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.

Autor: Wee LE; Department of Infectious Diseases, Singapore General Hospital, Singapore. Electronic address: ian.wee.l.e@singhealth.com.sg., Conceicao EP; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore., Aung MK; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore., Aung MO; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore., Yang Y; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore., Arora S; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore., Ko KK; Department of Molecular Pathology, Singapore General Hospital, Singapore; Department of Microbiology, Singapore General Hospital, Singapore., Venkatachalam I; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.
Jazyk: angličtina
Zdroj: Infection, disease & health [Infect Dis Health] 2023 May; Vol. 28 (2), pp. 81-87. Date of Electronic Publication: 2022 Oct 07.
DOI: 10.1016/j.idh.2022.09.003
Abstrakt: 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.
(Copyright © 2022 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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