tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2021 Jun 21;8(8)
fab328.
doi: 10.1093/ofid/ofab328. eCollection 2021 Aug.
Transmission of SARS-CoV-2 in Inpatient and Outpatient Settings in a Veterans Affairs Health Care System
Chetan Jinadatha[SUP] 1 2 [/SUP], Lucas D Jones[SUP] 3 [/SUP], Hosoon Choi[SUP] 4 [/SUP], Piyali Chatterjee[SUP] 4 [/SUP], Munok Hwang[SUP] 4 [/SUP], Sarah N Redmond[SUP] 5 [/SUP], Maria E Navas[SUP] 6 [/SUP], Trina F Zabarsky[SUP] 7 [/SUP], Davinder Bhullar[SUP] 8 [/SUP], Jennifer L Cadnum[SUP] 9 [/SUP], Curtis J Donskey[SUP] 5 10 [/SUP]
Affiliations
Abstract
Background: Health care personnel and patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in health care settings, including in outpatient clinics and ancillary care areas.
Methods: Between May 1, 2020, and January 31, 2021, we identified clusters of 3 or more coronavirus disease 2019 (COVID-19) cases in which nosocomial transmission was suspected in a Veterans Affairs health care system. Asymptomatic employees and patients were tested for SARS-CoV-2 if they were identified as being at risk through contact tracing investigations; for 7 clusters, all personnel and/or patients in a shared work area were tested regardless of exposure history. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from the clusters and from control employees and patients.
Results: Of 14 clusters investigated, 7 occurred in community-based outpatient clinics, 1 in the emergency department, 3 in ancillary care areas, and 3 on hospital medical/surgical wards that did not provide care for patients with known COVID-19 infection. Eighty-one of 82 (99%) symptomatic COVID-19 cases and 31 of 35 (89%) asymptomatic cases occurred in health care personnel. Sequencing analysis provided support for several transmission events between coworkers and in 2 cases supported transmission from health care personnel to patients. There were no documented transmissions from patients to personnel.
Conclusions: Clusters of COVID-19 with nosocomial transmission predominantly involved health care personnel and often occurred in outpatient clinics and ancillary care areas. There is a need for improved measures to prevent transmission of SARS-CoV-2 by health care personnel in inpatient and outpatient settings.
Keywords: SARS-CoV-2; health care personnel; outpatients; transmission.
. 2021 Jun 21;8(8)
fab328.doi: 10.1093/ofid/ofab328. eCollection 2021 Aug.
Transmission of SARS-CoV-2 in Inpatient and Outpatient Settings in a Veterans Affairs Health Care System
Chetan Jinadatha[SUP] 1 2 [/SUP], Lucas D Jones[SUP] 3 [/SUP], Hosoon Choi[SUP] 4 [/SUP], Piyali Chatterjee[SUP] 4 [/SUP], Munok Hwang[SUP] 4 [/SUP], Sarah N Redmond[SUP] 5 [/SUP], Maria E Navas[SUP] 6 [/SUP], Trina F Zabarsky[SUP] 7 [/SUP], Davinder Bhullar[SUP] 8 [/SUP], Jennifer L Cadnum[SUP] 9 [/SUP], Curtis J Donskey[SUP] 5 10 [/SUP]
Affiliations
- PMID: 34426792
- PMCID: PMC8344547
- DOI: 10.1093/ofid/ofab328
Abstract
Background: Health care personnel and patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in health care settings, including in outpatient clinics and ancillary care areas.
Methods: Between May 1, 2020, and January 31, 2021, we identified clusters of 3 or more coronavirus disease 2019 (COVID-19) cases in which nosocomial transmission was suspected in a Veterans Affairs health care system. Asymptomatic employees and patients were tested for SARS-CoV-2 if they were identified as being at risk through contact tracing investigations; for 7 clusters, all personnel and/or patients in a shared work area were tested regardless of exposure history. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from the clusters and from control employees and patients.
Results: Of 14 clusters investigated, 7 occurred in community-based outpatient clinics, 1 in the emergency department, 3 in ancillary care areas, and 3 on hospital medical/surgical wards that did not provide care for patients with known COVID-19 infection. Eighty-one of 82 (99%) symptomatic COVID-19 cases and 31 of 35 (89%) asymptomatic cases occurred in health care personnel. Sequencing analysis provided support for several transmission events between coworkers and in 2 cases supported transmission from health care personnel to patients. There were no documented transmissions from patients to personnel.
Conclusions: Clusters of COVID-19 with nosocomial transmission predominantly involved health care personnel and often occurred in outpatient clinics and ancillary care areas. There is a need for improved measures to prevent transmission of SARS-CoV-2 by health care personnel in inpatient and outpatient settings.
Keywords: SARS-CoV-2; health care personnel; outpatients; transmission.