Risk factors for nosocomial SARS-CoV-2 infections in patients: results from a retrospective matched case–control study in a tertiary care university center

Aghdassi, Seven Johannes Sam; Schwab, Frank J.; Diaz, Luis Alberto Peña; Brodzinski, A.; Fucini, Giovanni-Battista; Hansen, Sonja; Kohlmorgen, Britta; Piening, Brar; Schlösser, B.; Schneider, Sandra; Weikert, Beate; Wiese-Posselt, Miriam; Wolff, Sebastián; Behnke, Michael; Gastmeier, Petra; Geffers, Christine

doi:10.1186/s13756-022-01056-4

Cited by 11 publications

(14 citation statements)

References 40 publications

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“…Nosocomial coronavirus disease 2019 (COVID-19) outbreaks are associated with a poor patient prognosis, as well as disruption of medical services due to staff shortages. 1 Because inpatients frequently have co-morbidities or are immunocompromised, they are susceptible to severe COVID-19 infection. Thus, to prevent nosocomial outbreaks of COVID-19, many hospitals use multi-layered preventive strategies such as universal masking, universal reverse transcription polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), screening of patients, resident caregivers, and healthcare workers (HCWs)’ symptoms and epidemiologic links, and vaccination.…”

Section: Introductionmentioning

confidence: 99%

Nosocomial Outbreak by Delta Variant From a Fully Vaccinated Patient

et al. 2022

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Background The potential for a nosocomial outbreak of coronavirus disease 2019 (COVID-19) from a fully vaccinated individual is largely unknown. Methods In October 2021, during the time when the delta variant was dominant, a nosocomial outbreak of COVID-19 occurred in two wards in a tertiary care hospital in Seoul, Korea. We performed airflow investigations and whole-genome sequencing (WGS) of the virus. Results The index patient developed symptoms 1 day after admission, and was diagnosed with COVID-19 on day 4 post-admission. He was fully vaccinated (ChAdOx1 nCoV-19) 2 months before the diagnosis. Three inpatients and a caregiver in the same room, two inpatients in an adjacent room, two inpatients in rooms remote from the index room, and one nurse on the ward tested positive. Also, two resident doctors who stayed in an on-call room located on the same ward tested positive (although they had no close contact), as well as a caregiver who stayed on an adjacent ward, and a healthcare worker who had casual contact with this caregiver. Samples from five individuals were available for WGS, and all showed ≤ 1 single-nucleotide polymorphism difference. CCTV footage showed that the index case walked frequently in the corridors of two wards. An airflow study showed that the air from the corridor flowed into the resident on-call room, driven by an air circulator that was always turned on. Conclusion Transmission of severe acute respiratory syndrome coronavirus 2 from a fully vaccinated index occurred rapidly via the wards and on-call room. Care must be taken to not use equipment that can change the airflow.

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Section: Introductionmentioning

confidence: 99%

Nosocomial Outbreak by Delta Variant From a Fully Vaccinated Patient

et al. 2022

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“…A retrospective cohort study found in a crude analysis of 122 patients across three outbreak wards that being exposed to a symptomatic COVID-19 patient within the same 4-bed bay regardless of proximity in the room was associated with doubling the risk of becoming a case (crude RR, 2.3, 95% CI 1.42–3.65) [ 27 ]. In a matched case–control by Aghdassi et al [ 28 ], the multivariate analysis revealed that presence on a ward that experienced a COVID-19 outbreak (aOR 15.9, 95% CI 2.5–100.8) and documented contact with a COVID-19 case (aOR 23.4, 95% CI 4.6–117.7) to be the primary factors for nosocomial COVID-19 infections in patients [ 28 ]. This latter study and the results of our outbreak investigation supports the need to preemptively isolate patients known to be exposed to cases.…”

Section: Discussionmentioning

confidence: 99%

Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case–control study

Leal

O’Grady

Armstrong

et al. 2023

Antimicrob Resist Infect Control

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Background Risk factors for nosocomial COVID-19 outbreaks continue to evolve. The aim of this study was to investigate a multi-ward nosocomial outbreak of COVID-19 between 1st September and 15th November 2020, occurring in a setting without vaccination for any healthcare workers or patients. Methods Outbreak report and retrospective, matched case–control study using incidence density sampling in three cardiac wards in an 1100-bed tertiary teaching hospital in Calgary, Alberta, Canada. Patients were confirmed/probable COVID-19 cases and contemporaneous control patients without COVID-19. COVID-19 outbreak definitions were based on Public Health guidelines. Clinical and environmental specimens were tested by RT-PCR and as applicable quantitative viral cultures and whole genome sequencing were conducted. Controls were inpatients on the cardiac wards during the study period confirmed to be without COVID-19, matched to outbreak cases by time of symptom onset dates, age within ± 15 years and were admitted in hospital for at least 2 days. Demographics, Braden Score, baseline medications, laboratory measures, co-morbidities, and hospitalization characteristics were collected on cases and controls. Univariate and multivariate conditional logistical regression was used to identify independent risk factors for nosocomial COVID-19. Results The outbreak involved 42 healthcare workers and 39 patients. The strongest independent risk factor for nosocomial COVID-19 (IRR 3.21, 95% CI 1.47–7.02) was exposure in a multi-bedded room. Of 45 strains successfully sequenced, 44 (97.8%) were B.1.128 and differed from the most common circulating community lineages. SARS-CoV-2 positive cultures were detected in 56.7% (34/60) of clinical and environmental specimens. The multidisciplinary outbreak team observed eleven contributing events to transmission during the outbreak. Conclusions Transmission routes of SARS-CoV-2 in hospital outbreaks are complex; however multi-bedded rooms play a significant role in the transmission of SARS-CoV-2.

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“…A national study from India had 21 (1.43%) neonates who tested positive beyond 72 h and reported these as horizontal transmission and had a higher positivity rate in neonates rooming in with their mothers ( 22 ). Being in a ward where there is a documented SARS-CoV-2 outbreak and documented contact with a suspected SARS-CoV-2 patient have been reported as risk factors for nosocomial SARS-CoV-2 infections ( 37 ). The rates of infection were also noted to be higher if the duration of exposure was for longer than 5 days ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting

et al. 2022

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IntroductionThe provision of kangaroo mother care (KMC) involving continuous skin-to-skin care (SSC) is an important intervention in neonatal care, which is recommended even when women are infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2). We report on a nosocomial outbreak of SARS-CoV-2 infections in a KMC ward.MethodsContact tracing was conducted following the diagnosis of SARS-CoV-2 in a mother lodging in the KMC ward. All mother-newborn dyads in the KMC and healthcare workers (HCW) were tested for SARS-CoV-2 within 24–72 h of diagnosing the index case. Nasopharyngeal swab samples were obtained and tested from contacts, with a nucleic acid amplification test (NAAT) assay. Next-generation sequencing was done on positive samples. The secondary attack rate (SAR) was calculated assuming that the mother who presented with symptoms was the source of infection.ResultsTwelve (70.6%) of 17 mothers and 8 (42.1%) of 19 neonates who were in the KMC ward with the index case were found to be positive with SARS-CoV-2. Seven (87.5%) of the 8 neonates who tested positive had mothers who also tested positive. Seventy-five percent (9/12) of the mothers and 62.5% (5/8) of the neonates who tested positive were asymptomatic. Eight (27.6%) of 29 HCW were found to be positive and were all asymptomatic. One neonate died from Acinetobacter baumannii sepsis, and his post-mortem lung histopathology showed features compatible with SARS-CoV-2 pneumonia. The sequencing of 13 specimens, which included 1 mother-newborn dyad, indicated clustering to the same phylogenetic lineage with identical mutations. In assessing for factors contributing to this outbreak, it was found that spaces between beds were less than 1 m and mothers had their meals around the same table at the same time.ConclusionWe report on a nosocomial outbreak of SARS-CoV-2 in a KMC ward, affecting a high number of mothers and neonates, and to a lesser extent HCWs. Although it is difficult to point to the index case as the source of this outbreak, as asymptomatic individuals can spread infection, the inadequate adherence to non-pharmaceutical interventions was assessed to have contributed to the spread of infection. This highlights the need for awareness and adherence to mitigation strategies to avoid SARS-CoV-2 outbreaks.

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Risk factors for nosocomial SARS-CoV-2 infections in patients: results from a retrospective matched case–control study in a tertiary care university center

Cited by 11 publications

References 40 publications

Nosocomial Outbreak by Delta Variant From a Fully Vaccinated Patient

Nosocomial Outbreak by Delta Variant From a Fully Vaccinated Patient

Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case–control study

An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting

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