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. 2021 Nov;83(5):565-572.
doi: 10.1016/j.jinf.2021.08.039. Epub 2021 Aug 30.

Healthcare-associated COVID-19 in England: A national data linkage study

Alex Bhattacharya  1 , Simon M Collin  1 , James Stimson  1 , Simon Thelwall  1 , Olisaeloka Nsonwu  1 , Sarah Gerver  2 , Julie Robotham  2 , Mark Wilcox  3 , Susan Hopkins  4 , Russell Hope  5
Affiliations

Healthcare-associated COVID-19 in England: A national data linkage study

Alex Bhattacharya et al. J Infect. 2021 Nov.

Abstract

Objectives: Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally.

Methods: Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test <14 days pre-admission, up to day 2 of admission; hospital-onset indeterminate healthcare-associated, first positive on day 3-7; hospital-onset probable healthcare-associated, first positive on day 8-14; hospital-onset definite healthcare-associated, first positive from day 15 of admission until discharge; community-onset possible healthcare-associated, first positive test ≤14 days post-discharge.

Results: One-third (34.4%, 100,859/293,204) of all laboratory-confirmed COVID-19 cases were linked to a hospital record. Hospital-onset probable and definite cases represented 5.3% (15,564/293,204) of all laboratory-confirmed cases and 15.4% (15,564/100,859) of laboratory-confirmed cases among hospital patients. Community-onset community-acquired and community-onset possible healthcare-associated cases represented 86.5% (253,582/293,204) and 5.1% (14,913/293,204) of all laboratory-confirmed cases, respectively.

Conclusions: Up to 1 in 6 SARS-CoV-2 infections among hospitalised patients with COVID-19 in England during the first 6 months of the pandemic could be attributed to nosocomial transmission, but these represent less than 1% of the estimated 3 million COVID-19 cases in this period.

Keywords: COVID-19; Community-onset infection; Healthcare-associated infection; Sars-CoV-2.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Fig. 1
Fig. 1
Examples illustrating classification of patients admitted to hospitals in England who tested positive for SARS-CoV-2 as hospital-onset indeterminate, probable and definite healthcare-associated (HO.iHA, HO.pHA, HO.HA), community-onset community-acquired (CO.CA), and community-onset possible healthcare-associated (CO.pHA).
Fig. 2
Fig. 2
Patients admitted to hospitals in England who tested positive for SARS-CoV-2, showing the weekly numbers of cases classified as hospital-onset indeterminate, probable and definite healthcare-associated (HO.iHA, HO.pHA, HO.HA), community-onset community-acquired (CO.CA), and community-onset possible healthcare-associated (CO.pHA).
Fig. 3
Fig. 3
Patients admitted to hospitals in England who tested positive for SARS-CoV-2, showing the weekly proportions of cases classified as hospital-onset indeterminate, probable and definite healthcare-associated (HO.iHA, HO.pHA, HO.HA), community-onset community-acquired (CO.CA), and community-onset possible healthcare-associated (CO.pHA).
Fig. 4
Fig. 4
Patients admitted to NHS Acute Trust hospitals in England who tested positive for SARS-CoV-2, showing the proportions of cases classified as hospital-onset indeterminate, probable and definite healthcare-associated (HO.iHA, HO.pHA, HO.HA), community-onset community-acquired (CO.CA), and community-onset possible healthcare-associated (CO.pHA) by age group.
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References

    1. Zhou Q., Gao Y., Wang X., et al. Nosocomial infections among patients with COVID-19, SARS and MERS: a rapid review and meta-analysis. Ann Transl Med. 2020;8(10):629. doi: 10.21037/atm-20-3324. - DOI - PMC - PubMed
    1. Wang D., Hu B., Hu C., et al. Clinical Characteristics of 138 hospitalized patients With 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed
    1. DELVE Initiative . The Royal Society; London: 2020. DELVE Scoping Report on Hospital and Health Care Acquisition of COVID-19 and its Control.https://rs-delve.github.io/reports/2020/07/06/nosocomial-scoping-report....
    1. Carter B., Collins J.T., Barlow-Pay F., et al. Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople) J Hosp Infect. 2020;106(2):376–384. doi: 10.1016/j.jhin.2020.07.013. - DOI - PMC - PubMed
    1. Rickman H.M., Rampling T., Shaw K., et al. Nosocomial Transmission of Coronavirus Disease 2019: A Retrospective Study of 66 Hospital-acquired Cases in a London Teaching Hospital. Clin Infect Dis. 2021;72(4):690–693. doi: 10.1093/cid/ciaa816. - DOI - PMC - PubMed

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