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      Nosocomial Coronavirus Disease 2019 (COVID-19): Experience from a large Acute NHS Trust in South-West London

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          Summary

          Transmission of Coronavirus Disease 2019 (COVID-19) in healthcare settings has significant implications for patients and healthcare workers, can amplify local outbreaks, and place additional burden on already stretched resources. Risk of missed or late diagnosis of COVID-19 was high during the United Kingdom’s initial ‘containment phase’, because of strict criteria for testing. The risk remains due to asymptomatic/pre-symptomatic transmission, complicated by challenges faced with laboratory testing. We present a case study of potential nosocomial transmission associated with the first case of COVID-19 at a large acute NHS Trust in South-West London and describe the prevailing burden of nosocomial infections.

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          Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong

          S.C.-Y. Wong, R.T.-S. Kwong, T.C. Wu … (2020)
          SUMMARY Background Coronavirus disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and has rapidly spread across different cities within and outside China. Hong Kong started to prepare for COVID-19 on 31st December 2019 and infection control measures in public hospitals were tightened to limit nosocomial transmission within healthcare facilities. However, the recommendations on the transmission-based precautions required for COVID-19 in hospital settings vary from droplet and contact precautions, to contact and airborne precautions with placement of patients in airborne infection isolation rooms. Aim To describe an outbreak investigation of a patient with COVID-19 who was nursed in an open cubicle of a general ward before the diagnosis was made. Method Contacts were identified and risk categorized as ‘close’ or ‘casual’ for decisions on quarantine and/or medical surveillance. Respiratory specimens were collected from contacts who developed fever, and/or respiratory symptoms during the surveillance period and were tested for SARS-CoV-2. Findings A total of 71 staff and 49 patients were identified from contact tracing, seven staff and 10 patients fulfilled the criteria of ‘close contact’. At the end of 28-day surveillance, 76 tests were performed on 52 contacts and all were negative, including all patient close contacts and six of the seven staff close contacts. The remaining contacts were asymptomatic throughout the surveillance period. Conclusion Our findings suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions can be prevented through vigilant basic infection control measures, including wearing of surgical masks, hand and environmental hygiene.
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            SARS-CoV-2 infection in 86 healthcare workers in two Dutch hospitals in March 2020

            Marjolein Kluytmans, Anton Buiting, Suzan Pas … (2020)
            COVID-19 is spreading rapidly over the world. On February 27, 2020, the first patient with COVID-19 was reported in the Netherlands, linked to a trip to Northern Italy. In the following weeks, we identified nine Health Care Workers (HCW) of whom eight had no epidemiological link to countries with a high incidence of COVID-19 at that time. This suggested local spread of SARS-CoV-2 in the community and prompted a low-threshold screening in HCWs. Screening was performed in two large teaching hospitals in the southern part of the Netherlands. HCWs who suffered from fever or mild respiratory symptoms were tested for SARS-CoV-2 by RT-PCR on oropharyngeal samples. Structured interviews were conducted to document symptoms. Eighty-six (6.4%) out of 1,353 HCWs were infected with SARS-Cov-2. The median age was 49 years and 15 (17.4%) were male. Most suffered from relatively mild disease. Only 46 (53.5%) HCWs had fever during the course of illness. Seventy-nine (91.9%) HCWs met a case definition of fever and/or coughing and/or shortness of breath. The majority (n=54, 62.8%) reported to have worked while being symptomatic. Within one week after the first case was reported, a substantial proportion of HCWs with fever or respiratory symptoms were proven to be infected with SARS-Cov-2. This observation suggests that there is a relatively high prevalence of mild clinical presentations that may go undetected. The spectrum of symptoms present in HCWs with COVID-19, frequently not including fever, asks for less stringent use of the currently recommended case-definition for suspected COVID-19.
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              The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals

              Stephanie Evans, Emily Agnew, Emilia Vynnycky … (2020)
              Nosocomial transmission of SARS-CoV-2 is a key concern and evaluating the effect of testing and infection prevention control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical UK hospital, we predict that approximately 20% of infections in inpatients, and 89% of infections in HCWs were due to nosocomial transmission. Placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 80%. Periodic testing of HCWs has a smaller effect on the patient-burden of COVID-19 but would considerably reduce infection in HCWs by as much as 64% and result in only a small proportion of staff absences (approximately 1% per day). This is considerably fewer than currently observed due to suspected COVID-19 and self-isolation.
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                Author and article information

                Contributors
                Jennifer Taylor
                Journal
                Journal ID (nlm-ta): J Hosp Infect
                Journal ID (iso-abbrev): J. Hosp. Infect
                Title: The Journal of Hospital Infection
                Publisher: Published by Elsevier Ltd on behalf of The Healthcare Infection Society.
                ISSN (Print): 0195-6701
                ISSN (Electronic): 1532-2939
                Publication date PMC-release: 22 August 2020
                Publication date (Electronic): 22 August 2020
                Affiliations
                [1 ]Public Health England
                [2 ]Epsom and St Helier University Hospitals NHS Trust
                Author notes
                [∗ ]Corresponding author. Jennifer Taylor, , 07841656411, 4 Albert Road, Twickenham, TW1 4HU. jennifer.a.taylor@ 123456phe.gov.uk
                [#]

                Joint first authors.

                Article
                Publisher ID: S0195-6701(20)30405-9
                DOI: 10.1016/j.jhin.2020.08.018
                PMC ID: 7443059
                PubMed ID: 32841703
                SO-VID: 3ac9df32-769c-4f8c-bb6f-c651f8c61d86
                Copyright © © 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 3 June 2020
                Date accepted : 18 August 2020
                Categories
                Subject: Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: covid-19,sars-cov-2,nosocomial transmission,infection control,outbreak investigation,healthcare associated infection
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: covid-19, sars-cov-2, nosocomial transmission, infection control, outbreak investigation, healthcare associated infection

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