Incidence and outcomes of healthcare-associated COVID-19 infections: significance of delayed diagnosis and correlation with staff absence

Abstract

Background The sudden increase in COVID-19 admissions in hospitals during the SARS-CoV2 pandemic of 2020 led to onward transmissions among vulnerable inpatients. Aims This study was performed to evaluate the prevalence and clinical outcomes of Healthcare-associated COVID-19 infections (HA-COVID-19) during the 2020 epidemic and study factors which may promote or correlate with its incidence and transmission in a Teaching Hospital NHS Trust in London, England. Methods Electronic laboratory, patient and staff self-reported sickness records were interrogated from 1 st March to 18 th April 2020. HA-COVID-19 was defined as COVID-19 with symptom onset >14 days of admission. Test performance of a single combined throat and nose swab (CTNS) for patient placement was calculated. The effect of delayed RNA positivity (DRP, defined as >48h delay), staff self-reported COVID-19 sickness absence, hospital bed occupancy, and community incidence of COVID-19 was compared for HA-COVID-19. The incidence of other significant hospital-acquired bacterial infections (HAB) was compared to previous years. Results 58 HA-COVID-19 (7.1%) cases were identified. When compared to community-acquired admitted cases (CA-COVID-19), significant differences were observed in age (p=0.018), ethnicity (p<0.001) and comorbidity burden (p<0.001) but not in 30 d mortality. CTNS negative predictive value was 60.3%. DRP was associated with greater mortality (p=0.034) and incidence of HA-COVID-19 correlated positively with DRP (R=0.7108) and staff sickness absence (R=0.7815). For the study period HAB rates were similar to previous 2 years. Conclusion Early diagnosis and isolation of COVID-19 patients would help reduce transmission. A single CTNS has limited value in segregating patients into positive and negative pathways.

A Systematic Review and Meta-Analysis of Inpatient Mortality Associated With Nosocomial and Community COVID-19 Exposes the Vulnerability of Immunosuppressed Adults

“…Of the 7 studies we (54). Generalising these practices may constitute a challenge across global health care settings acutely, for instance shortages of negative pressure isolation rooms were reported during the first wave in UK hospitals (34), but remain relevant as part of a longer-term "rebuild better" strategy.…”

“…Estimates of age-stratified infection fatality rates in the adult UK general population during the first wave ranged from 0.03% (20-29 years) to 7.8% (over 80 years) (61), far lower than the inpatient comparator mortality rate used in our analysis. By contrast, individuals admitted during nosocomial outbreaks were more likely to be subject to screening, resulting in sampling of individuals across the true spectrum of disease severities (29,34), including earlier in their disease course. Our risk of bias assessment therefore focused on study inclusion and adequate follow-up as essential domains, to account for unequal disease progression at study entry between groups.…”

“…Critical care admission rates were reported in 8 studies reporting nosocomial outbreaks (11,13,29,31,32,34,36,37); with a crude rate of 27/252 (10.7%) in patients with nosocomial COVID-19 compared to 359/1396 (25.7%) in those hospitalised with community-acquired COVID-19. Meta-analysis is shown in Figure 4, with the pooled relative risk indicating this trend did not reach statistical significance (RR= 0.70, 95% CI: 0.48 to 1.03).…”

Seroprevalence of SARS-CoV-2 Antibodies in Employees of Three Hospitals of a Secondary Care Hospital Network in Germany and an Associated Fire Brigade: Results of a Repeated Cross-Sectional Surveillance Study Over 1 Year

“…The current SARS-CoV-2 pandemic is a worldwide challenge for the medical sector. Healthcare workers (HCWs) are at specific risk for SARS-CoV-2 [8], especially if they are inadequately protected [9,10]. Serological testing of specific antibodies against SARS-CoV-2 has commonly been used to investigate infections of HCWs [11].…”

Protecting adults at risk of pneumococcal infection and influenza from exposure to SARS-CoV-2

“…8 All SARS-CoV-2 positive patients at a south-east London tertiary care facility, from 1 March to 18 April 2020, who developed symptoms >14 days after admission were classified as having hospital-associated COVID-19. 9 Approximately 5000 patients were tested for SARS-CoV-2 and of those 1729 tested positive. Of these, 865 (50%) were admitted to hospital within 14 days of testing.…”