The contribution of hospital-acquired infections to the COVID-19 epidemic in England in the first half of 2020.
COVID-19
Mathematical modelling
Nosocomial transmission
SARS-CoV-2
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
18 Jun 2022
18 Jun 2022
Historique:
received:
05
12
2021
accepted:
25
05
2022
entrez:
18
6
2022
pubmed:
19
6
2022
medline:
22
6
2022
Statut:
epublish
Résumé
SARS-CoV-2 is known to transmit in hospital settings, but the contribution of infections acquired in hospitals to the epidemic at a national scale is unknown. We used comprehensive national English datasets to determine the number of COVID-19 patients with identified hospital-acquired infections (with symptom onset > 7 days after admission and before discharge) in acute English hospitals up to August 2020. As patients may leave the hospital prior to detection of infection or have rapid symptom onset, we combined measures of the length of stay and the incubation period distribution to estimate how many hospital-acquired infections may have been missed. We used simulations to estimate the total number (identified and unidentified) of symptomatic hospital-acquired infections, as well as infections due to onward community transmission from missed hospital-acquired infections, to 31st July 2020. In our dataset of hospitalised COVID-19 patients in acute English hospitals with a recorded symptom onset date (n = 65,028), 7% were classified as hospital-acquired. We estimated that only 30% (range across weeks and 200 simulations: 20-41%) of symptomatic hospital-acquired infections would be identified, with up to 15% (mean, 95% range over 200 simulations: 14.1-15.8%) of cases currently classified as community-acquired COVID-19 potentially linked to hospital transmission. We estimated that 26,600 (25,900 to 27,700) individuals acquired a symptomatic SARS-CoV-2 infection in an acute Trust in England before 31st July 2020, resulting in 15,900 (15,200-16,400) or 20.1% (19.2-20.7%) of all identified hospitalised COVID-19 cases. Transmission of SARS-CoV-2 to hospitalised patients likely caused approximately a fifth of identified cases of hospitalised COVID-19 in the "first wave" in England, but less than 1% of all infections in England. Using time to symptom onset from admission for inpatients as a detection method likely misses a substantial proportion (> 60%) of hospital-acquired infections.
Sections du résumé
BACKGROUND
BACKGROUND
SARS-CoV-2 is known to transmit in hospital settings, but the contribution of infections acquired in hospitals to the epidemic at a national scale is unknown.
METHODS
METHODS
We used comprehensive national English datasets to determine the number of COVID-19 patients with identified hospital-acquired infections (with symptom onset > 7 days after admission and before discharge) in acute English hospitals up to August 2020. As patients may leave the hospital prior to detection of infection or have rapid symptom onset, we combined measures of the length of stay and the incubation period distribution to estimate how many hospital-acquired infections may have been missed. We used simulations to estimate the total number (identified and unidentified) of symptomatic hospital-acquired infections, as well as infections due to onward community transmission from missed hospital-acquired infections, to 31st July 2020.
RESULTS
RESULTS
In our dataset of hospitalised COVID-19 patients in acute English hospitals with a recorded symptom onset date (n = 65,028), 7% were classified as hospital-acquired. We estimated that only 30% (range across weeks and 200 simulations: 20-41%) of symptomatic hospital-acquired infections would be identified, with up to 15% (mean, 95% range over 200 simulations: 14.1-15.8%) of cases currently classified as community-acquired COVID-19 potentially linked to hospital transmission. We estimated that 26,600 (25,900 to 27,700) individuals acquired a symptomatic SARS-CoV-2 infection in an acute Trust in England before 31st July 2020, resulting in 15,900 (15,200-16,400) or 20.1% (19.2-20.7%) of all identified hospitalised COVID-19 cases.
CONCLUSIONS
CONCLUSIONS
Transmission of SARS-CoV-2 to hospitalised patients likely caused approximately a fifth of identified cases of hospitalised COVID-19 in the "first wave" in England, but less than 1% of all infections in England. Using time to symptom onset from admission for inpatients as a detection method likely misses a substantial proportion (> 60%) of hospital-acquired infections.
Identifiants
pubmed: 35717168
doi: 10.1186/s12879-022-07490-4
pii: 10.1186/s12879-022-07490-4
pmc: PMC9206097
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
556Subventions
Organisme : National Institute for Health Research
ID : COV0357/MR/V028456/1
Organisme : Medical Research Council
ID : MR/P014658/1
Pays : United Kingdom
Organisme : National Institute for Health Research
ID : NIHR200915
Organisme : Wellcome Trust
ID : 210758/Z/18/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_19059
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_19025
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/V028456/1
Pays : United Kingdom
Organisme : Singapore National Medical Research Council
ID : NMRC/Fellowship/0051/2017
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Society for Laboratory Automation and Screening
ID : SLAS_VS2020
Investigateurs
Sam Abbott
(S)
Amy Gimma
(A)
Hamish P Gibbs
(HP)
Kaja Abbas
(K)
Rosanna C Barnard
(RC)
Frank G Sandmann
(FG)
Nikos I Bosse
(NI)
Paul Mee
(P)
Ciara V McCarthy
(CV)
Matthew Quaife
(M)
Adam J Kucharski
(AJ)
Christopher I Jarvis
(CI)
Joel Hellewell
(J)
Emilie Finch
(E)
Alicia Rosello
(A)
Mark Jit
(M)
Rachael Pung
(R)
Rosalind M Eggo
(RM)
Akira Endo
(A)
Graham Medley
(G)
Damien C Tully
(DC)
Kerry L M Wong
(KLM)
Yang Liu
(Y)
Katharine Sherratt
(K)
James D Munday
(JD)
Lloyd A C Chapman
(LAC)
Stéphane Hué
(S)
Kathleen O'Reilly
(K)
Nicholas G Davies
(NG)
Sophie R Meakin
(SR)
Fiona Yueqian Sun
(FY)
Oliver Brady
(O)
C Julian Villabona-Arenas
(CJ)
Katherine E Atkins
(KE)
Kiesha Prem
(K)
David Hodgson
(D)
Mihaly Koltai
(M)
Carl A B Pearson
(CAB)
William Waites
(W)
Simon R Procter
(SR)
Rachel Lowe
(R)
Commentaires et corrections
Type : UpdateOf
Informations de copyright
© 2022. The Author(s).
Références
Clin Infect Dis. 2021 Feb 16;72(4):690-693
pubmed: 32562422
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
PLoS Med. 2020 Sep 22;17(9):e1003346
pubmed: 32960881
Lancet. 2021 Sep 18;398(10305):1037-1038
pubmed: 34391505
J Infect. 2021 Nov;83(5):565-572
pubmed: 34474055
BMC Med. 2021 Apr 27;19(1):106
pubmed: 33902581
Lancet Infect Dis. 2020 Jun;20(6):669-677
pubmed: 32240634
Science. 2021 Feb 12;371(6530):708-712
pubmed: 33419936
BMC Med. 2015 Sep 03;13:210
pubmed: 26336062
Clin Med (Lond). 2020 Sep;20(5):e173-e177
pubmed: 32719035
Ann Intern Med. 2020 May 05;172(9):577-582
pubmed: 32150748
Sci Transl Med. 2021 Jul 14;13(602):
pubmed: 34158411
BMJ. 2020 May 22;369:m1985
pubmed: 32444460
Lancet Public Health. 2020 Jul;5(7):e375-e385
pubmed: 32502389
Clin Med (Lond). 2020 Sep;20(5):e141-e145
pubmed: 32788160
Lancet Infect Dis. 2020 Nov;20(11):1263-1272
pubmed: 32679081
J Hosp Infect. 2020 Nov;106(3):621-625
pubmed: 32841703
Ann Transl Med. 2020 May;8(10):629
pubmed: 32566566
Philos Trans R Soc Lond B Biol Sci. 2021 Jul 19;376(1829):20200268
pubmed: 34053255