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Hildebrandt A, Dolega K, Uflacker L, Rudolf H, Gatermann SG. SARS-CoV-2 infections in patients, health care workers and hospital outbreaks during the first 3 waves of the pandemic: a retrospective analysis in a secondary care hospital network in Germany. BMC Infect Dis 2024; 24:859. [PMID: 39187755 PMCID: PMC11346040 DOI: 10.1186/s12879-024-09641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Hospital infections with SARS-CoV-2 continued during the initial waves of the pandemic worldwide. So far, Data on the dynamics of these infections and the economic burden of outbreaks are rare. METHODS We retrospectively analysed SARS-CoV-2 infections in patients, hospital employees and nosocomial infections resulting in outbreaks in two hospitals of a secondary care hospital network in Germany during the initial 3 pandemic waves (03/2020-06/2021). In addition to hospital infections, we evaluated infection prevention strategies and the economic burden of hospital outbreaks. RESULTS A total of 396 patients with SARS-CoV-2 infection were hospitalized in both hospitals. The risk factors for severe disease and death increased with age, male sex and a CRB-65 score > 0. The most frequent symptom was dyspnoea (30.1%). Sixty-five patients died, most of whom were in the 2nd wave. A total of 182 (12.5%) hospital employees were infected, 63 (34.6%) of whom were involved in outbreaks. An occupational risk of infection during outbreaks was particularly common among nurses and HCWs working on regular wards. Eleven hospital outbreaks led to high economic impact on both hospitals through the loss of manpower as result of infected employees, temporary locked wards, blocked beds, a reduced number of total hospitalized patients and increased personnel costs. CONCLUSION Continuously adaptation of infection prevention strategies is a valuable tool to keep hospitals safe places for patients and employees. We do need more analyses of the different pandemic waves and applied infection prevention strategies to learn from weak points. TRIAL REGISTRATION This research was conducted in accordance with the Declaration of Helsinki and national standards. The study protocol was approved by the relevant ethics committee of the Chamber of Physicians Westphalia-Lippe and University of Münster (no. 2021-475-f-S). The study was registered on 25th August 2021 at the German Clinical Trials Register (DRKS00025865).
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Affiliation(s)
- Anke Hildebrandt
- Department of Internal Medicine I, St. Vincenz-Hospital, Rottstr. 11, Datteln, 45711, Germany.
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
| | - Kirsten Dolega
- Department of Hygiene, St. Vincenz-Hospital, Rottstr. 11, Datteln, 45711, Germany
| | - Lutz Uflacker
- Department of Internal Medicine I, St. Vincenz-Hospital, Rottstr. 11, Datteln, 45711, Germany
| | - Henrik Rudolf
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, University Medical Center Rostock, Rostock, Germany
| | - Sören G Gatermann
- National Reference Centre for Multidrug-Resistant Gram-Negative Bacteria, Ruhr University Bochum, Bochum, Germany
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Klompas M, McKenna CS, Kanjilal S, Pak T, Rhee C, Chen T. Morbidity and Mortality of Hospital-Onset SARS-CoV-2 Infections Due to Omicron Versus Prior Variants : A Propensity-Matched Analysis. Ann Intern Med 2024; 177:1078-1088. [PMID: 39008853 DOI: 10.7326/m24-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Many hospitals have scaled back measures to prevent nosocomial SARS-CoV-2 infection given large decreases in the morbidity and mortality of SARS-CoV-2 infections for most people. Little is known, however, about the morbidity and mortality of nosocomial SARS-CoV-2 infections for hospitalized patients in the Omicron era. OBJECTIVE To estimate the effect of nosocomial SARS-CoV-2 infection on hospitalized patients' outcomes during the pre-Omicron and Omicron periods. DESIGN Retrospective matched cohort study. SETTING 5 acute care hospitals in Massachusetts, December 2020 to April 2023. PATIENTS Adults testing positive for SARS-CoV-2 on or after hospital day 5, after negative SARS-CoV-2 test results on admission and on hospital day 3, were matched to control participants by hospital, service, time period, days since admission, and propensity scores that incorporated demographics, comorbid conditions, vaccination status, primary diagnosis category, vital signs, and laboratory test values. MEASUREMENTS Primary outcomes were hospital mortality and time to discharge. Secondary outcomes were intensive care unit (ICU) admission, need for advanced oxygen support, discharge destination, hospital-free days, and 30-day readmissions. RESULTS There were 274 cases of hospital-onset SARS-CoV-2 infection during the pre-Omicron period and 1037 cases during the Omicron period (0.17 vs. 0.49 cases per 100 admissions). Patients with hospital-onset SARS-CoV-2 infection were older and had more comorbid conditions than those without. During the pre-Omicron period, hospital-onset SARS-CoV-2 infection was associated with increased risk for ICU admission, increased need for high-flow oxygen, longer time to discharge (median difference, 4.7 days [95% CI, 2.9 to 6.6 days]), and higher mortality (risk ratio, 2.0 [CI, 1.1 to 3.8]) versus matched control participants. During the Omicron period, hospital-onset SARS-CoV-2 infection remained associated with increased risk for ICU admission and increased time to discharge (median difference, 4.2 days [CI, 3.6 to 5.0 days]). The association with increased hospital mortality was attenuated but still significant (risk ratio, 1.6 [CI, 1.2 to 2.3]). LIMITATION Residual confounding may be present. CONCLUSION Hospital-onset SARS-CoV-2 infection during the Omicron period remains associated with increased morbidity and mortality. PRIMARY FUNDING SOURCE Harvard Medical School Department of Population Medicine.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., S.K., T.P., C.R.)
| | - Caroline S McKenna
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (C.S.M., T.C.)
| | - Sanjat Kanjilal
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., S.K., T.P., C.R.)
| | - Theodore Pak
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., S.K., T.P., C.R.)
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., S.K., T.P., C.R.)
| | - Tom Chen
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (C.S.M., T.C.)
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McAndrew F, Abeysuriya RG, Sacks-Davis R, Sammann M, Lister DM, West D, Majumdar SS, Scott N. Admission screening testing of patients and staff N95 respirators are cost-effective in reducing COVID-19 hospital-acquired infections. J Hosp Infect 2024; 152:81-92. [PMID: 39019117 DOI: 10.1016/j.jhin.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) outbreaks in acute care settings can have severe consequences for patients due to their underlying vulnerabilities, and can be costly due to additional patient bed-days and the need to replace isolating staff. This study assessed the cost-effectiveness of clinical staff N95 respirators and admission screening testing of patients to reduce COVID-19 hospital-acquired infections. METHODS An agent-based model was calibrated to data on 178 outbreaks in acute care settings in Victoria, Australia between October 2021 and July 2023. Outbreaks were simulated under different combinations of staff masking (surgical, N95) and patient admission screening testing [none, rapid antigen test (RAT), polymerase chain reaction]. For each scenario, average diagnoses, COVID-19 deaths, quality-adjusted life years from discharged patients, and costs (masks, testing, patient COVID-19 bed-days, staff replacement costs while isolating) from acute COVID-19 were estimated over a 12-month period. FINDINGS Compared with no admission screening testing and staff surgical masks, all scenarios were cost saving with health gains. Staff N95 respirators + RAT admission screening of patients was the cheapest scenario, saving A$78.4M [95% uncertainty interval (UI) 44.4M-135.3M] and preventing 1543 (95% UI 1070-2146) deaths state-wide per annum. Both interventions were individually beneficial: staff N95 respirators saved A$54.7M and 854 deaths state-wide per annum, while RAT admission screening of patients saved A$57.6M and 1176 deaths state-wide per annum. INTERPRETATION In acute care settings, staff N95 respirators and admission screening testing of patients can reduce hospital-acquired COVID-19 and COVID-19 deaths, and are cost saving because of reduced patient bed-days and staff replacement needs.
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Affiliation(s)
- F McAndrew
- Burnet Institute, Melbourne, Victoria, Australia.
| | - R G Abeysuriya
- Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - R Sacks-Davis
- Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - M Sammann
- Victorian Government Department of Health, Victoria, Australia
| | - D M Lister
- Victorian Government Department of Health, Victoria, Australia
| | - D West
- Victorian Government Department of Health, Victoria, Australia
| | - S S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - N Scott
- Burnet Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Klompas M. Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic. Respir Care 2024; 69:854-868. [PMID: 38806219 DOI: 10.4187/respcare.11961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
The COVID-19 pandemic has had an unprecedented impact on population health and hospital operations. Over 7 million patients have been hospitalized for COVID-19 thus far in the United States alone. Mortality rates for hospitalized patients during the first wave of the pandemic were > 30%, but as we enter the fifth year of the pandemic hospitalizations have fallen and mortality rates for hospitalized patients with COVID-19 have plummeted to 5% or less. These gains reflect lessons learned about how to optimize respiratory support for different kinds of patients, targeted use of therapeutics for patients with different manifestations of COVID-19 including immunosuppressants and antivirals as appropriate, and high levels of population immunity acquired through vaccines and natural infections. At the same time, the pandemic has helped highlight some longstanding sources of harm for hospitalized patients including hospital-acquired pneumonia, ventilator-associated events (VAEs), and hospital-acquired respiratory viral infections. We are, thankfully, on the leeside of the pandemic at present; but the large increases in ventilator-associated pneumonia (VAP), VAEs, bacterial superinfections, and nosocomial respiratory viral infections associated with the pandemic beg the question of how best to prevent these complications moving forward. This paper reviews the burden of hospitalization for COVID-19, the intersection between COVID-19 and both VAP and VAEs, the frequency and impact of hospital-acquired respiratory viral infections, new recommendations on how best to prevent VAP and VAEs, and current insights into effective strategies to prevent nosocomial spread of respiratory viruses.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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5
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Nachtigall I, Kwast S, Hohenstein S, König S, Dang PL, Leiner J, Giesen N, Schleenvoigt BT, Bonsignore M, Bollmann A, Kuhlen R, Jah F. Retrospective, Observational Analysis on the Impact of SARS-CoV-2 Variant Omicron in Hospitalized Immunocompromised Patients in a German Hospital Network-The VISAGE Study. Vaccines (Basel) 2024; 12:634. [PMID: 38932363 PMCID: PMC11209028 DOI: 10.3390/vaccines12060634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS Endemic SARS-CoV-2 infections still burden the healthcare system and represent a considerable threat to vulnerable patient cohorts, in particular immunocompromised (IC) patients. This study aimed to analyze the in-hospital outcome of IC patients with severe SARS-CoV-2 infection in Germany. METHODS This retrospective, observational study, analyzed administrative data from inpatient cases (n = 146,324) in 84 German Helios hospitals between 1 January 2022 and 31 December 2022 with regard to in-hospital outcome and health care burden in IC patients during the first 12 months of Omicron dominance. As the primary objective, in-hospital outcomes of patients with COVID-19-related severe acute respiratory infection (SARI) were analyzed by comparing patients with (n = 2037) and without IC diagnoses (n = 14,772). Secondary analyses were conducted on IC patients with (n = 2037) and without COVID-19-related SARI (n = 129,515). A severe in-hospital outcome as a composite endpoint was defined per the WHO definition if one of the following criteria were met: intensive care unit (ICU) treatment, mechanical ventilation (MV), or in-hospital death. RESULTS In total, 12% of COVID-related SARI cases were IC patients, accounting for 15% of ICU admissions, 15% of MV use, and 16% of deaths, resulting in a higher prevalence of severe in-hospital courses in IC patients developing COVID-19-related SARI compared to non-IC patients (Odds Ratio, OR = 1.4, p < 0.001), based on higher in-hospital mortality (OR = 1.4, p < 0.001), increased need for ICU treatment (OR = 1.3, p < 0.001) and mechanical ventilation (OR = 1.2, p < 0.001). Among IC patients, COVID-19-related SARI profoundly increased the risk for severe courses (OR = 4.0, p < 0.001). CONCLUSIONS Our findings highlight the vulnerability of IC patients to severe COVID-19. The persistently high prevalence of severe outcomes in these patients in the Omicron era emphasizes the necessity for continuous in-hospital risk assessment and monitoring of IC patients.
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Affiliation(s)
- Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, Helios Hospital Emil-von-Behring, 14165 Berlin, Germany;
- Medical School Berlin, Chair of Infectiology and Immunology, 14197 Berlin, Germany
| | - Stefan Kwast
- Helios Health Institute, Real World Evidence and Health Technology Assessment, 13125 Berlin, Germany; (S.H.); (S.K.); (J.L.)
| | - Sven Hohenstein
- Helios Health Institute, Real World Evidence and Health Technology Assessment, 13125 Berlin, Germany; (S.H.); (S.K.); (J.L.)
| | - Sebastian König
- Helios Health Institute, Real World Evidence and Health Technology Assessment, 13125 Berlin, Germany; (S.H.); (S.K.); (J.L.)
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany
| | | | - Johannes Leiner
- Helios Health Institute, Real World Evidence and Health Technology Assessment, 13125 Berlin, Germany; (S.H.); (S.K.); (J.L.)
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany
| | - Nicola Giesen
- Department of Hematology, Oncology and Palliative Care, Robert Bosch Hospital, 70376 Stuttgart, Germany
| | | | - Marzia Bonsignore
- Center for Clinical and Translational Research, Helios Universitätsklinikum Wuppertal, University of Witten/Herdecke, 42283 Wuppertal, Germany
| | - Andreas Bollmann
- Helios Health Institute, Real World Evidence and Health Technology Assessment, 13125 Berlin, Germany; (S.H.); (S.K.); (J.L.)
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany
| | | | - Fungwe Jah
- Medical Affairs, AstraZeneca, 22763 Hamburg, Germany
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Rubeshkumar P, Beer J, McClure V, Morgan M. Mortality amongst hospitalized COVID-19 cases by acquisition and pandemic wave in Wales, UK, February 2020-March 2022. J Hosp Infect 2024; 143:48-52. [PMID: 37852537 DOI: 10.1016/j.jhin.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hospital populations are vulnerable to COVID-19, but the relative severity of hospital acquisition compared to community is unknown. We investigated differences in mortality between hospital and community acquired cases in Wales. METHODS Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction tests from February 2020 to March 2022 were linked with hospital admissions to identify likely hospital-acquired cases. All-cause mortality within 28 days of a positive SARS-CoV-2 were measured by source of acquisition. Multi-variable logistic regression was used to compare mortality by source of acquisition, adjusting for confounders, computing adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS There were 25,263 hospital-acquired cases of COVID-19 and 5490 (22%) deaths in the study period. Although significant on univariate analysis, adjustment for confounding showed no association with increased mortality for hospital-acquired cases compared with cases admitted with COVID-19 (aOR 0.8, 95% CI 0.7-0.8). Vaccination (aOR 0.6, 95% CI 0.5-0.7) and infection in later pandemic waves (aOR 0.5, 95% CI 0.4-0.6) were associated with lower mortality; older age (≥85 vs <25 years: aOR 76.4, 95% CI 41.8-160.5) and male sex (aOR 1.5, 95% CI 1.4-1.6) were associated with higher mortality. CONCLUSION One in five hospitalised COVID-19 cases died within a month of infection. Mortality in nosocomial cases was not worse than those admitted with COVID-19, possibly reflecting early identification of nosocomial cases through screening.
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Affiliation(s)
- P Rubeshkumar
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK.
| | - J Beer
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
| | - V McClure
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
| | - M Morgan
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
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Kamiya T, Alvarez-Iglesias A, Ferguson J, Murphy S, Sofonea MT, Fitz-Simon N. Estimating time-dependent contact: a multi-strain epidemiological model of SARS-CoV-2 on the island of Ireland. GLOBAL EPIDEMIOLOGY 2023; 5:100111. [PMID: 37162815 PMCID: PMC10159265 DOI: 10.1016/j.gloepi.2023.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Mathematical modelling plays a key role in understanding and predicting the epidemiological dynamics of infectious diseases. We construct a flexible discrete-time model that incorporates multiple viral strains with different transmissibilities to estimate the changing patterns of human contact that generates new infections. Using a Bayesian approach, we fit the model to longitudinal data on hospitalisation with COVID-19 from the Republic of Ireland and Northern Ireland during the first year of the pandemic. We describe the estimated change in human contact in the context of government-mandated non-pharmaceutical interventions in the two jurisdictions on the island of Ireland. We take advantage of the fitted model to conduct counterfactual analyses exploring the impact of lockdown timing and introducing a novel, more transmissible variant. We found substantial differences in human contact between the two jurisdictions during periods of varied restriction easing and December holidays. Our counterfactual analyses reveal that implementing lockdowns earlier would have decreased subsequent hospitalisation substantially in most, but not all cases, and that an introduction of a more transmissible variant - without necessarily being more severe - can cause a large impact on the health care burden.
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Affiliation(s)
- Tsukushi Kamiya
- HRB Clinical Research Facility, University of Galway, Ireland
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, Université PSL, Paris, France
| | | | - John Ferguson
- HRB Clinical Research Facility, University of Galway, Ireland
| | - Shane Murphy
- HRB Clinical Research Facility, University of Galway, Ireland
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Helanne H, Forsblom E, Kainulainen K, Järvinen A, Kortela E. Incidence and outcome of hospital-acquired COVID-19 infections in secondary and tertiary care hospitals in the era of COVID-19 vaccinations. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e216. [PMID: 38156200 PMCID: PMC10753469 DOI: 10.1017/ash.2023.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 12/30/2023]
Abstract
Objective Hospital-acquired (HA) COVID-19 infections are known to increase morbidity and mortality. The aim of this study was to investigate the incidence and outcome of HA COVID-19 in different specialties across the wards in 18 hospitals belonging to the Helsinki University Hospital (HUH) responsible for secondary and tertiary care of a population of 1.8 million. Design Retrospective population-based cohort study. Setting Secondary and tertiary care hospitals. Patients Inpatients with HA COVID-19 infection. Methods The HA COVID-19 infections with patient characteristics were retrospectively searched from HUH patient database from 1st October 2021 to 31st March 2022. All positive SARS-CoV-2 nucleic acid amplification tests (NAATs) from any ward were reviewed. The COVID-19 infection was classified as HA if a notification of HA infection was done or SARS-CoV-2 NAAT was positive ≥6 days after hospital admission or medical records revealed a known exposure for COVID-19 during hospital stay. Results 177 HA COVID-19 infections were retrieved with an incidence of 0.55 per 1000 patient days. Of these patients, 71 (40%) were treated in medicine, 52 (29%) in operative, and 54 (31%) in psychiatric wards, leading to incidences of 0.51, 0.39, and 1.10 per 1,000 patient days, respectively. In association with COVID-19, 16 (23%) in medicine, 3 (6%) in operative, and 1 (2%) patient in psychiatric wards deceased. Of the deceased patients, 16 (80%) had received at least one COVID-19 vaccine. Conclusions Hospital-acquired COVID-19 infections in omicron era were related to high mortality, especially among patients in medicine wards who also had good vaccination coverage.
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Affiliation(s)
- Hanna Helanne
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Erik Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Katariina Kainulainen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Elisa Kortela
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
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Dave N, Sjöholm D, Hedberg P, Ternhag A, Granath F, Verberk JDM, Johansson AF, van der Werff SD, Nauclér P. Nosocomial SARS-CoV-2 Infections and Mortality During Unique COVID-19 Epidemic Waves. JAMA Netw Open 2023; 6:e2341936. [PMID: 37948082 PMCID: PMC10638644 DOI: 10.1001/jamanetworkopen.2023.41936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/08/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Quantifying the burden of nosocomial SARS-CoV-2 infections and associated mortality is necessary to assess the need for infection prevention and control measures. Objective To investigate the occurrence of nosocomial SARS-CoV-2 infections and associated 30-day mortality among patients admitted to hospitals in Region Stockholm, Sweden. Design, Setting, and Participants A retrospective, matched cohort study divided the period from March 1, 2020, until September 15, 2022, into a prevaccination period, early vaccination and pre-Omicron (period 1), and late vaccination and Omicron (period 2). From among 303 898 patients 18 years or older living in Region Stockholm, 538 951 hospital admissions across all hospitals were included. Hospitalized admissions with nosocomial SARS-CoV-2 infections were matched to as many as 5 hospitalized admissions without nosocomial SARS-CoV-2 by age, sex, length of stay, admission time, and hospital unit. Exposure Nosocomial SARS-CoV-2 infection defined as the first positive polymerase chain reaction test result at least 8 days after hospital admission or within 2 days after discharge. Main Outcomes and Measures Primary outcome of 30-day mortality was analyzed using time-to-event analyses with a Cox proportional hazards regression model adjusted for age, sex, educational level, and comorbidities. Results Among 2193 patients with SARS-CoV-2 infections or reinfections (1107 women [50.5%]; median age, 80 [IQR, 71-87] years), 2203 nosocomial SARS-CoV-2 infections were identified. The incidence rate of nosocomial SARS-CoV-2 infections was 1.57 (95% CI, 1.51-1.64) per 1000 patient-days. In the matched cohort, 1487 hospital admissions with nosocomial SARS-CoV-2 infections were matched to 5044 hospital admissions without nosocomial SARS-CoV-2 infections. Thirty-day mortality was higher in the prevaccination period (adjusted hazard ratio [AHR], 2.97 [95% CI, 2.50-3.53]) compared with period 1 (AHR, 2.08 [95% CI, 1.50-2.88]) or period 2 (AHR, 1.22 [95% CI, 0.92-1.60]). Among patients with nosocomial SARS-CoV-2 infections, 30-day AHR comparing those with 2 or more doses of SARS-CoV-2 vaccination and those with less than 2 doses was 0.64 (95% CI, 0.46-0.88). Conclusions and Relevance In this matched cohort study, nosocomial SARS-CoV-2 infections were associated with higher 30-day mortality during the early phases of the pandemic and lower mortality during the Omicron variant wave and after the introduction of vaccinations. Mitigation of excess mortality risk from nosocomial transmission should be a strong focus when population immunity is low through implementation of adequate infection prevention and control measures.
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Affiliation(s)
- Nishi Dave
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Sjöholm
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Pontus Hedberg
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Granath
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Janneke D. M. Verberk
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anders F. Johansson
- Department of Clinical Microbiology and Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Suzanne D. van der Werff
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Honda H, Nakagawa M, Nisida R, Shintani C, Hamagishi M, Uehara Y, Iwata M, Doi Y. Discontinuation of admission screening for coronavirus disease 2019 (COVID-19) and the impact on in-hospital clusters of COVID-19: Experience at a tertiary-care center. Infect Control Hosp Epidemiol 2023; 44:1877-1880. [PMID: 37088552 DOI: 10.1017/ice.2023.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
We evaluated the impact of discontinuing universal preadmission screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) on the occurrence of nosocomial clusters of coronavirus disease 2019 (COVID-19) during the SARS-CoV-2 o (omicron) variant period. No increasing trend in nosocomial clusters was observed during community-based surges before and after discontinuation. This finding supports the safety of the practice change.
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Affiliation(s)
- Hitoshi Honda
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
| | - Masataka Nakagawa
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
| | - Rie Nisida
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
| | - Chiyo Shintani
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
| | - Manami Hamagishi
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Aichi, Japan
| | - Yuki Uehara
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
| | - Mitsunaga Iwata
- Department of General Internal Medicine, Emergency and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Yohei Doi
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
- Center for Innovative Antimicrobial Therapy, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania, United States
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11
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Klompas M, Baker MA, Rhee C. Is Nosocomial SARS-CoV-2 Still Worth Preventing? JAMA Netw Open 2023; 6:e2344704. [PMID: 37948088 DOI: 10.1001/jamanetworkopen.2023.44704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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12
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Hatfield KM, Baggs J, Maillis A, Warner S, Jernigan JA, Kadri SS, Klompas M, Reddy SC. Assessment of Hospital-Onset SARS-CoV-2 Infection Rates and Testing Practices in the US, 2020-2022. JAMA Netw Open 2023; 6:e2329441. [PMID: 37639273 PMCID: PMC10463096 DOI: 10.1001/jamanetworkopen.2023.29441] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/04/2023] [Indexed: 08/29/2023] Open
Abstract
Importance Characterizing the scale and factors associated with hospital-onset SARS-CoV-2 infections could help inform hospital and public health policies regarding prevention and surveillance needs for these infections. Objective To evaluate associations of hospital-onset SARS-CoV-2 infection rates with different periods of the COVID-19 pandemic, hospital characteristics, and testing practices. Design, Setting, and Participants This cohort study of US hospitals reporting SARS-CoV-2 testing data in the PINC AI Healthcare Database COVID-19 special release files was conducted from July 2020 through June 2022. Data were collected from hospitals that reported at least 1 SARS-CoV-2 reverse transcription-polymerase chain reaction or antigen test during hospitalizations discharged that month. For each hospital-month where the hospital reported sufficient data, all hospitalizations discharged in that month were included in the cohort. SARS-CoV-2 viral tests and results reported in the microbiology files for all hospitalizations in the study period by discharge month were identified. Data analysis was conducted from September 2022 to March 2023. Exposure Hospitalizations discharged in an included hospital-month. Main Outcomes and Measures Multivariable generalized estimating equation negative-binomial regression models were used to assess associations of monthly rates of hospital-onset SARS-CoV-2 infections per 1000 patient-days (defined as a first positive SARS-CoV-2 test during after hospitalization day 7) with the phase of the pandemic (defined as the predominant SARS-CoV-2 variant in circulation), admission testing rates, and hospital characteristics (hospital bed size, teaching status, urban vs rural designation, Census region, and patient distribution variables). Results A total of 5687 hospital-months from 288 distinct hospitals were included, which contributed 4 421 268 hospitalization records. Among 171 564 hospitalizations with a positive SARS-CoV-2 test, 7591 (4.4%) were found to be hospital onset and 6455 (3.8%) were indeterminate onset. The mean monthly hospital-onset infection rate per 1000 patient-days was 0.27 (95 CI, 0.26-0.29). Hospital-onset infections occurred in 2217 of 5687 hospital-months (39.0%). The monthly percentage of discharged patients tested for SARS-CoV-2 at admission varied; 1673 hospital-months (29.4%) had less than 25% of hospitalizations tested at admission; 2199 hospital-months (38.7%) had 25% to 50% of all hospitalizations tested, and 1815 hospital months (31.9%) had more than 50% of all hospitalizations tested at admission. Postadmission testing rates and community-onset infection rates increased with admission testing rates. In multivariable models restricted to hospital-months testing at least 25% of hospitalizations at admission, a 10% increase in community-onset SARS-CoV-2 infection rate was associated with a 178% increase in the hospital-onset infection rate (rate ratio, 2.78; 95% CI, 2.52-3.07). Additionally, the phase of the COVID-19 pandemic, the admission testing rate, Census region, and bed size were all significantly associated with hospital-onset SARS-CoV-2 infection rates. Conclusions and Relevance In this cohort study of hospitals reporting SARS-CoV-2 infections, there was an increase of hospital-onset SARS-CoV-2 infections when community-onset infections were higher, indicating a need for ongoing and enhanced surveillance and prevention efforts to reduce in-hospital transmission of SARS-CoV-2 infections, particularly when community-incidence of SARS-CoV-2 infections is high.
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Affiliation(s)
- Kelly M. Hatfield
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Baggs
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander Maillis
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Warner
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - John A. Jernigan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sameer S. Kadri
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sujan C. Reddy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Wu Y, Pan Y, Su K, Zhang Y, Jia Z, Yi J, Lv H, Zhang L, Xue M, Cao D, Jiang J. Elder and booster vaccination associates with decreased risk of serious clinical outcomes in comparison of Omicron and Delta variant: A meta-analysis of SARS-CoV-2 infection. Front Microbiol 2023; 14:1051104. [PMID: 37125157 PMCID: PMC10140352 DOI: 10.3389/fmicb.2023.1051104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Background The COVID-19 pandemic brings great pressure to the public health systems. This meta-analysis aimed to compare the clinical outcomes among different virus variants, to clarify their impact on medical resources and to provide evidence for the formulation of epidemic prevention policies. Methods A systematic literature search was performed in the PubMed, Embase, and Cochrane Library databases using the key words "Omicron" and "Delta." The adjusted Risk ratios (RRs), Odds ratios (ORs) and Hazard ratios (HRs) were extracted, and RRs and Rate difference % (RD%) were used to interpret the risk estimates of the outcomes ultimately. Results Forty-three studies were included, with 3,812,681 and 14,926,841 individuals infected with SARS-CoV-2 Delta and Omicron variant, respectively. The relative risks of hospitalization, death, ICU admission, and mechanical ventilation use after infection with the Omicron variant were all significantly reduced compared those after infection with the Delta variant (RRhospitalization = 0.45, 95%CI: 0.40-0.52; RRdeath = 0.37, 95%CI: 0.30-0.45; RRICU = 0.35, 95%CI: 0.29-0.42; RRmechanical ventilation = 0.33, 95%CI: 0.25-0.44). The change of both absolute and relative risks for hospitalization was more evident (RR = 0.47, 95%CI: 0.42-0.53;RD% =10.61, 95%CI: 8.64-12.59) and a significant increase was observed for the absolute differences in death in the elderly (RD% = 5.60, 95CI%: 4.65-6.55); the change of the absolute differences in the risk of hospitalization and death were most markedly observed in the patients with booster vaccination (RD%hospitalization = 8.60, 95CI%: 5.95-11.24; RD%death = 3.70, 95CI%: 0.34-7.06). Conclusion The ability of the Omicron variant to cause severe clinical events has decreased significantly, as compared with the Delta variant, but vulnerable populations still need to be vigilant. There was no interaction between the vaccination doses and different variants.
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Affiliation(s)
- Yanhua Wu
- Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, Changchun, China
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Yuchen Pan
- Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, Changchun, China
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Kaisheng Su
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Yangyu Zhang
- Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, Changchun, China
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Zhifang Jia
- Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, Changchun, China
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Jiaxin Yi
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Haiyong Lv
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Lihuan Zhang
- The Second Hospital of Jilin University, Changchun, China
| | - Mingyang Xue
- School of Public Health, Jilin University, Changchun, China
| | - Donghui Cao
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Jing Jiang
- Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, Changchun, China
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
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