Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large US Academic Medical Center
Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large US Academic Medical Center
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DOI：
10.1001/jamanetworkopen.2020.20498
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发表时间：
2020-09-09
影响因子：
13.8
通讯作者：
Klompas, Michael
中科院分区：
文献类型：
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作者：
Rhee, Chanu;Baker, Meghan;Klompas, Michael
本队列研究评估了在全面进行性感染控制计划的背景下，在美国医疗中心入院的患者中2019年医院性冠状病毒病（COVID-19）的发病率。一些患者因担心在医院感染2019冠状病毒病（COVID-19）而避免接受必要的治疗。然而，关于在美国医院感染COVID-19的风险的数据很少。目的评估美国某大型学术医疗中心发现首例住院病例后12周内新冠肺炎患者的发病率。设计、环境和参与者本队列研究包括2020年3月7日至5月30日期间布里格姆妇女医院（马萨诸塞州波士顿）收治的所有患者。随访持续到2020年6月17日。回顾了所有通过反转录聚合酶链反应（RT-PCR）首次检测出严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）阳性的患者在出院第3天或之后或出院14天内的医疗记录。实施了全面的感染控制计划，包括配备空气传播感染隔离室的专用COVID-19单元，按照美国疾病控制和预防中心的建议配备个人防护设备，穿戴个人防护设备和脱下监视器，通用口罩，限制访客，以及对有症状和无症状患者进行自由RT-PCR检测。根据检测时间、临床病程和暴露情况，感染是社区获得还是医院获得。结果12周内入院患者9149例（平均[SD]年龄46.1[26.4]岁，中位[IQR]年龄51[30-67]岁，女性5243例（57.3%）），其中进行了7394例SARS-CoV-2 RT-PCR检测；确诊病例697例，累计护理8656天。697名COVID-19住院患者中有12人（1.7%）在住院第3天或之后首次检测呈阳性（中位数为4天；范围为3-15天）。在这些病例中，只有1例被认为是医院获得性的，很可能来自一名症状前的配偶，她每天都来探望，在实施访客限制和口罩之前被诊断出患有COVID-19。在截至6月17日出院的8370名非covid -19相关住院患者中，11名（0.1%）在14天内检测呈阳性（到诊断的中位时间为6天，范围为1-14天）。只有1例被认为可能是医院获得性的，尽管没有已知的暴露。结论与意义本队列研究在感染控制措施严格的大型学术医疗中心患者中进行，在该地区大流行高峰期间医院感染的COVID-19罕见。这些发现可能为其他机构的实践提供参考，并为担心在医院感染COVID-19的患者提供保证。美国一家大型学术医疗中心2019年医院获得性冠状病毒病（COVID-19）的发病率是多少？在这项对美国一家大型学术医疗中心住院的9149名患者进行的为期12周的队列研究中，697名患者被诊断出患有COVID-19。在全面和渐进式感染控制规划的背景下，仅检测到2例医院获得性病例：1例患者可能在实施探视限制之前被症状前配偶感染，1例患者在住院16天后4天出现症状，但在医院没有已知暴露。这些发现表明，医院获得性COVID-19的总体风险较低，严格的感染控制措施可能与风险最小化有关。
This cohort study evaluates the incidence of nosocomial coronavirus disease 2019 (COVID-19) among patients admitted to a US medical center in the context of a comprehensive and progressive infection control program.Importance Some patients are avoiding essential care for fear of contracting coronavirus disease 2019 (COVID-19) in hospitals. There are few data, however, on the risk of acquiring COVID-19 in US hospitals. Objective To assess the incidence of COVID-19 among patients hospitalized at a large US academic medical center in the 12 weeks after the first inpatient case was identified. Design, Setting, and Participants This cohort study included all patients admitted to Brigham and Women's Hospital (Boston, Massachusetts) between March 7 and May 30, 2020. Follow-up occurred through June 17, 2020. Medical records for all patients who first tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction (RT-PCR) on hospital day 3 or later or within 14 days of discharge were reviewed. Exposures A comprehensive infection control program was implemented that included dedicated COVID-19 units with airborne infection isolation rooms, personal protective equipment in accordance with US Centers for Disease Control and Prevention recommendations, personal protective equipment donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients. Main Outcomes and Measures Whether infection was community or hospital acquired based on timing of tests, clinical course, and exposures. Results Over the 12-week period, 9149 patients (mean [SD] age, 46.1 [26.4] years; median [IQR] age, 51 years [30-67 years]; 5243 female [57.3%]) were admitted to the hospital, for whom 7394 SARS-CoV-2 RT-PCR tests were performed; 697 COVID-19 cases were confirmed, translating into 8656 days of COVID-19-related care. Twelve of the 697 hospitalized patients with COVID-19 (1.7%) first tested positive on hospital day 3 or later (median, 4 days; range, 3-15 days). Of these, only 1 case was deemed to be hospital acquired, most likely from a presymptomatic spouse who was visiting daily and diagnosed with COVID-19 before visitor restrictions and masking were implemented. Among 8370 patients with non-COVID-19-related hospitalizations discharged through June 17, 11 (0.1%) tested positive within 14 days (median time to diagnosis, 6 days; range, 1-14 days). Only 1 case was deemed likely to be hospital acquired, albeit with no known exposures. Conclusions and Relevance In this cohort study of patients in a large academic medical center with rigorous infection control measures, nosocomial COVID-19 was rare during the height of the pandemic in the region. These findings may inform practices in other institutions and provide reassurance to patients concerned about contracting COVID-19 in hospitals.Question What is the incidence of hospital-acquired coronavirus disease 2019 (COVID-19) at a large US academic medical center? Findings In this cohort study of 9149 patients admitted to a large US academic medical center over a 12-week period, 697 were diagnosed with COVID-19. In the context of a comprehensive and progressive infection control program, only 2 hospital-acquired cases were detected: 1 patient was likely infected by a presymptomatic spouse before visitor restrictions were implemented, and 1 patient developed symptoms 4 days after a 16-day hospitalization but without known exposures in the hospital. Meaning These findings suggest that overall risk of hospital-acquired COVID-19 was low and that rigorous infection control measures may be associated with minimized risk.