Hospital-acquired COVID-19 Research Articles

Possibilities of comprehensive rehabilitation in combination with vitamin and mineral preparations for patients who have undergone hospitalization COVID-19 form

Relevance. Rehabilitation of patients who have suffered severe and moderate COVID-19 is an urgent task of modern medicine. Today, the most important are rehabilitation measures for people who have undergone hospitalization. The goal is to study. The possibility of comprehensive rehabilitation of patients who have suffered hospital-acquired COVID-19, incl. using vitamin and mineral preparations. Materials and methods. A total of 195 consecutively recruited patients were examined. There were 2 groups of patients: with moderate severity (111 (56.92 %)) and severe severity (84 (43.0 %)). After discharge from the hospital, patients were randomly divided into 4 groups: Group A — 47 patients who received a rehabilitation complex, including therapeutic physical education (therapeutic and breathing exercises), physiotherapeutic treatment (inhalation and respiratory support) in accordance with the recommendations of the Ministry of Health Russian Federation, drug therapy in accordance with the recommendations of the Ministry of Health of the Russian Federation (anticoagulant therapy, if indicated — HMG-CoA reductase inhibitors, oral hypoglycemic therapy, ACE inhibitors and sartans); Group B — 49 patients who, in addition to the above methods, received vitamin preparations (vitamin D 1500 IU/day and vitamin C 30 mg/day); Group B — 48 patients who, in addition to the above methods, received mineral preparations (zinc 15 mg/day and selenium 70 mcg/day); Group D — 51 patients who, in addition to the above methods, received vitamins and mineral preparations in the previously indicated doses for groups B and C. The dynamics of mineral metabolism parameters were assessed. Results. During the examination of patients upon discharge from the hospital, a change in the content of macroelements was established: an increase in the level of potassium, sodium, sulfur and a decrease in calcium, as well as microelements: an increase in antimony and barium and a decrease in zinc, selenium and silicon. The most pronounced positive effect in terms of increasing the levels of essential macro- and microelements in the body (zinc, selenium and iron) in patients who had hospitalized COVID-19 was observed when using rehabilitation complexes in combination with vitamin and mineral preparations.

Impact of removing the healthcare mask mandate on hospital-acquired COVID-19 rates

Mandatory mask-wearing policies were one of several measures employed to reduce hospital-acquired SARS-CoV-2 infection throughout the pandemic. Many nations have removed healthcare mask mandates, but there remains a risk of new SARS-CoV-2 variants or epidemics of other respiratory viruses. To demonstrate the impact of removing the healthcare mask mandate. SARS-CoV-2 infections were analysed in a large teaching hospital for 40 weeks in 2022 using a controlled interrupted time-series design. The intervention was the removal of a staff/visitor surgical mask-wearing policy for the most wards at week 26 (intervention group) with a subset of specific wards retaining the mask policy (control group). The hospital-acquired SARS-CoV-2 infection rate was adjusted by the underlying community infection rate. In the context of a surge in SARS-CoV-2 infection, removal of the mask mandate for staff/visitors was not associated with a statistically significant change in the rate of nosocomial SARS-CoV-2 infection in the intervention group (incidence rate ratio: 1.105; 95% confidence interval: 0.523-2.334; P= 0.79) and there was no post-intervention trend (1.013; 0.932-1.100; P= 0.76) to suggest a delayed effect. The control group also showed no immediate or delayed change in infection rate. No evidence was found that removal of a staff/visitor mask-wearing policy had a significant effect on the rate of hospital-acquired SARS-CoV-2 infection. This does not demonstrate that masks were ineffective through the pandemic, but provides some objective evidence to justify the removal of healthcare mask mandates once there was widespread immunity and reduced disease severity.

2331. Characteristics Associated with Hospital-Acquired COVID-19 Infections in Los Angeles County

Abstract Background Few studies have characterized nosocomial transmission of SARS-CoV-2. We examined factors associated with hospital-acquired infections (HAIs) rates for SARS-CoV-2 in Los Angeles County (LAC). Methods In this retrospective cohort study, data were collected from 70 acute care hospitals between July 1, 2020 and March 31, 2022. We defined COVID HAIs as a patient with laboratory-confirmed SARS-CoV-2 (PCR or antigen test), which was first positive 4 or more days after hospital admission and before discharge. Community transmission (CT) level was calculated by dividing new cases within the past 7 days by the population in the county (per 100,000). Variant predominant periods were defined as periods when the variant exceeded 50% of sequenced specimens during the specimen collection month. The percent of core healthcare personnel (HCP) receiving a completed COVID vaccination series (as of 11/28/2021) was obtained from the National Healthcare Safety Network (NHSN). Incidence rates were calculated using patient-days as a denominator, as reported to NHSN. Mantel-Haenszel test was performed to assess COVID HAIs and predominant variant periods, controlling for effect of CT level. We analyzed hospital characteristics associated with incidence rate using multiple regression (SAS 9.4). Results During the 21-month study period, 2107 patients were identified as having COVID HAIs at 70 hospitals using the standardized definition. COVID HAIs were more likely to occur during high CT levels (RR=6.2; 95% CI=4.9, 8.0) and when the Omicron variant was predominant (RRCMH = 1.2; 95% CI=1.1, 1.4). In multivariate analysis, a higher rate of COVID HAIs was associated with hospitals unaffiliated with medical schools (β= -30.9, p< .05), lower HCP vaccination coverage (β= -0.6, p< .05), more hospital beds (β= 0.1, p< .05), and ownership type (β= 19.2, p< .01). In comparison to government hospitals, HAIs were three times more likely to occur in for-profit hospitals (95% CI=2.6, 3.6) and 1.4 times more likely to occur in not-for-profit hospitals (95% CI=1.2, 1.7). Conclusion COVID HAIs are more likely to occur during high transmission periods and at hospitals without medical schools, with for-profit ownership, lower HCP vaccination rates, and with a higher number of beds. Disclosures All Authors: No reported disclosures

Influencing factors of hospital-acquired COVID-19 prevention and control status among emergency support frontline healthcare workers under closed-loop management: a cross-sectional study.

This study aimed to understand the hospital-acquired COVID-19 infection rate and infection prevention and control status of emergency support frontline healthcare workers (ESFHCWs) under closed-loop management, and to explore the related factors affecting hospital-acquired COVID-19 prevention and control status. The study site was a provincial-level tertiary hospital in the Xinjiang Uygur Autonomous Region specializing in treating COVID-19 patients. ESFHCWs were assigned from different hospitals in Zhejiang Province to provide emergency medical support in this specialized hospital. All ESFHCWs were managed using a closed loop. A self-designed questionnaire was used to estimate basic information, work experience, and the status of infection prevention and control (SIPC). A total of 269 ESFHCWs responded to the questionnaire. A generalized linear regression model was used to estimate the factors influencing SIPC. There were six hospital-acquired COVID-19 cases, with an infection rate of 2.23%. The independent risk factors influencing COVID-19 prevention and control status were work seniority, anxiety disorder, and consumption of gastrointestinal, anti-inflammatory and anti-asthmatic, and hypnotic sedative drugs. Compared with ESFHCWs with more than 10 years of work seniority, ESFHCWs with less than 5 years of work seniority and 5-10 years of work seniority had lower COVID-19 SIPC scores. Among ESFHCWs with anxiety disorder, the SIPC score was significantly lower than that of ESFHCWs without anxiety disorder. The SIPC scores of ESFHCWs taking other medications (gastrointestinal, anti-inflammatory and anti-asthmatic, and hypnotic sedative drugs) were lower than those of ESFHCWs who did not. The closed-loop management method may be effective in reducing the infection rate of hospital-acquired COVID-19 among ESFHCWs. HCWs with less than 10 years of work seniority, anxiety disorder, and other medications (gastrointestinal, anti-inflammatory and anti-asthmatic, and hypnotic sedative drugs) were probably not suitable for participating in emergency assistant actions because of their poor SIPC scores. Further studies are needed to develop the selection criteria for ESFHCWs.

Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study

It is unclear what effect the pattern of health-care use before admission to hospital with COVID-19 (index admission) has on the long-term outcomes for patients. We sought to describe mortality and emergency readmission to hospital after discharge following the index admission (index discharge), and to assess associations between these outcomes and patterns of health-care use before such admissions. We did a national, retrospective, complete cohort study by extracting data from several national databases and linking the databases for all adult patients admitted to hospital in Scotland with COVID-19. We used latent class trajectory modelling to identify distinct clusters of patients on the basis of their emergency admissions to hospital in the 2 years before the index admission. The primary outcomes were mortality and emergency readmission up to 1 year after index admission. We used multivariable regression models to explore associations between these outcomes and patient demographics, vaccination status, level of care received in hospital, and previous emergency hospital use. Between March 1, 2020, and Oct 25, 2021, 33 580 patients were admitted to hospital with COVID-19 in Scotland. Overall, the Kaplan-Meier estimate of mortality within 1 year of index admission was 29·6% (95% CI 29·1-30·2). The cumulative incidence of emergency hospital readmission within 30 days of index discharge was 14·4% (95% CI 14·0-14·8), with the number increasing to 35·6% (34·9-36·3) patients at 1 year. Among the 33 580 patients, we identified four distinct patterns of previous emergency hospital use: no admissions (n=18 772 [55·9%]); minimal admissions (n=12 057 [35·9%]); recently high admissions (n=1931 [5·8%]), and persistently high admissions (n=820 [2·4%]). Patients with recently or persistently high admissions were older, more multimorbid, and more likely to have hospital-acquired COVID-19 than patients with no or minimal admissions. People in the minimal, recently high, and persistently high admissions groups had an increased risk of mortality and hospital readmission compared with those in the no admissions group. Compared with the no admissions group, mortality was highest in the recently high admissions group (post-hospital mortality HR 2·70 [95% CI 2·35-2·81]; p<0·0001) and the risk of readmission was highest in the persistently high admissions group (3·23 [2·89-3·61]; p<0·0001). Long-term mortality and readmission rates for patients hospitalised with COVID-19 were high; within 1 year, one in three patients had died and a third had been readmitted as an emergency. Patterns of hospital use before index admission were strongly predictive of mortality and readmission risk, independent of age, pre-existing comorbidities, and COVID-19 vaccination status. This increasingly precise identification of individuals at high risk of poor outcomes from COVID-19 will enable targeted support. Chief Scientist Office Scotland, UK National Institute for Health Research, and UK Research and Innovation.

Evaluation of the Geriatric Nutritional Risk Index in predicting mortality in older patients with COVID-19 in the AgeBru cohort

To determine whether the Geriatric Nutritional Risk Index (GNRI) on hospital admission was associated to an increased 14-day and 12-month mortality-risk in older inpatients with COVID-19. Cohort study of consecutive inpatients admitted with COVID-19 in a university hospital (20/03/2020-11/05/2021). age over 65 years and positive polymerase chain reaction test. missing data for weight, height, and/or albumin, hospital-acquired COVID-19, or patients transferred to other health facilities. all-cause mortality at 14-day and 12-month follow-up. GNRI [1.489× albumin (g/L)]+[41.7 (weight/ideal body weight)] was assessed at admission; scores ≤98 indicated risk of malnutrition. Cox-proportional hazards models assessed the association between the admission GNRI and 14-day and 12-month mortality-risk, after adjusting by demographic and clinical variables, including inflammation (C-reactive protein). Of the 570 eligible patients, 224 (mean age 78 years; 52.2% women) met inclusion criteria and 151 (67.4%) were classified at risk of malnutrition. Twenty patients died during the 14-day and 42 during the 12-month follow-up. The risk of 14-day mortality was nearly 10 times higher in patients with GNRI scores ≤98 (HR=9.6 [95%CI 1.3-71.6], P=0.028); this association was marginally significant in the adjusted model (HR=6.73 [95%CI 0.89-51.11], P=0.065)]. No association between GNRI and the 12-month mortality-risk was found. The GNRI may play a role in the short-term prognosis of older inpatients with COVID-19. Further studies are required to confirm the short-term predictive validity of the GNRI within this population (Clinicaltrials.gov_NCT05276752).

Baricitinib or Tocilizumab? Treatment of Patients Hospitalized With Severe COVID-19.

Baricitinib or Tocilizumab? Treatment of Patients Hospitalized With Severe COVID-19.

Incidence and outcome of hospital-acquired COVID-19 infections in secondary and tertiary care hospitals in the era of COVID-19 vaccinations.

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. Retrospective population-based cohort study. Secondary and tertiary care hospitals. Inpatients with HA COVID-19 infection. 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. 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. 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.

Experience with SARS-CoV-2 in an orthopaedic hospital

Concerns about nosocomial transmission of SARS-CoV-2 have been described since the COVID-19 pandemic was first reported and cases of hospital-acquired (HA) COVID-19 and COVID-19 outbreaks have been reported even in clinical areas not intended for the specific care of COVID-19 and declared as "non-COVID" areas. Retrospective analysis of measures to prevent of hospital acquisition of COVID-19 in patients admitted to a tertiary referral specialist orthopaedic hospital in Brazil in which emergency care was maintained during the pandemic. The proportion of HA-COVID-19 (0.07%) was lower than the value reported for general healthcare in Brazil (0.72%, P<0.001). The integration of several clinical teams to maintain a constant surveillance system, as well as the immediate isolation of patients with any compatible symptoms of COVID-19 and the restriction from work and the testing of symptomatic healthcare workers, were an important part of the strategies adopted. We suggest that the described strategies for preventing the nosocomial spread of SARS-CoV-2 contributed to the observed proportion of HA-COVID-19 to be significantly lower than the reported national value. Future studies that investigate these and other preventative measures are important so that hospitals are prepared for further periods of a high incidence of COVID-19, as well as for other epidemics associated with respiratory transmission.

Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

ObjectiveTo estimate continuous positive airway pressure (CPAP) length of treatment effect on survival of hospitalised COVID-19 patients in a medium-sized UK Hospital, and how this effect changes according to the...

The burden of hospital-acquired COVID-19: the Welsh and international experience

The burden of hospital-acquired COVID-19: the Welsh and international experience

Estimating the Nosocomial Transmission Rate of COVID-19 in Orthopaedic Surgery Patients During the Peak of the Pandemic.

PurposeTo estimate the risk of hospital-acquired COVID-19 transmission in a population of orthopaedic trauma patients during the first wave of the pandemic.Patients and MethodsThis is a retrospective cohort study of 109 patients who underwent an emergent orthopedic procedure by a single orthopedic traumatologist between March 1, 2020 and May 15, 2020 during the first peak of the pandemic. After applying inclusion and exclusion criteria, a total of 82 patients (67 inpatients and 15 ambulatory) were identified for final analysis. The primary outcome measured was postoperative Coronavirus (COVID-19) status. Secondary outcome measures included length of stay and discharge disposition.ResultsThe mean age and length of stay in the hospital group was 59.5 years (± 21.7) and 4.3 days (± 4.6), respectively, versus 47.9 years (± 9.8) in the ambulatory group. 7.3% (6/82) of the inpatients subsequently tested or screened positive for COVID-19 at 2 weeks post-operatively, compared to 0/15 ambulatory patients (P=0.58). Of the 6 inpatients who tested positive, 4 (66.7%) were discharged to a rehabilitation center. Diabetes (P=0.05), hypertension (P=0.02), and congestive heart failure (P=0.005) were associated with transmission.ConclusionIn this analysis, there was a nosocomial transmission rate of 7% compared to zero in the ambulatory surgery center, however this was not found to be statistically significant. This data supports the use of precautions such as frequent screening, hand washing, and masks to reduce transmission when COVID-19 rates are high. There is a lower risk of nosocomial COVID-19 transmission for patients treated as an outpatient and elective surgical procedures may be safer in this setting.

Management strategy for control and prevention of SARS-CoV-2 infection in hospital settings - a brief review

The current pandemic of COVID-19 has spread worldwide rapidly. Many countries are struggling with the third pandemic wave despite having the vaccine distribution to frontline workers and people at high risk. Several studies have suggested a high possibility of hospital-acquired COVID-19. Therefore, it is vital to have proper recommendations and guidelines to prevent COVID-19 transmission in hospitals. Eliminating hospital-acquired infection is impossible, but reducing the rate and severity is possible by following appropriate guidelines. This paper reviews the strategies and recommendations that can be helpful for a hospital authority to control and prevent SARS-CoV-2 infection among the patients and healthcare workers. IMC J Med Sci 2022; 16(2): 006. DOI: https://doi.org/10.55010/imcjms.16.016 *Correspondence: Akash Ahmed, Department of Mathematics &amp; Natural Sciences, BRAC University, Dhaka, Bangladesh. Email: akash.ahmed@bracu.ac.bd

(PO-158) Case Report: Myxedema Coma, Scurvy, and Hospital-Acquired COVID-19 as Complications of Severe Major Depressive Episode in the Setting of a Global Pandemic

(PO-158) Case Report: Myxedema Coma, Scurvy, and Hospital-Acquired COVID-19 as Complications of Severe Major Depressive Episode in the Setting of a Global Pandemic

Nationwide surveillance system to evaluate hospital-acquired COVID-19 in Brazilian hospitals

BackgroundAlthough the risk of SARS-CoV-2 transmission within hospitals has been well recognized, there is a paucity of data on its occurrence. Our aim was to report the incidence of hospital-acquired (HA) COVID-19 at Brazilian hospitals.MethodsWe investigated the incidence of HA COVID-19 in Brazilian hospitals using data from a national surveillance system, from August 2020 through September 2021. Definitions of HA COVID-19 were: (1) symptom onset >14 days after hospital admission plus a positive SARS-CoV-2 RNA or antigen test; (2) symptom onset on days 8–14 after admission, plus a positive SARS-CoV-2 RNA or antigen test positive, plus documented high-risk exposure. We performed descriptive analyses and reported HA COVID-19 rates using pooled mean and percentile distribution.ResultsA total of 48,634 cases of HA COVID-19 were reported from 1428 hospitals. Incidence ranged from 0.16/1000 patient-days at neonatal intensive care units (ICUs) to 5.8/1000 patient-days at adult ICUs. The highest incidence of HA COVID-19 was during the months March to July 2021, similar to that which was observed for community-acquired COVID-19.ConclusionsThis report provides a national view of the burden of HA COVID-19. The highest incidence of HA COVID-19 similar that which was observed for community-acquired COVID-19. We believe that this reflects the difficulty of implementing preventive measures. Further studies evaluating risk factors for the hospital transmission of SARS-Cov-2 should clarify strategies to minimize the risk of HA COVID-19 and may be applicable to other respiratory diseases. Furthermore, the implementation of a national system to evaluate HA COVID-19 has the potential to shine a light on this problem and lead to interventions in each hospital.

Routine molecular point-of-care testing for SARS-CoV-2 reduces hospital-acquired COVID-19

ObjectivesRisk of hospital-acquired COVID-19 (HA-COVID-19) infection is increased by cohorting infected and non-infected patients together in assessment areas, whist awaiting laboratory PCR results. Molecular point-of-care tests (mPOCT) reduce time to results and improve patient flow but the impact on HA-COVID-19 is unknown.MethodsIn this pre and post implementation study patients were evaluated across two time periods: March 1st to August 13th 2020, prior to the introduction of mPOCT in medical admissions areas, and 14th August 2020 to 1st April 2021, after mPOCT introduction. The primary outcome was proportion of HA-COVID-19 infection among all COVID-19 positive patients. Secondary outcome measures included time to SARS-CoV-2 results, length of time spent in the medical assessment area and comparison of local, regional and national proportions of HA-COVID-19.Results1988 patients were admitted through the acute medicine admission cohorting area and tested for SARS-CoV-2 prior to introducing mPOCT and 4640 afterwards. Median (IQR) time to SARS-CoV-2 result was 6.5 (2.1–17.9) hours prior to introducing mPOCT and 1.0 (0.8–1.3) hours afterwards (p < 0.0001). Median (IQR) duration in the assessment cohort area was 12.0 (4.8–20.6) hours prior to introduction of POCT and 3.2 (2.0–5.6) hours afterwards (p < 0.0001). The proportion of hospital-acquired COVID-19 cases was 108 (16.5%) of 654 prior to introducing mPOCT compared with 168 (9.4%) of 1782 afterwards, (HR 0.55, 95%CI 0.43–0.70; p < 0.0001). In the period following the introduction of mPOCT up to 1st April 2021 the median proportion of HA-COVID-19 was 13.6% (95%CI 8.2–18.9%) locally, compared with 43.8% (95%CI 37.8–49.9%) for all acute NHS trusts regionally and 30.9% (95%CI 28.4–33.5%) for all NHS trusts nationally.ConclusionsRoutine mPOCT for SARS-CoV-2 was associated with reduced time to results, time spent in admission cohort areas, and hospital-acquired COVID-19, compared to laboratory PCR.

39. Anti-Spike Monoclonal Antibody Therapy for Kidney Transplant Recipients with COVID-19

BackgroundOrgan transplant recipients may not mount an adequate immune response to COVID-19 infection, and therefore may benefit greatly from passive immunization with anti-spike monoclonal antibodies (mAb), which have been shown to decrease hospitalization rates in the general outpatient population. We evaluated the efficacy of mAb therapy in decreasing hospitalizations or emergency room (ER) visits among kidney transplant recipients (KTR) with COVID-19.MethodsWe identified KTR with COVID-19 between 3/1/2020 and 4/30/2021. Patients were excluded if they had multiorgan transplant or hospital-acquired COVID-19. Data were analyzed by Cox regression with mAb administration as time-dependent variable, and the day of symptom onset as baseline.ResultsWe studied 95 KTR; 20 received mAb. Comorbidities and immunosuppression were balanced between the two groups. mAb administration was associated with a significant decrease in hospitalizations or ER visits (15 vs. 76%, P< 0.001). This association remained significant after adjustment for confounders and by analyzing mAb administration as a time-dependent variable (Table: adj. HR 0.2, P=0.04). No KTR who received mAb died or required mechanical ventilation. Black or Hispanic KTR were less likely to receive mAb and more likely to be admitted to the hospital or visit the ER (Table).Table Factors significantly associated with hospitalization or ER visit.ConclusionIn our KTR population, mAb therapy for COVID-19 may have helped decrease hospitalizations and ER visits. Healthcare inequities, including access to investigational treatments, were exacerbated by the COVID-19 pandemic. Acknowledging the nonconcurrent control group as a limitation, we found a strong signal for benefit from mAb treatment. Antiviral mAb are a promising therapeutic modality for immunosuppressed patients. Disclosures Dimitrios Farmakiotis, M.D., Astellas (Grant/Research Support)Merck (Grant/Research Support)Viracor (Grant/Research Support)

399. Epidemiology of Laboratory-identified Late-onset SARS-CoV-2 Positivity in Two Large, Urban, Acute-Care Hospitals: Implications for Surveillance of Hospital-Acquired COVID-19

BackgroundLaboratory identification (Lab-ID) of late-onset SARS-CoV-2 positive tests during a hospital stay is a potential public health surveillance approach for hospital-acquired COVID-19. However, prolonged RNA fragment shedding and intermittent detection of SARS-CoV-2 virus via PCR testing among infected patients may hamper interpretation of laboratory-identified events. We aimed to describe the epidemiology of late-onset SARS-CoV-2 laboratory events using clinical criteria, to evaluate the feasibility of a Lab-ID approach to detection of nosocomial SARS-COV-2 infection.MethodsWe evaluated all SARS-CoV-2 RT-PCR positive results recovered from patients at two acute-care hospitals in Chicago, IL, during March 1 — November 30, 2020. Each hospital maintained stringent infection control policies through-out the study period. Through chart review (WT & CS), we categorized all initial SARS-CoV-2 positive tests collected > Hospital Day 5 (defined as ‘late-onset’ based on the 5-day mean incubation period for COVID-19) into the following clinical categories: Community Acquired; Unlikely Hospital Acquired; Possible Hospital Acquired; and Probable Hospital Acquired. Categorizations were made using hospital day, symptoms, alternative diagnoses, and clinical notes (Figure 1). ResultsOf 2,671 SARS-CoV-2-positive patients, most positive tests (n=2,551; 96%) were recovered pre-admit or by Hospital Day 2; first positive tests were uncommon during Hospital Days 6 to 14 (n=40; 1.5%); and rare after Hospital Day 14 (n=15; 0.6%). By chart review, of the 55 late-onset records reviewed, categorizations in descending order were: Prior positive at outside facility (n=23); Possible Hospital Acquired (n=16); Community Acquired (n=12); Probable Hospital Acquired (n=4). Less than half of the late-onset cases were categorized as a possible or probable hospital acquisition (Figure 2). ConclusionHospital-acquired SARS-CoV-2 infection was uncommon. Most late-onset episodes of SARS-CoV-2 were explained by detection at an outside healthcare facility or by delayed diagnosis of patients with symptoms at time of presentation. A Lab-ID approach to nosocomial COVID-19 surveillance would potentially misclassify a substantial number of patients.Disclosures All Authors: No reported disclosures

Analysis of an outbreak of nosocomial COVID-19 at a tertiary care centre in South India.

Nosocomial outbreaks of COVID-19 have been reported sporadically since the beginning of the COVID-19 pandemic. We sought to study the transmission dynamics in a nosocomial COVID-19 outbreak in our centre. This was a retrospective cohort study in a 500 bedded tertiary care hospital in South India. Inpatients who were suspected to have likely or definite hospital-acquired COVID-19 and hospital staff members who were found to be COVID-19 positive during the same time frame were studied and the likely transmission dynamics described. During the study period, 173 patients were diagnosed to have COVID-19, out of which, 15 (8.6%) patients who fulfilled the criteria for likely or definitely hospital-acquired COVID-19 infection were identified from six different wards. During the same period, 121 hospital staff members were diagnosed with COVID-19. Out of these, 18 (14.9%) hospital staff members were identified who could have been the potential source of infection for these 15 patients based on the overlap of location of the staff and the patients, and their infectivity windows. Direct contact and fomite transmission were likely the predominant driver of transmission in our study as there was use of universal face masks and face shields. Despite the admission of a large number of COVID-19 patients and a relatively large proportion of hospital staff members who tested positive for the disease, the proportion of nosocomial COVID-19 in our centre remained low. A policy of universal gloving, coupled with the already existing practice of universal N95 masking and face shield use, could potentially bring down the rate of nosocomial COVID-19 even further.

Airborne protection for staff is associated with reduced hospital-acquired COVID-19 in English NHS trusts

IntroductionThe rate of hospital-acquired coronavirus disease 2019 has reduced from 14.3% to 4.2% over the last year, but substantial differences still exist between English National Health Service (NHS) hospital trusts.MethodsThis study assessed rates of hospital-acquired infection (HAI), comparing NHS hospital trusts using airborne respiratory protection (e.g. FFP3 masks) for all staff, as a marker of measures to reduce airborne spread, with NHS hospital trusts using mainly droplet precautions (e.g. surgical masks).Results/discussionThe use of respiratory protective equipment was associated with a 33% reduction in the odds of HAI in the Delta wave, and a 21% reduction in the odds of HAI in the Alpha wave (P<0.00001). It is recommended that all hospitals should prioritize airborne mitigation.