Routine molecular point-of-care testing for SARS-CoV-2 reduces hospital-acquired COVID-19
Routine molecular point-of-care testing for SARS-CoV-2 reduces hospital-acquired COVID-19
Objectives: Risk of hospital-acquired COVID-19 (HA-COVID-19) infection is increased by cohorting infected and non-infected patients together in assessment areas, whist awaiting laboratory PCR results. Molecular point-of-care tests (mPOCT) reduce time to results and improve patient flow but the impact on HA-COVID-19 is unknown. Methods: In this pre and post implementation study patients were evaluated across two time periods: March 1st to August 13th 2020, prior to the introduction of mPOCT in medical admissions areas, and 14th August 2020 to 1st April 2021, after mPOCT introduction. The primary outcome was proportion of HA-COVID-19 infection among all COVID-19 positive patients. Secondary outcome measures included time to SARS-CoV-2 results, length of time spent in the medical assessment area and comparison of local, regional and national proportions of HA-COVID-19. Results: 1988 patients were admitted through the acute medicine admission cohorting area and tested for SARS-CoV-2 prior to introducing mPOCT and 4640 afterwards. Median (IQR) time to SARS-CoV-2 result was 6.5 (2.1–17.9) hours prior to introducing mPOCT and 1.0 (0.8–1.3) hours afterwards (p < 0.0001). Median (IQR) duration in the assessment cohort area was 12.0 (4.8–20.6) hours prior to introduction of POCT and 3.2 (2.0–5.6) hours afterwards (p < 0.0001). The proportion of hospital-acquired COVID-19 cases was 108 (16.5%) of 654 prior to introducing mPOCT compared with 168 (9.4%) of 1782 afterwards, (HR 0.55, 95%CI 0.43–0.70; p < 0.0001). In the period following the introduction of mPOCT up to 1st April 2021 the median proportion of HA-COVID-19 was 13.6% (95%CI 8.2–18.9%) locally, compared with 43.8% (95%CI 37.8–49.9%) for all acute NHS trusts regionally and 30.9% (95%CI 28.4–33.5%) for all NHS trusts nationally. Conclusions: Routine mPOCT for SARS-CoV-2 was associated with reduced time to results, time spent in admission cohort areas, and hospital-acquired COVID-19, compared to laboratory PCR.
COVID-19, Hospital acquired infection, Point-of-care testing, SARS-CoV-2
558-565
Livingstone, Robert
a84784e0-c608-40b2-8aec-83369b4b159e
Lin, Hlaing
326bfbdd-debf-4662-bfaa-06618d1b66d6
Brendish, Nathan
a8a4189e-01eb-4ab3-933e-a24cd188a4d7
Poole, Stephen
440d7904-ab72-469c-892b-c910cd1cb19b
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Tanner, Alex
cac6d816-602b-4dcf-961e-22f2cbdc501d
Smith, Trevor
f04e866f-0ec5-488d-b04a-d25ccee94616
Stammers, Matt
85e202da-1879-4f96-8e24-5059a1fa3f1e
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
April 2022
Livingstone, Robert
a84784e0-c608-40b2-8aec-83369b4b159e
Lin, Hlaing
326bfbdd-debf-4662-bfaa-06618d1b66d6
Brendish, Nathan
a8a4189e-01eb-4ab3-933e-a24cd188a4d7
Poole, Stephen
440d7904-ab72-469c-892b-c910cd1cb19b
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Tanner, Alex
cac6d816-602b-4dcf-961e-22f2cbdc501d
Smith, Trevor
f04e866f-0ec5-488d-b04a-d25ccee94616
Stammers, Matt
85e202da-1879-4f96-8e24-5059a1fa3f1e
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
Livingstone, Robert, Lin, Hlaing, Brendish, Nathan, Poole, Stephen, Borca, Florina, Tanner, Alex, Smith, Trevor, Stammers, Matt and Clark, Tristan
(2022)
Routine molecular point-of-care testing for SARS-CoV-2 reduces hospital-acquired COVID-19.
Journal of Infection, 84 (4), .
(doi:10.1016/j.jinf.2022.01.034).
Abstract
Objectives: Risk of hospital-acquired COVID-19 (HA-COVID-19) infection is increased by cohorting infected and non-infected patients together in assessment areas, whist awaiting laboratory PCR results. Molecular point-of-care tests (mPOCT) reduce time to results and improve patient flow but the impact on HA-COVID-19 is unknown. Methods: In this pre and post implementation study patients were evaluated across two time periods: March 1st to August 13th 2020, prior to the introduction of mPOCT in medical admissions areas, and 14th August 2020 to 1st April 2021, after mPOCT introduction. The primary outcome was proportion of HA-COVID-19 infection among all COVID-19 positive patients. Secondary outcome measures included time to SARS-CoV-2 results, length of time spent in the medical assessment area and comparison of local, regional and national proportions of HA-COVID-19. Results: 1988 patients were admitted through the acute medicine admission cohorting area and tested for SARS-CoV-2 prior to introducing mPOCT and 4640 afterwards. Median (IQR) time to SARS-CoV-2 result was 6.5 (2.1–17.9) hours prior to introducing mPOCT and 1.0 (0.8–1.3) hours afterwards (p < 0.0001). Median (IQR) duration in the assessment cohort area was 12.0 (4.8–20.6) hours prior to introduction of POCT and 3.2 (2.0–5.6) hours afterwards (p < 0.0001). The proportion of hospital-acquired COVID-19 cases was 108 (16.5%) of 654 prior to introducing mPOCT compared with 168 (9.4%) of 1782 afterwards, (HR 0.55, 95%CI 0.43–0.70; p < 0.0001). In the period following the introduction of mPOCT up to 1st April 2021 the median proportion of HA-COVID-19 was 13.6% (95%CI 8.2–18.9%) locally, compared with 43.8% (95%CI 37.8–49.9%) for all acute NHS trusts regionally and 30.9% (95%CI 28.4–33.5%) for all NHS trusts nationally. Conclusions: Routine mPOCT for SARS-CoV-2 was associated with reduced time to results, time spent in admission cohort areas, and hospital-acquired COVID-19, compared to laboratory PCR.
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Journal of Infection revised pre-submission TWC 18-01-22
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Accepted/In Press date: 18 January 2022
e-pub ahead of print date: 31 January 2022
Published date: April 2022
Additional Information:
Funding Information:
This study was funded by University Hospital Southampton NHS Foundation Trust.
Funding Information:
We acknowledge and thank all the patients who kindly participated in this study and all the clinical staff at University Hospital Southampton who cared for them. We also acknowledge the Department of Health and Social Care Antimicrobial Research Capital Funding Award (reference NIHR200638).
Publisher Copyright:
© 2022 The British Infection Association
Copyright:
Copyright 2022 Elsevier B.V., All rights reserved.
Keywords:
COVID-19, Hospital acquired infection, Point-of-care testing, SARS-CoV-2
Identifiers
Local EPrints ID: 454444
URI: http://eprints.soton.ac.uk/id/eprint/454444
ISSN: 0163-4453
PURE UUID: 45c23554-ce44-407a-bb3c-3de58a5af068
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Date deposited: 09 Feb 2022 17:42
Last modified: 21 Nov 2024 05:03
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Contributors
Author:
Robert Livingstone
Author:
Hlaing Lin
Author:
Stephen Poole
Author:
Florina Borca
Author:
Alex Tanner
Author:
Trevor Smith
Author:
Matt Stammers
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