Discontinuation of Universal Admission Testing for SARS-CoV-2 and Hospital-Onset COVID-19 Infections in England and Scotland

Pak, Theodore R.; Rhee, Chanu; Wang, Rui; Klompas, Michael

doi:10.1001/jamainternmed.2023.1261

JAMA Intern Med

2023

DOI: 10.1001/jamainternmed.2023.1261

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Discontinuation of Universal Admission Testing for SARS-CoV-2 and Hospital-Onset COVID-19 Infections in England and Scotland

Theodore R. Pak,

Chanu Rhee,

Rui Wang

et al.

Abstract: This quality improvement study examines the association between the discontinuation of universal admission testing for SARS-CoV-2 infections and hospital-onset SARS-CoV-2 infections in England and Scotland.

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Cited by 10 publications

(1 citation statement)

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“…Masking health care workers is associated with a 50% to 60% decrease in hospital-onset respiratory viral infections; respirators may prevent additional patient infections because they provide superior source control, but their impact on preventing transmission from health care workers to patients has not been well studied . Universal testing on admission for SARS-CoV-2 and other viruses is associated with fewer hospital-onset infections . Hospital-onset infections are frequently linked to symptomatic visitors; successful prevention bundles often include visitor screening …”

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confidence: 99%

Is Nosocomial SARS-CoV-2 Still Worth Preventing?

Klompas,

Baker,

Rhee

2023

JAMA Netw Open

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During the initial months of the SARS-CoV-2 pandemic, hospitals implemented extensive measures to prevent nosocomial transmission of SARS-CoV-2. Actions varied among hospitals but commonly included universal masking, restricting visitors, limiting occupancy, modifying ventilation, testing all patients on admission (and sometimes serially thereafter), extensive contact tracing, and/or requiring employees to attest to their health before each shift.However, much has changed since the early days of the pandemic. The morbidity and mortality associated with SARS-CoV-2 has plunged dramatically in the wake of widespread immunity acquired through natural infections and vaccines, evolving variants, and effective treatments. Hospitalizations and deaths due to SARS-CoV-2 are now unusual, particularly on a per-infection basis. Public health agencies have declared an end to the public health emergency, and most people have reverted to prepandemic behaviors. Mask wearing outside hospitals is rare, social gatherings are common, and fewer and fewer people who develop symptoms of SARS-CoV-2 elect to get tested or to isolate if test results are positive.Hospital leaders face the dilemma of deciding whether hospitals and clinics can also revert to prepandemic practices or whether health care ought to be different. Some argue that with the drop in SARS-CoV-2 morbidity, the downsides of masking and other prevention measures now outweigh their potential benefits. Others argue that while SARS-CoV-2 is currently well tolerated by many people, the potential morbidity of nosocomial SARS-CoV-2 remains high because hospitals concentrate the subset of the population that remains at increased risk for complications, particularly older adults, people with weakened immune systems, and those with chronic conditions. Indeed, much of the harm caused by SARS-CoV-2 and other respiratory viruses is due to exacerbations of chronic disease leading to heart attacks, arrythmias, congestive heart failure, obstructive lung disease, stroke, bacterial superinfections, and delays in time-sensitive treatments rather than respiratory disease per se. 1 In our opinion, 3 considerations should inform whether hospitals should take extra measures to protect patients from SARS-CoV-2 and other respiratory viruses: frequency, morbidity, and preventability. We have good data on frequency and preventability. Tens of thousands of hospitalacquired SARS-CoV-2 infections have been documented, and these are just the tip of the iceberg. 2 Many infections go undiagnosed because they are asymptomatic, paucisymptomatic, occur early in hospitalization and are misattributed as community exposures, occur after hospital discharge, or are otherwise untested. During surges, up to 10% of hospitalized patients with SARS-CoV-2 and other respiratory viruses may have acquired their infection in the hospital. 2,3 Likewise, we have good data that nosocomial respiratory viral infections can be prevented. Masking health care workers is associated with a 50% to 60% decrease in hospital-onset res...

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mentioning

confidence: 99%

Is Nosocomial SARS-CoV-2 Still Worth Preventing?

Klompas,

Baker,

Rhee

2023

JAMA Netw Open

Self Cite

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Testing and Masking Policies and Hospital-Onset Respiratory Viral Infections

Pak,

Chen,

Kanjilal

et al. 2024

JAMA Netw Open

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Predicting consequences of COVID-19 control measure de-escalation on nosocomial transmission and mortality: a modelling study in a French rehabilitation hospital

Smith,

Duval,

Grant

et al. 2024

Journal of Hospital Infection

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Discontinuation of Universal Admission Testing for SARS-CoV-2 and Hospital-Onset COVID-19 Infections in England and Scotland

Abstract: This quality improvement study examines the association between the discontinuation of universal admission testing for SARS-CoV-2 infections and hospital-onset SARS-CoV-2 infections in England and Scotland.

Cited by 10 publications

References 5 publications

Is Nosocomial SARS-CoV-2 Still Worth Preventing?

Is Nosocomial SARS-CoV-2 Still Worth Preventing?

Testing and Masking Policies and Hospital-Onset Respiratory Viral Infections

Predicting consequences of COVID-19 control measure de-escalation on nosocomial transmission and mortality: a modelling study in a French rehabilitation hospital

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