Transmission of community- and hospital-acquired SARS-CoV-2 in hospital settings in the UK: A cohort study.
Transmission of community- and hospital-acquired SARS-CoV-2 in hospital settings in the UK: A cohort study.
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在英国医院环境中，社区和医院获得的SARS-COV-2传播：一项队列研究。
DOI：
10.1371/journal.pmed.1003816
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发表时间：
2021-10
期刊：
影响因子：
15.8
通讯作者：
Cooper BS
中科院分区：
文献类型：
--
作者：
Mo Y;Eyre DW;Lumley SF;Walker TM;Shaw RH;O'Donnell D;Butcher L;Jeffery K;Donnelly CA;Oxford COVID infection review team;Cooper BS
严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）的医院传播已被广泛报道，但其在患者和医护人员中的传播途径尚不清楚。确定这些医院传播的风险因素和驱动因素对于感染预防和控制干预至关重要。我们研究的主要目的是量化SARS-CoV-2在医院环境中不同传播途径的相对重要性。这是一项观察性队列研究，使用了英国牛津郡4家教学医院2020年1月至10月的数据。使用logistic、广义相加和线性混合模型定量了传染性SARS-CoV-2个体与感染风险之间的关联。病例被归类为社区或医院获得性，可能潜伏期为3至7天。在研究期间住院的66，184名患者中，920名患者在同一时期（1.4%）的SARS-CoV-2 PCR检测呈阳性。平均年龄为67.9（±20.7）岁，49.2%为女性，68.5%来自白色种族。其中，571例患者在住院期间首次PCR检测阳性（62.1%），其中97例发生在入院后至少7天（10.5%）。在5 596名医务人员中，615名（11.0%）在研究期间使用聚合酶链反应或血清学检测呈阳性。平均年龄为39.5（±11.1）岁，78.9%为女性，49.8%为护士。对于易感患者，与另一名医院获得性SARS-CoV-2患者在同一病房1天与每1，000名易感患者每天额外7.5例感染相关（95%可信区间（CrI）为5.5至9.5/1，000名易感患者/天）。接触2019年社区获得性冠状病毒病（COVID-19）感染患者或接触传染性HCW与感染风险显著降低相关（2.0/1，000易感患者/天，95%CrI 1.6至2.2）。至于HCW感染，接触医院获得性SARS-CoV-2感染患者或接触感染性HCW均与每天每1，000名易感HCW额外0.8例感染相关（95%CrI分别为0.3至1.6和0.6至1.0）。接触社区获得性SARS-CoV-2感染患者与不到一半的风险相关（0.2/1，000易感HCW/天，95%CrI 0.2至0.2）。这些假设在敏感性分析中进行了测试，结果大致相似。主要局限性是症状发作日期和HCW缺勤天数不可用。在这项研究中，我们观察到接触医院获得性SARS-CoV-2患者与HCW和其他住院患者的重大感染风险相关。必须优化限制医院传播的感染控制措施，以保护工作人员和患者免受SARS-CoV-2感染。在一项队列研究中，Mo Yin及其同事调查了英国医院环境中社区和医院获得性SARS-CoV-2的传播。严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）在医院环境中的传播已被广泛报道，但对传播的发生率和途径知之甚少。住院患者特别容易受到2019冠状病毒病（COVID-19）相关并发症的影响，受感染的患者出院后可能会导致SARS-CoV-2在社区和养老院的进一步传播。医护人员（HCW）感染SARS-CoV-2的比例过高，由于SARS-CoV-2感染而减少的工作人员可能会影响患者的临床管理和感染预防和控制措施。提高对医院获得性SARS-CoV-2感染驱动因素的认识对于预防和控制SARS-CoV-2在医院的传播非常重要。我们从英国牛津郡的4家教学医院收集了2020年1月至10月的数据。对数据进行了分析，以发现传染性SARS-CoV-2个体（分类为社区获得性或医院获得性）与使用统计模型对易感个体造成的感染风险之间的关联。对于易感患者，与另一名医院获得性SARS-CoV-2患者在同一病房1天与每1，000名易感患者中额外的8例感染相关，而接触社区获得性COVID-19感染患者或感染性HCW与每1，000名易感患者中2例感染风险显著降低相关。至于HCW感染，接触医院获得性SARS-CoV-2感染患者或接触感染性HCW均与每天每1，000名易感HCW中额外1例感染相关，而接触社区获得性SARS-CoV-2感染患者的风险不到一半。我们的数据提供了强有力的证据，证明新感染的COVID-19患者与向住院患者和医护人员传播的高风险相关。我们的研究结果支持加强策略，以预防和识别住院患者中的早期医院发病SARS-CoV-2感染，例如，定期筛查和及时检测以识别这些患者。确保受感染的工作人员不在工作的措施，包括定期的工作人员筛查和适当的病假工资安排，是至关重要的。与疑似社区获得性COVID-19患者相关的传播风险相对较低，这表明对于这些患者而言，其传染性的高峰可能已经过去，因此现有的感染预防和控制政策，包括普遍使用个人防护设备，及时检测以及隔离疑似或已知病例，足以减轻大部分剩余的传染性。主要的局限性是症状发作日期和HCW缺勤天数不可用，这可能影响传播途径的估计。
Nosocomial spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been widely reported, but the transmission pathways among patients and healthcare workers (HCWs) are unclear. Identifying the risk factors and drivers for these nosocomial transmissions is critical for infection prevention and control interventions. The main aim of our study was to quantify the relative importance of different transmission pathways of SARS-CoV-2 in the hospital setting. This is an observational cohort study using data from 4 teaching hospitals in Oxfordshire, United Kingdom, from January to October 2020. Associations between infectious SARS-CoV-2 individuals and infection risk were quantified using logistic, generalised additive and linear mixed models. Cases were classified as community- or hospital-acquired using likely incubation periods of 3 to 7 days. Of 66,184 patients who were hospitalised during the study period, 920 had a positive SARS-CoV-2 PCR test within the same period (1.4%). The mean age was 67.9 (±20.7) years, 49.2% were females, and 68.5% were from the white ethnic group. Out of these, 571 patients had their first positive PCR tests while hospitalised (62.1%), and 97 of these occurred at least 7 days after admission (10.5%). Among the 5,596 HCWs, 615 (11.0%) tested positive during the study period using PCR or serological tests. The mean age was 39.5 (±11.1) years, 78.9% were females, and 49.8% were nurses. For susceptible patients, 1 day in the same ward with another patient with hospital-acquired SARS-CoV-2 was associated with an additional 7.5 infections per 1,000 susceptible patients (95% credible interval (CrI) 5.5 to 9.5/1,000 susceptible patients/day) per day. Exposure to an infectious patient with community-acquired Coronavirus Disease 2019 (COVID-19) or to an infectious HCW was associated with substantially lower infection risks (2.0/1,000 susceptible patients/day, 95% CrI 1.6 to 2.2). As for HCW infections, exposure to an infectious patient with hospital-acquired SARS-CoV-2 or to an infectious HCW were both associated with an additional 0.8 infection per 1,000 susceptible HCWs per day (95% CrI 0.3 to 1.6 and 0.6 to 1.0, respectively). Exposure to an infectious patient with community-acquired SARS-CoV-2 was associated with less than half this risk (0.2/1,000 susceptible HCWs/day, 95% CrI 0.2 to 0.2). These assumptions were tested in sensitivity analysis, which showed broadly similar results. The main limitations were that the symptom onset dates and HCW absence days were not available. In this study, we observed that exposure to patients with hospital-acquired SARS-CoV-2 is associated with a substantial infection risk to both HCWs and other hospitalised patients. Infection control measures to limit nosocomial transmission must be optimised to protect both staff and patients from SARS-CoV-2 infection. In a cohort study, Mo Yin and colleagues investigate transmission of community- and hospital-acquired SARS-CoV-2 in hospital settings in the UK. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the hospital setting has been widely reported, but little is known about the incidence and pathways of transmission. Hospitalised patients are especially vulnerable to Coronavirus Disease 2019 (COVID-19)-associated complications, and infected patients may contribute to the further spread of SARS-CoV-2 in the community and nursing homes upon discharge. Healthcare workers (HCWs) are disproportionately infected with SARS-CoV-2, and a reduced staff workforce due to SARS-CoV-2 infection may compromise the clinical management of patients and infection prevention and control measures. Improved understanding of the drivers of hospital-acquired SARS-CoV2 infection is important to prevent and control the spread of SARS-CoV-2 in hospitals. We collected data from 4 teaching hospitals in Oxfordshire, United Kingdom, from January to October 2020. The data were analysed to find the associations between infectious SARS-CoV-2 individuals (classified as community- or hospital-acquired) and infection risk posed to the susceptible individuals using statistical models. For susceptible patients, 1 day in the same ward with another patient with hospital-acquired SARS-CoV-2 was associated with an additional 8 infections per 1,000 susceptible patients, while exposure to an infectious patient with community-acquired COVID-19 or to an infectious HCW was associated with substantially lower infection risks of 2 per 1,000 susceptible patients. As for HCW infections, exposure to an infectious patient with hospital-acquired SARS-CoV-2 or to an infectious HCW were both associated with an additional 1 infection per 1,000 susceptible HCWs per day, while exposure to an infectious patient with community-acquired SARS-CoV-2 was associated with less than half this risk. Our data provide strong evidence that newly infected COVID-19 patients are associated with a high risk of onward transmission to patients and HCWs in hospital. Our findings support enhanced strategies to prevent and identify early hospital-onset SARS-CoV-2 infection among hospitalised patients, for example, regular screening and prompt testing to identify these patients. Measures to ensure infected staff are not at work, including regular staff screening and adequate sick pay arrangements, are vital. The relatively low risk of transmission associated with patients with suspected community-acquired COVID-19 suggests that for these patients, the peak of their infectivity may have passed such that existing infection prevention and control policies including universal use of personal protective equipment, prompt testing, and isolation of suspected or known cases are sufficient to mitigate most of the remaining infectiousness. The main limitations were that the symptom onset dates and HCW absence days were not available, which may affect the estimation of the transmission pathways.
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影响因子：
6.9
作者：
Carter, B.;Collins, J. T.;McCarthy, K.
通讯作者：
McCarthy, K.
DOI：
10.1056/nejmoa2034545
发表时间：
2021-02-11
期刊：
The New England journal of medicine
影响因子：
--
作者：
Lumley SF;O'Donnell D;Stoesser NE;Matthews PC;Howarth A;Hatch SB;Marsden BD;Cox S;James T;Warren F;Peck LJ;Ritter TG;de Toledo Z;Warren L;Axten D;Cornall RJ;Jones EY;Stuart DI;Screaton G;Ebner D;Hoosdally S;Chand M;Crook DW;O'Donnell AM;Conlon CP;Pouwels KB;Walker AS;Peto TEA;Hopkins S;Walker TM;Jeffery K;Eyre DW;Oxford University Hospitals Staff Testing Group
通讯作者：
Oxford University Hospitals Staff Testing Group
影响因子：
7.7
作者：
Illingworth CJ;Hamilton WL;Warne B;Routledge M;Popay A;Jackson C;Fieldman T;Meredith LW;Houldcroft CJ;Hosmillo M;Jahun AS;Caller LG;Caddy SL;Yakovleva A;Hall G;Khokhar FA;Feltwell T;Pinckert ML;Georgana I;Chaudhry Y;Curran MD;Parmar S;Sparkes D;Rivett L;Jones NK;Sridhar S;Forrest S;Dymond T;Grainger K;Workman C;Ferris M;Gkrania-Klotsas E;Brown NM;Weekes MP;Baker S;Peacock SJ;Goodfellow IG;Gouliouris T;de Angelis D;Török ME
通讯作者：
Török ME
影响因子：
82.9
作者：
He, Xi;Lau, Eric H. Y.;Leung, Gabriel M.
通讯作者：
Leung, Gabriel M.
影响因子：
168.9
作者：
Pollan, Marina;Perez-Gomez, Beatriz;Yotti, Raquel
通讯作者：
Yotti, Raquel