Incidence and outcomes of healthcare-associated COVID-19 infections: significance of delayed diagnosis and correlation with staff absence

Khonyongwa, Kirstin; Taori, Surabhi K.; Soares, Ana; Desai, Nergish; Sudhanva, Malur; Bernal, William; Schelenz, Silke; Curran, Lisa A.

BACKGROUND: The sudden increase in COVID-19 admissions in hospitals during the SARS-CoV2 pandemic of 2020 led to onward transmissions among vulnerable inpatients. AIMS: This study was performed to evaluate the prevalence and clinical outcomes of Healthcare-associated COVID-19 infections (HA-COVID-19) during the 2020 epidemic and study factors which may promote or correlate with its incidence and transmission in a Teaching Hospital NHS Trust in London, England. METHODS: Electronic laboratory, patient and staff self-reported sickness records were interrogated from 1(st) March to 18(th) April 2020. HA-COVID-19 was defined as COVID-19 with symptom onset >14 days of admission. Test performance of a single combined throat and nose swab (CTNS) for patient placement was calculated. The effect of delayed RNA positivity (DRP, defined as >48h delay), staff self-reported COVID-19 sickness absence, hospital bed occupancy, and community incidence of COVID-19 was compared for HA-COVID-19. The incidence of other significant hospital-acquired bacterial infections (HAB) was compared to previous years. RESULTS: 58 HA-COVID-19 (7.1%) cases were identified. When compared to community-acquired admitted cases (CA-COVID-19), significant differences were observed in age (p=0.018), ethnicity (p<0.001) and comorbidity burden (p<0.001) but not in 30 d mortality. CTNS negative predictive value was 60.3%. DRP was associated with greater mortality (p=0.034) and incidence of HA-COVID-19 correlated positively with DRP (R=0.7108) and staff sickness absence (R=0.7815). For the study period HAB rates were similar to previous 2 years. CONCLUSION: Early diagnosis and isolation of COVID-19 patients would help reduce transmission. A single CTNS has limited value in segregating patients into positive and negative pathways.