there is insufficient evidence on how demographic and occupational factors influence infection risk among ethnic minority HCWs. Methods and findings We conducted a cross-sectional analysis using data from the baseline questionnaire of the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH) cohort study, administered between December 2020 and March 2021. We used logistic regression to examine associations of demographic, household, and occupational risk factors with SARS-CoV-2 infection (defined by polymerase chain reaction (PCR), serology, or suspected COVID-19) in a diverse group of HCWs. The primary exposure of interest was self-reported ethnicity. Among 10,772 HCWs who worked during the first UK national lockdown in March 2020, the median age was 45 (interquartile range [IQR] 35 to 54), 75.1% were female and 29.6% were from ethnic minority groups. A total of 2,496 (23.2%) reported previous SARS-CoV-2 infection. The fully adjusted model contained the following dependent variables: demographic factors (age, sex, ethnicity, migration status, deprivation, religiosity), household factors (living with key workers, shared spaces in accommodation, number of people in household), health factors (presence/absence of diabetes or immunosuppression, smoking history, shielding status, SARS-CoV-2 vaccination status), the extent of social mixing outside of the household, and occupational factors (job role, the area in which a participant worked, use of public transport to work, exposure to confirmed suspected COVID-19 patients, personal protective equipment [PPE] access, aerosol generating procedure exposure, night shift pattern, and the UK region of workplace). After adjustment, demographic and household factors associated with increased odds of infection included younger age, living with other key workers, and higher religiosity. Important occupational risk factors associated with increased odds of infection included attending to a higher number of COVID-19 positive patients (aOR 2.59, 95% CI 2.11 to 3.18 for ≥21 patients per week versus none), working in a nursing or midwifery role (1.30, 1.11 to 1.53, compared to doctors), reporting a lack of access to PPE (1.29, 1.17 to 1.43), and working in an ambulance (2.00, 1.56 to 2.58) or hospital inpatient setting (1.55, 1.38 to 1.75). Those who worked in intensive care units were less likely to have been infected (0.76, 0.64 to 0.92) than those who did not. Black HCWs were more likely to have been infected than their White colleagues, an effect which attenuated after adjustment for other known risk factors. This study is limited by self-selection bias and the cross sectional nature of the study means we cannot infer the direction of causality. Conclusions We identified key sociodemographic and occupational risk factors associated with SARS-CoV-2 infection among UK HCWs, and have determined factors that might contribute to a disproportionate odds of infection in HCWs from Black ethnic groups. These findings demonstrate the importance of social and occupational factors in driving ethnic disparities in COVID-19 outcomes, and should inform policies, including targeted vaccination strategies and risk assessments aimed at protecting HCWs in future waves of the COVID-19 pandemic. Trial registration The study was prospectively registered at ISRCTN (reference number: ISRCTN11811602).

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“…Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, 1 there have been reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission to patients and healthcare workers (HCW) within healthcare facilities. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Factors contributing to these outbreaks have included patient accommodation in multibed rooms or bays, [6][7][8]11,12,17 lack of infection prevention and control precautions due to failure to identify patients admitted with or incubating SARS-CoV-2, [6][7][8][9][10]20 and nosocomial exposure to a patient with COVID-19. [15][16][17][18][19][20] Rhee et al 22 demonstrated that consistent application of infection prevention and control measures can reduce or prevent the spread of SARS-CoV-2 in healthcare settings.…”

mentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Factors contributing to these outbreaks have included patient accommodation in multibed rooms or bays, [6][7][8]11,12,17 lack of infection prevention and control precautions due to failure to identify patients admitted with or incubating SARS-CoV-2, [6][7][8][9][10]20 and nosocomial exposure to a patient with COVID-19. [15][16][17][18][19][20] Rhee et al 22 demonstrated that consistent application of infection prevention and control measures can reduce or prevent the spread of SARS-CoV-2 in healthcare settings. However, outbreaks in healthcare facilities continue.…”

mentioning

confidence: 99%

Factors contributing to a coronavirus disease 2019 (COVID-19) outbreak on a mixed medical-surgical unit in a Canadian acute-care hospital

McCallum

Patriquin

Davis

et al. 2022

ASHE

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Objective: To identify preventable factors that contribute to the cross transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to patients in healthcare facilities. Design: A case–control study was conducted among inpatients on a coronavirus disease 2019 (COVID-19) outbreak unit. Setting: This study was conducted in a medical-surgical unit of a tertiary-care hospital in Nova Scotia in May 2021. Patients: Patients hospitalized on the unit for at least 12 hours and healthcare workers (HCW) working on the unit within 2 weeks of outbreak declaration were included. Methods: Risk factors for SARS-CoV-2 infection were analyzed using simple and multiple logistic regression. Whole-genome sequencing (WGS) was performed to identify SARS-CoV-2 strain relatedness. Network analysis was used to describe patient accommodation. Results: SARS-CoV-2 infections were identified in 21 patients (29.6%) and 11 HCWs (6.6%). WGS data revealed 4 distinct clades of related sequences. Several factors likely contributed to the outbreak, including failure to identify SARS-CoV-2, a largely incomplete or unvaccinated population, and patient wandering behaviors. The most significant risk factor for SARS-CoV-2 infection was room sharing with an infectious patient, which was the only factor that remained statistically significant following multivariate analysis (odds ratio [OR], 9.2l; 95% confidence interval [CI], 2.04–41.67; P = .004). Conclusions: This outbreak likely resulted from admission of 2 patients with COVID-19, with subsequent transmissions to 17 patients and 11 staff. WGS and bioinformatics analyses were critical to identifying previously unrecognized nosocomial transmissions of SARS-CoV-2. This study supports strategies to reduce nosocomial transmissions of SARS-CoV-2, such as single-patient rooms, promotion of COVID-19 vaccination, and infection prevention and control measures including management of wandering behaviors.

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Characterising within-hospital SARS-CoV-2 transmission events using epidemiological and viral genomic data across two pandemic waves

Cited by 46 publications

References 30 publications

Risk factors for SARS-CoV-2 seroprevalence following the first pandemic wave in UK healthcare workers in a large NHS Foundation Trust

Risk factors for SARS-CoV-2 seroprevalence following the first pandemic wave in UK healthcare workers in a large NHS Foundation Trust

Risk factors associated with SARS-CoV-2 infection in a multiethnic cohort of United Kingdom healthcare workers (UK-REACH): A cross-sectional analysis

Factors contributing to a coronavirus disease 2019 (COVID-19) outbreak on a mixed medical-surgical unit in a Canadian acute-care hospital

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