Robust and rigorous infection control practices may be associated with minimized risk of nosocomial spread of coronavirus disease 2019 (COVID-19) to hospitalized patients, according to study results published in JAMA Network Open.

To assess the incidence of COVID-19 among patients hospitalized at the Brigham and Women’s Hospital in Boston, Massachusetts, researchers analyzed medical records of all patients admitted between March 7 and May 30. Researchers reviewed records of 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.

Brigham and Women’s Hospital implemented a comprehensive infection control program, which included the following: screening of all patients for COVID-19 symptoms on admission and daily thereafter, liberal use of RT-PCR testing initially for all symptomatic patients and subsequently for all patients at the time of admission (including asymptomatic patients), dedicated COVID-19 units with airborne infection isolation rooms, personal protective equipment (PPE) in accordance with US Centers for Disease Control and Prevention recommendations, PPE donning and doffing monitors, universal masking of staff and subsequently patients and visitors, and restriction of visitors.

Between March 7 and May 30, a total of 9149 patients were admitted to the hospital. The mean age was 46.1 years (±26.4), median age was 51 years (interquartile range, 30-67), and 57.3% of patients were women. Researchers performed 7394 SARS-CoV-2 RT-PCR tests and 697 patients were diagnosed with their first episode of COVID-19.


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Of the 697 hospitalized patients with confirmed COVID-19, 12 (1.7%) were first diagnosed on hospital day 3 or later (median, 4 days; range, 3-15 days). Of the 12 cases, 11 were definite or likely community-acquired cases, and only 1 was deemed to be hospital-acquired, most likely from a presymptomatic spouse visiting daily and diagnosed with COVID-19 before visitor restrictions and masking were implemented.

Among 8370 patients who were hospitalized with non-COVID-19-related conditions and were 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 with no known exposures inside the hospital.

Despite the high burden of COVID-19, researchers identified 2 patients who likely acquired the infection in the hospital, including 1 who was most likely infected by a visiting spouse. The findings suggest that rigorous infection control measures may be associated with minimized risk and provide reassurance to patients concerned about contracting COVID-19 in hospitals.

A separate analysis is warranted to provide insight into the risk of nosocomial infection among healthcare workers. As policies evolved rapidly during the pandemic, it is unclear which control measure was most effective. Lastly, the findings of this study may not be generalizable to all hospitals, since Brigham and Women’s Hospital cared for many patients with COVID-19 in newly improvised intensive care units and wards but never exceeded surge capacity.

Disclosure: Several study authors declared affiliations with government agencies. Please see the original reference for a full list of authors’ disclosures.

Reference

Rhee C, Baker M, Vaidya V, et al. CDC Prevention Epicenters Program. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw Open. 2020;3(9):e2020498.