Nosocomial SARS-CoV-2 transmission in multi-bedded hospital cubicles over successive pandemic waves: Lower mortality but wider spread with Omicron despite enhanced infection-prevention measures

IF 2.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Infection Disease & Health Pub Date : 2023-05-01 DOI:10.1016/j.idh.2022.09.003

Liang En Wee , Edwin Philip Conceicao , May Kyawt Aung , Myat Oo Aung , Yong Yang , Shalvi Arora , Karrie Kwan-Ki Ko , Indumathi Venkatachalam

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引用次数: 4

Abstract

Background

Increased transmissibility of severe-acute-respiratory-syndrome-coronavirus-2(SARS-CoV-2) variants, such as the Omicron-variant, presents an infection-control challenge. We contrasted nosocomial transmission amongst hospitalized inpatients across successive pandemic waves attributed to the Delta- and Omicron variants, over a 9-month period in which enhanced-infection-prevention-measures were constantly maintained.

Methods

Enhanced-infection-prevention-measures in-place at a large tertiary hospital included universal N95-usage, routine-rostered-testing (RRT) for all inpatient/healthcare-workers (HCWs), rapid-antigen-testing (RAT) for visitors, and outbreak-investigation coupled with enhanced-surveillance (daily-testing) of exposed patients. The study-period lasted from 21st June 2021–21st March 2022. Chi-square test and multivariate-logistic-regression was utilized to identify factors associated with onward transmission and 28d-mortality amongst inpatient cases of hospital-onset COVID-19.

Results

During the Delta-wave, hospital-onset cases formed 2.7% (47/1727) of all COVID-19 cases requiring hospitalisation; in contrast, hospital onset-cases formed a greater proportion (17.7%, 265/1483; odds-ratio, OR = 7.78, 95%CI = 5.65–10.70) during the Omicron-wave, despite universal N95-usage and other enhanced infection-prevention measures that remained unchanged. The odds of 28d-mortality were higher during the Delta-wave compared to the Omicron-wave (27.7%, 13/47, vs. 10.6%, 28/265, adjusted-odds-ratio, aOR = 2.78, 95%CI = 1.02–7.69). Onward-transmission occurred in 21.2% (66/312) of hospital-onset cases; being on enhanced-surveillance (daily-testing) was independently associated with lower odds of onward-transmission (aOR = 0.18, 95%CI = 0.09–0.38). Costs amounted to $USD7141 per-hospital-onset COVID-19 case.

Conclusion

A surge of hospital-onset COVID-19 cases was encountered during the Omicron-wave, despite continuation of enhanced infection-prevention measures; mortality amongst hospital-onset cases was reduced. The Omicron variant poses an infection-control challenge in contrast to Delta; surveillance is important especially in settings where infrastructural limitations make room-sharing unavoidable, despite the high risk of transmission.

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在连续的大流行浪潮中，多床位医院隔间中的SARS-CoV-2医院传播:尽管加强了感染预防措施，但Omicron的死亡率较低，但传播范围更广

严重急性呼吸综合征-冠状病毒-2(SARS-CoV-2)变异体(如ommicron变异体)的传播性增加，对感染控制提出了挑战。在持续加强感染预防措施的9个月期间，我们对比了由德尔塔和欧米克隆变异引起的连续大流行波中住院住院患者的医院传播情况。方法某大型三级医院实施的强化感染预防措施包括:n95的普遍使用、所有住院/医护人员的常规登记检测(RRT)、出诊人员的快速抗原检测(RAT)，以及对暴露患者进行疫情调查并加强监测(每日检测)。研究时间为2021年6月21日至2022年3月21日。采用卡方检验和多变量logistic回归来确定与医院发病的COVID-19住院病例的进一步传播和28天死亡率相关的因素。结果在delta波期间，住院病例占所有COVID-19住院病例的2.7% (47/1727);相比之下，医院发病病例所占比例更大(17.7%，265/1483;比值比(OR = 7.78, 95%CI = 5.65-10.70)在欧米克朗波期间，尽管普遍使用n95和其他增强的感染预防措施保持不变。δ波28d死亡率高于欧米克隆波(27.7%，13/47,10.6%，28/265，调整比值比，aOR = 2.78, 95%CI = 1.02-7.69)。21.2%(66/312)的住院病例发生正向传播;加强监测(每日检测)与较低的向前传播几率独立相关(aOR = 0.18, 95%CI = 0.09-0.38)。每个住院的COVID-19病例的费用为7141美元。结论尽管继续加强感染预防措施，但在欧米克隆波期间，新冠肺炎住院病例仍出现激增;住院病例的死亡率降低。与Delta相比，Omicron变体带来了感染控制方面的挑战;监测非常重要，特别是在基础设施限制使共用房间不可避免的环境中，尽管传播风险很高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection Disease & Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

5.70

自引率

5.70%

发文量

审稿时长

20 days

期刊介绍： The journal aims to be a platform for the publication and dissemination of knowledge in the area of infection and disease causing infection in humans. The journal is quarterly and publishes research, reviews, concise communications, commentary and other articles concerned with infection and disease affecting the health of an individual, organisation or population. The original and important articles in the journal investigate, report or discuss infection prevention and control; clinical, social, epidemiological or public health aspects of infectious disease; policy and planning for the control of infections; zoonoses; and vaccination related to disease in human health. Infection, Disease & Health provides a platform for the publication and dissemination of original knowledge at the nexus of the areas infection, Disease and health in a One Health context. One Health recognizes that the health of people is connected to the health of animals and the environment. One Health encourages and advances the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment. This approach is fundamental because 6 out of every 10 infectious diseases in humans are zoonotic, or spread from animals. We would be expected to report or discuss infection prevention and control; clinical, social, epidemiological or public health aspects of infectious disease; policy and planning for the control of infections; zoonosis; and vaccination related to disease in human health. The Journal seeks to bring together knowledge from all specialties involved in infection research and clinical practice, and present the best work in this ever-changing field. The audience of the journal includes researchers, clinicians, health workers and public policy professionals concerned with infection, disease and health.