Problem: COVID-19 Hospital-Acquired Infections

One of the most disturbing reports, which has largely gone unnoticed by the news media, was released on December 18, 2020 by the Health Service Journal (HSJ, Wilmington Healthcare). HSJ analyzed England’s National Health Service Data regarding hospital-acquired SARS-CoV-2 infections. SARS-CoV-2 is the virus that causes COVID-19 and unfortunately HSJ found that hospital-acquired infections (HAIs) are not uncommon, estimated to cause almost 1 in 4 hospital COVID-19 cases. The NHS metric considers any COVID-19 case diagnosed 8 days or more after admission an HAI. The United Kingdom also has a more infectious strain of the virus (B.1.1.7) than is commonly found in the United States.

Kevin Kavanagh, MD

Information has not been widely available in the United States regarding COVID-19 HAIs. The metric used in the USA is even more restrictive than the one used in the United Kingdom. The U.S. metric defines a COVID-19 HAIs as the: “Total current inpatients with onset of suspected or laboratory-confirmed COVID-19 fourteen or more days after admission for a condition other than COVID-19.”

If one considers that the average incubation period for SARS-CoV-2 is 5.1 days and the average hospital stay in the United States is 4.6 days, this metric is next to useless. It will at best detect only a very small minority of cases. A more accurate metric would define cases which occur after 5 days as an HAI, which would better create a balance between false positive and negative cases. And the metric should count cases which occur for a period of 5 days after the patient leaves the facility. Again, creating a balance between false positive and negative cases.

With the CDC projecting that the UK variant will become the dominant strain in the US by March, it is imperative that we bolster our strategies to safeguard both staff and patients.

With the CDC projecting that the UK variant will become the dominant strain in the US, it is imperative that we bolster our strategies to safeguard both staff and patients.

Some have postulated the increase in infectivity of the UK strain to an increased ability to attach to cells or to more viruses being reproduced by the infected cells. Recently sources have released data that the UK variant may be more lethal, possibly up to 30%, than our current variant infecting the United States, D614G. Thus, it is plausible that the UK Variant’s increased infectivity is related to the shedding of more viruses into the environment by infected individuals.

Other possible mechanism’s for the UK variant’s increased spread is either greater survivability in the environment or an increased ability to aerosolize. Thus, we need an increased commitment and enhanced strategies to prevent spread. This includes all health care workers becoming vaccinated. You owe it to yourselves, your family, and your patients to receive the vaccine. The increase in infectivity also raises concern regarding the importance of spread by fomites. Hence, environmental cleaning needs to have strict and comprehensive protocols. All segments of our society, including frontline health care workers, need better personal protective equipment and N95 masks (without exhalation valves). Facilities of all types (including schools and retail establishments) need to increase complete air exchanges and air sanitization. Testing needs to be increased for staff and patients. We also need to eliminate, whenever possible, outpatient waiting rooms. And implement strict social distancing (not having chairs next to doors and areas of traffic flow). Finally, we need “data for action.” We need to have mandatory reporting of worker and patient acquisition of SARS-CoV-2 and the development of COVID-19 with metrics to provide us the most accurate estimate of cases so we can effectively plan and allocate resources.