Healthcare-associated COVID-19 in England: A national data linkage study

Alex Bhattacharya, Simon M. Collin, James Stimson, Simon Thelwall, Olisaeloka Nsonwu, Sarah Gerver, Julie Robotham, Mark Wilcox, Susan Hopkins, Russell Hope*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. Methods: Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test <14 days pre-admission, up to day 2 of admission; hospital-onset indeterminate healthcare-associated, first positive on day 3–7; hospital-onset probable healthcare-associated, first positive on day 8–14; hospital-onset definite healthcare-associated, first positive from day 15 of admission until discharge; community-onset possible healthcare-associated, first positive test ≤14 days post-discharge. Results: One-third (34.4%, 100,859/293,204) of all laboratory-confirmed COVID-19 cases were linked to a hospital record. Hospital-onset probable and definite cases represented 5.3% (15,564/293,204) of all laboratory-confirmed cases and 15.4% (15,564/100,859) of laboratory-confirmed cases among hospital patients. Community-onset community-acquired and community-onset possible healthcare-associated cases represented 86.5% (253,582/293,204) and 5.1% (14,913/293,204) of all laboratory-confirmed cases, respectively. Conclusions: Up to 1 in 6 SARS-CoV-2 infections among hospitalised patients with COVID-19 in England during the first 6 months of the pandemic could be attributed to nosocomial transmission, but these represent less than 1% of the estimated 3 million COVID-19 cases in this period.

Original languageEnglish
JournalJournal of Infection
DOIs
Publication statusAccepted/In press - 2021

Bibliographical note

Funding Information:
We would like to thank the Public Health England (PHE) National Incident Coordination center (NICC) Epidemiology Cell (EpiCell) and the PHE Data Lake team. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. SH, JR and RH are partly funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare-Associated Infections and Antimicrobial Resistance in a partnership between Public Health England (PHE) and the University of Oxford [NIHR200915]. AB, SH, SC and RH work on a data project within PHE that is funded by an NIHR AMR award [NIHR200658].

Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. SH, JR and RH are partly funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare-Associated Infections and Antimicrobial Resistance in a partnership between Public Health England (PHE) and the University of Oxford [NIHR200915]. AB, SH, SC and RH work on a data project within PHE that is funded by an NIHR AMR award [NIHR200658].

Publisher Copyright:
© 2021

Keywords

  • Community-onset infection
  • COVID-19
  • Healthcare-associated infection
  • Sars-CoV-2

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