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Effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control for hospital-onset COVID-19 infection: multicenter, prospective study

Effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control for hospital-onset COVID-19 infection: multicenter, prospective study
Effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control for hospital-onset COVID-19 infection: multicenter, prospective study
Background: Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings.
Methods: We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data-collection period, followed by intervention periods comprising 8 weeks of 'rapid' (<48h) and 4 weeks of 'longer-turnaround' (5-10 day) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital onset COVID-19 infections (HOCIs; detected ≥48h from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on incidence of probable/definite hospital-acquired infections (HAIs) was evaluated.
Results: A total of 2170 HOCI cases were recorded from October 2020-April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95%CI 0.85-3.01; P=0.14) or rapid (0.85, 0.48-1.50; P=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8% and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2% and 11.6% of cases where the report was returned. In a 'per-protocol' sensitivity analysis there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources.
Conclusion: While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days.
Funding: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) [grant code: MC_PC_19027], and Genome Research Limited, operating as the Wellcome Sanger Institute.Clinical trial number: ClinicalTrials.gov Identifier: NCT04405934.
COVID-19, epidemiology, global health, healthcare-associated infection, hospital-acquired infection, human, infection control, infection prevention, infectious disease, microbiology, molecular epidemiology, viral genomics
2050-084X
Stirrup, Oliver
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Blackstone, James
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Mapp, Fiona
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MacNeil, Alyson
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Panca, Monica
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Holmes, Alison
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Machin, Nicholas
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Shin, Gee Yen
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Mahungu, Tabitha
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Saeed, Kordo
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Chawla, Anu
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Tamuri, Asif
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Williams, Rachel
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Darby, Alistair
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Robertson, David L
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Flaviani, Flavia
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Nastouli, Eleni
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Robson, Samuel
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Smith, Darren
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Laing, Kenneth
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Monahan, Irene
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Kele, Beatrix
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Haldenby, Sam
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George, Ryan
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Bashton, Matthew
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Witney, Adam A
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Byott, Matthew
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Coll, Francesc
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Chapman, Michael
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Peacock, Sharon J
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Hughes, Joseph
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Nebbia, Gaia
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Partridge, David G
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Parker, Matthew
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Price, James Richard
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Peters, Christine
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Roy, Sunando
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Snell, Luke B
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de Silva, Thushan I
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Thomson, Emma
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Flowers, Paul
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Copas, Andrew
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Breuer, Judith
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COG‐UK HOCI Investigators
Stirrup, Oliver
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Blackstone, James
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Mapp, Fiona
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MacNeil, Alyson
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Panca, Monica
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Holmes, Alison
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Machin, Nicholas
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Shin, Gee Yen
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Mahungu, Tabitha
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Saeed, Kordo
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Saluja, Tranprit
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Taha, Yusri
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Mahida, Nikunj
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Pope, Cassie
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Chawla, Anu
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Cutino-Moguel, Maria-Teresa
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Tamuri, Asif
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Williams, Rachel
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Darby, Alistair
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Robertson, David L
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Flaviani, Flavia
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Nastouli, Eleni
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Robson, Samuel
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Smith, Darren
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Laing, Kenneth
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Monahan, Irene
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Kele, Beatrix
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Haldenby, Sam
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George, Ryan
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Bashton, Matthew
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Witney, Adam A
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Byott, Matthew
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Coll, Francesc
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Chapman, Michael
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Peacock, Sharon J
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Hughes, Joseph
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Nebbia, Gaia
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Partridge, David G
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Parker, Matthew
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Price, James Richard
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Peters, Christine
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Roy, Sunando
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Snell, Luke B
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de Silva, Thushan I
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Thomson, Emma
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Flowers, Paul
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Copas, Andrew
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Breuer, Judith
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Stirrup, Oliver, Blackstone, James, Mapp, Fiona and Saeed, Kordo , COG‐UK HOCI Investigators (2022) Effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control for hospital-onset COVID-19 infection: multicenter, prospective study. eLife, 11, [e78427]. (doi:10.7554/eLife.78427).

Record type: Article

Abstract

Background: Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings.
Methods: We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data-collection period, followed by intervention periods comprising 8 weeks of 'rapid' (<48h) and 4 weeks of 'longer-turnaround' (5-10 day) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital onset COVID-19 infections (HOCIs; detected ≥48h from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on incidence of probable/definite hospital-acquired infections (HAIs) was evaluated.
Results: A total of 2170 HOCI cases were recorded from October 2020-April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95%CI 0.85-3.01; P=0.14) or rapid (0.85, 0.48-1.50; P=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8% and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2% and 11.6% of cases where the report was returned. In a 'per-protocol' sensitivity analysis there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources.
Conclusion: While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days.
Funding: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) [grant code: MC_PC_19027], and Genome Research Limited, operating as the Wellcome Sanger Institute.Clinical trial number: ClinicalTrials.gov Identifier: NCT04405934.

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More information

Accepted/In Press date: 25 August 2022
Published date: 13 September 2022
Additional Information: Funding Information: COG‐UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) [grant code: MC_PC_19027], and Genome Research Limited, operating as the Wellcome Sanger Institute. COG‐UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) [grant code: MC_PC_19027], and Genome Research Limited, operating as the Wellcome Sanger Institute. UCLH APDU is funded by the UCLH NHS Foundation Trust and the UCLH NIHR BRC. MRC‐University of Glasgow Centre for Virus Research has received funding from the Medical Research Council. SR is part‐funded from Research England’s Expanding Excellence in England (E3) Fund, and additional funding for sequencing of SARS‐CoV‐2 at University of Portsmouth came from the Wessex Academic Health Sciences Centre (AHSC). FC was funded by a Wellcome Trust Sir Henry Postdoctoral Fellowship. LS has received support for research from NIHR Biomedical Research Centre at Guy’s and St Thomas NHS Foundation Trust, Guy’s & St Thomas Charity and King’s Health Partners. We also acknowledge the support of the independent members of the Joint Trial Steering Committee and Data Monitoring Committee (TSC‐DMC): Prof Marion Koopmans (Erasmus MC), Prof Walter Zingg (University of Geneva), Prof Colm Bergin (Trinity College Dublin), Prof Karla Hemming (University of Birmingham), Prof Katherine Fielding (LSHTM). As well as TSC‐DMC non‐independent members: Prof Nick Lemoine (NIHR CRN), Prof Sharon Peacock (COG‐UK). We would also thank members of COG‐UK who have directly supported the study: Dr Ewan Harrison (Cambridge University), Dr Katerina Galai (PHE), Dr Francesc Coll (LSHTM), Dr Michael Chapman (HDR‐UK), Prof Thomas Connor and team (Cardiff University), Prof Nick Loman and team (University of Birmingham). We also thank the COG‐UK Consortium, and the UK National Institute for Health Research Clinical Research Network (NIHR CRN). Funding Information:  COG 爀栀K is supported by funding from the Medical Research Couln c縀i MRC 缀 part of ?K Research 頀  Innovation 縀?KRI 缃? the National Institute of Health ReseaIrHchR ? ? 老N倁? ant code P MC YPC Y ? ? 脃? and  Genome Research Limited 唀 operatgin as the Wellcome Sanger Institute 堀 Funding Information: C L H APD? is funded by the ?CLH NHS Foundation Trust and the ?CLH NIHR BRC ? MRC ? ?niversity of G lasgow Centre for Virus Research has received funding from the Medical Research Council 堀 SR is p art ?funded from Research England ?s Expanding Excellence inl aEndg ?E ? 缀 Fund 唀 and additional f unding for sequencing of SARS 爀CoV 爃 at ?niversity of Portshm coaumt e from the Wessex Academic H ealth Sciences Centre ?AHSC ?C ?wa Fs funded by a Wellcome Trust Sir Henry Postdoctoral F ellowship ? LS has received suppto fror research from NIHR Biomedical Research Centre at Guy 嬁退 and S t Thomas NHS Foundation Trust 唀Gu y ? s ? St Thomas Charity anindg K 嬁退 Health Partners 堀 Publisher Copyright: © 2022, eLife Sciences Publications Ltd. All rights reserved. This article contains valuable information on the potential value of real-time genome sequencing to inform infection control practices. The study, unique in its size, addresses the implementation of this approach during the height of the COVID-19 pandemic. Naturally, the extreme situation limited the options for choices in infection control practices.
Keywords: COVID-19, epidemiology, global health, healthcare-associated infection, hospital-acquired infection, human, infection control, infection prevention, infectious disease, microbiology, molecular epidemiology, viral genomics

Identifiers

Local EPrints ID: 475639
URI: http://eprints.soton.ac.uk/id/eprint/475639
ISSN: 2050-084X
PURE UUID: 4ffcea09-5286-48ff-92a0-ff086d0ef066
ORCID for Kordo Saeed: ORCID iD orcid.org/0000-0003-0123-0302

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Date deposited: 23 Mar 2023 17:35
Last modified: 17 Mar 2024 03:57

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Contributors

Author: Oliver Stirrup
Author: James Blackstone
Author: Fiona Mapp
Author: Alyson MacNeil
Author: Monica Panca
Author: Alison Holmes
Author: Nicholas Machin
Author: Gee Yen Shin
Author: Tabitha Mahungu
Author: Kordo Saeed ORCID iD
Author: Tranprit Saluja
Author: Yusri Taha
Author: Nikunj Mahida
Author: Cassie Pope
Author: Anu Chawla
Author: Maria-Teresa Cutino-Moguel
Author: Asif Tamuri
Author: Rachel Williams
Author: Alistair Darby
Author: David L Robertson
Author: Flavia Flaviani
Author: Eleni Nastouli
Author: Samuel Robson
Author: Darren Smith
Author: Kenneth Laing
Author: Irene Monahan
Author: Beatrix Kele
Author: Sam Haldenby
Author: Ryan George
Author: Matthew Bashton
Author: Adam A Witney
Author: Matthew Byott
Author: Francesc Coll
Author: Michael Chapman
Author: Sharon J Peacock
Author: Joseph Hughes
Author: Gaia Nebbia
Author: David G Partridge
Author: Matthew Parker
Author: James Richard Price
Author: Christine Peters
Author: Sunando Roy
Author: Luke B Snell
Author: Thushan I de Silva
Author: Emma Thomson
Author: Paul Flowers
Author: Andrew Copas
Author: Judith Breuer
Corporate Author: COG‐UK HOCI Investigators

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