Risk of Healthcare-Associated Transmission of Sever Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Hospitalized Cancer Patients

Abstract

Background There is limited information on the risk of hospital-acquired COVID-19 among high-risk hospitalized patients after exposure to an infected patient or healthcare worker (HCW) in a non-outbreak setting. Methods This study was conducted at a tertiary care cancer center in New York City from March 10, 2020, until February 28, 2021. In early April 2020, the study institution implemented universal SARS-CoV-2 testing at admission and retesting every three days through the hospital stay. Contact tracing records were reviewed for all exposures to SARS-CoV-2 positive patients and HCWs. Results From March 10, 2020, to February 28, 2021, 11,348 unique patients who were SARS-CoV-2 PCR negative at the time of admission underwent 31,662 post-admission tests during their hospitalization, and 112 tested positive (0.98%). Among these, 49 patients housed in semi-private rooms during admission resulted in 74 close contacts and 14 secondary infections within 14 days, for an overall attack rate of 18.9%. Among those exposed to a roommate undergoing an aerosol-generating procedure (AGP), the attack rate was 35.7%. WGS corroborated transmission in 6/8 evaluated pairs. In addition, three transmission events occurred in 214 patients with significant exposure to 105 COVID-19 positive healthcare workers (1.4%). Conclusion The overall risk of hospital-acquired COVID-19 is low for hospitalized cancer patients, even during periods of high community prevalence. However, shared occupancy with an unrecognized case is associated with a high secondary attack rate in exposed roommates.

Outcomes of hospital-acquired SARS-CoV-2 infection in the Canadian first wave epicentre: a retrospective cohort study

“…This proportion is consistent with household transmission rates between spouses (37.8%, 95% CI 25.8%-50.5%) 17 and other reports on transmission between hospital roommates (up to 39%). 18,19 Although only 45/254 (17.7%) of cases of HA-SARS-CoV-2 infection in our study were directly linked to transmission between patients in a multi-bed room, more HA cases might be indirectly linked to high population density. 7 The importance of crowding on COVID-19 incidence and mortality has already been shown in Canadian long-term care settings.…”

Infection Prevention and Control of Severe Acute Respiratory Syndrome Coronavirus 2 in Health Care Settings

“…A separate study found a secondary attack rate for hospitalized roommates of 18.9% overall and 35.7% in the setting of AGPs. 86 The attack rate in these scenarios mirrors that observed in household settings. 11 , 12 , 13 , 87 Infections among patients have also been observed in inpatient psychiatric units where it is difficult to promote mask wearing, distancing, and hand hygiene, and group activities are instrumental to treatment.…”

“…Patient-to-patient transmission in the setting of roommates in semi-private accommodations in healthcare facilities has been directly studied. 85 , 86 In one report over 7 months at an acute care hospital, there were 31 exposed patient roommates, 39% of whom ultimately tested positive for SARS-CoV-2. 85 The beds were 5 feet apart side-by-side and 7 feet apart mid-pillow to mid-pillow with a closed curtain between them.…”

Use of carbon dioxide measurements to assess ventilation in an acute care hospital

“… 2 Finally, there is evidence that transmission of SARS-CoV-2 may occur in areas of healthcare facilities with adequate ventilation. 12 For example, Chow et al 12 reported frequent transmission of SARS-CoV-2 from patients with unsuspected COVID-19 to roommates, particularly if aerosol-generating procedures were performed. Thus, adequate ventilation based on carbon dioxide measurements should not provide complete reassurance that airborne transmission will not occur.…”