Coronavirus disease 2019 (COVID-19) incidence after exposures in shared patient rooms in a tertiary-care center in Iowa, July 2020–May 2021

Trannel, Alexandra; Kobayashi, Takaaki; Dains, Angelique; Abosi, Oluchi; Jenn, Kyle; Meacham, Holly; Sheeler, Lorinda; Etienne, William; Kukla, Mary; Alsuhaibani, Mohammed; Holley, Stephanie; Strandberg, Kelsey; Marra, Alexandre R.; Kritzman, Jeffrey; Ford, Bradley; Wellington, Melanie; Diekema, Daniel J.; Salinas, Jorge

doi:10.1017/ice.2021.313

Cited by 16 publications

(16 citation statements)

References 12 publications

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“…These SAR numbers are comparable to those in households (11), implying either that distancing and masking are of limited effectiveness for preventing transmission while sharing accommodations (supporting an aerosol transmission pathway between patients) (13) or that adherence to distancing and masking were low. Unsurprisingly, as also demonstrated elsewhere (8,10), the 2 parameters most strongly associated with SARS-CoV-2 were longer contact time between index and exposed patients and low Ct values (i.e., high viral loads) among index patients; Ct values <21 were shown to be associated with transmission.…”

Section: The Studymentioning

confidence: 52%

Nosocomial COVID-19 Incidence and Secondary Attack Rates among Patients of Tertiary Care Center, Zurich, Switzerland

Wolfensberger¹,

Kufner²,

Zaheri³

et al. 2022

Emerg. Infect. Dis.

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Section: The Studymentioning

confidence: 52%

Nosocomial COVID-19 Incidence and Secondary Attack Rates among Patients of Tertiary Care Center, Zurich, Switzerland

Wolfensberger¹,

Kufner²,

Zaheri³

et al. 2022

Emerg. Infect. Dis.

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“…In line with our findings of SARS-CoV-2 transmission occurring through shared patient rooms, Trannel et al observed a secondary attack rate of 21.6% among patients sharing a room with a previously unidentified COVID-19 case. In their study, longer exposure was associated with a higher risk for transmission [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hospitals are not always designed in a way to minimize the risk of patient-to-patient transmission (e.g. having limited isolation capacities) [ 4 ]. To keep medical operations running and ensure safe patient care, various IPC strategies have been developed tailored to the COVID-19 population prevalence, changes in transmissibility due to the emergence of new variants, the speed of spread, testing capacity, the availability of personal protective equipment, hospital infrastructure and vaccination coverage rates [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Provision of safe patient care during the COVID-19 pandemic despite shared patient rooms in a tertiary hospital

Füszl

Bouvier-Azula

Nest

et al. 2022

Antimicrob Resist Infect Control

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Background The COVID-19 pandemic has resulted in the disruption of healthcare systems. Vienna General Hospital (VGH), a tertiary hospital located in Austria, ran at almost full capacity despite high levels of community SARS-CoV-2 transmission and limited isolation room capacity. To ensure safe patient care, a bundle of infection prevention and control (IPC) measures including universal pre-admission screening and serial SARS-CoV-2 testing during hospitalization was implemented. We evaluated whether testing as part of our IPC approach was effective in preventing hospital outbreaks during different stages of the pandemic. Methods In this retrospective single center study, we analyzed the SARS-CoV-2 PCR test results of cases admitted to VGH between a low (15/05/2020–01/08/2020) and a high incidence period (15/09/2020–18/05/2021). Outcomes were the diagnostic yield of (a) admission screening, (b) the yield of serial testing during hospitalization and (c) the occurrence of healthcare-associated COVID-19 (HA-COVID-19) and SARS-CoV-2 related hospital outbreaks. Results The admission test positivity rate was 0.2% during the low and 2.3% during the high incidence phase. Regarding test conversions, 0.04% (low incidence phase) and 0.5% (high incidence phase) of initially negative cases converted to a positive test result within 7 days after admission The HA-COVID-19 incidence rate per 100,000 patient days was 1.0 (low incidence phase) and 10.7 (high incidence phase). One COVID-19 outbreak affecting eight patients in total could be potentially ascribed to the non-compliance with our IPC protocol. Conclusion Testing in conjunction with other IPC measures enabled the safe provision of patient care at a hospital with predominantly shared patient rooms despite high case numbers in the community.

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“…44 Indeed, patients admitted to a shared hospital room with acute but occult SARS-CoV-2 infection transmit the virus to their roommate an estimated 30 to 40% of the time. 40,84,85 Indeed, one of the ironies of SARS-CoV-2 and influenza is that newly infected patients with few or no symptoms tend to be far more contagious than patients with established infections admitted for virus-associated respiratory failure. This is because viral loads tend to be highest in both SARS-CoV-2 and influenza immediately before and following symptom onset and then steadily decline thereafter.…”

Section: Symptom Screening and Universal Testingmentioning

confidence: 99%

“…44 Indeed, patients admitted to a shared hospital room with acute but occult SARS-CoV-2 infection transmit the virus to their roommate an estimated 30 to 40% of the time. 40 84 85…”

Section: Symptom Screening and Universal Testingmentioning

confidence: 99%

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

Klompas

2022

Semin Respir Crit Care Med

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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.

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Coronavirus disease 2019 (COVID-19) incidence after exposures in shared patient rooms in a tertiary-care center in Iowa, July 2020–May 2021

Cited by 16 publications

References 12 publications

Nosocomial COVID-19 Incidence and Secondary Attack Rates among Patients of Tertiary Care Center, Zurich, Switzerland

Nosocomial COVID-19 Incidence and Secondary Attack Rates among Patients of Tertiary Care Center, Zurich, Switzerland

Provision of safe patient care during the COVID-19 pandemic despite shared patient rooms in a tertiary hospital

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

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