Thomas Nahass, MD
Physician Fellow
Memorial Sloan Kettering Cancer Center Department of Anesthesiology and Critical Care Medicine, United States
Disclosure information not submitted.
Anup Regunathan, MD
Internal Medicine Resident
Robert Wood Johnson University Hospital
New Brunswick, New Jersey, United States
Disclosure information not submitted.
Alec Weber, MD
Resident Physician
Rutgers Robert Wood Johnson Medical School, United States
Disclosure information not submitted.
Sabiha Hussain, MD,MPH
Associate Professor of Medicine
Rutgers Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States
Disclosure information not submitted.
Title: Nosocomial COVID-19 Incidence and Outcomes: A Single-Center Retrospective Study
Background: The current COVID-19 pandemic has been driven in large part by a high rate of human-to-human transmission. Hospitals are high-risk environments that can amplify this effect, particularly with more transmissible variants emerging. Yet little is known about the true incidence of hospital-acquired COVID-19 (HAC), as well as the magnitude of its effect on clinical outcomes. Understanding this risk will allow for more targeted policy and infection control measures to limit further spread of an already devastating virus.
Methods: EHR data was acquired for all patients who tested positive for COVID-19 at our institution from 03/01/20202 to 05/03/2021. Data were analyzed using R version 4.0.3 and RStudio 1.3.1093. Patients with HAC were isolated as those admitted with an initial negative test, with a subsequent positive test after 7 or more days of hospital stay. Demographics, hospital stay data, and overall outcomes were then reviewed and compared with patients who acquired COVID-19 from the community.
Results: 2,684 patients were hospitalized over the period of the study. Of these patients, 91 (3.4%) were identified as patients with likely HAC and 2593 (96.6%) with COVID-19 likely acquired in the community. There were no significant differences in age, gender, race, or insurance status between both groups. Patients with HAC were more likely to require an ICU stay when compared to community-acquired COVID-19 (42.9% vs 20.4%, p< .0001) and were more likely to be intubated (30.8% vs 16%, p=.0005). Of the patients with HAC, 30 died during their stay when compared to 405 patients with community infection (33% vs 15.6%, p< .0001). Mean LOS was also significantly longer in the HAC group (27.6 days vs 8.1 days, p< .0001).
Discussion: The goal of this project was to estimate the incidence of HAC in a single center and assess differences in patient demographics and outcomes. The relative uniformity in demographics suggests that all patients admitted to the hospital setting are at risk of infection with COVID-19. The magnitude of this risk was significant, with 3.4% of all patients acquiring infection within the hospital. These patients furthermore had markedly poorer outcomes across the spectrum. Overall, HAC is a critical issue in need of evidence-based solutions as infection rates once again rise across the country.