Interventions to control nosocomial transmission of SARS-CoV-2: a modelling study

Pham, Thi Mui ORCID: 0000-0001-6748-2479, Tahir, Hannan, van de Wijgert, Janneke HHM ORCID: 0000-0003-2728-4560, Van der Roest, Bastiaan ORCID: 0000-0002-8985-8964, Ellerbroek, Pauline, Bonten, Marc JM, Bootsma, Martin CJ and Kretzschmar, Mirjam
(2021) Interventions to control nosocomial transmission of SARS-CoV-2: a modelling study. [Preprint]

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<h4>Background</h4> Emergence of more transmissible SARS-CoV-2 variants requires more efficient control measures to limit nosocomial transmission and maintain healthcare capacities during pandemic waves. Yet, the relative importance of different strategies is unknown. <h4>Methods</h4> We developed an agent-based model and compared the impact of personal protective equipment (PPE), screening of healthcare workers (HCWs), contact tracing of symptomatic HCWs, and restricting HCWs from working in multiple units (HCW cohorting) on nosocomial SARS-CoV-2 transmission. The model was fit on hospital data from the first wave in the Netherlands (February until August 2020) and assumed that HCWs used 90% effective PPE in COVID-19 wards and self-isolated at home for seven days immediately upon symptom onset. Intervention effects on the effective reproduction number ( R E ), HCW absenteeism and the proportion of infected individuals among tested individuals (positivity rate) were estimated for a more transmissible variant. <h4>Results</h4> <h4>Introduction: </h4> of a variant with 56% higher transmissibility increased – all other variables kept constant – R E from 0.4 to 0.65 (+63%) and nosocomial transmissions by 303%, mainly because of more transmissions caused by pre-symptomatic patients and HCWs. Compared to baseline, PPE use in all hospital wards (assuming 90% effectiveness) reduced R E by 85% and absenteeism by 57%. Screening HCWs every three days with perfect test sensitivity reduced R E by 67%, yielding a maximum test positivity rate of 5%. Screening HCWs every three or seven days assuming time-varying test sensitivities reduced R E by 9% and 3%, respectively. Contact tracing reduced R E by at least 32% and achieved higher test positivity rates than screening interventions. HCW cohorting reduced R E by 5%. Sensitivity analyses for 50% and 70% effectiveness of PPE use did not change interpretation. <h4>Conclusions</h4> In response to the emergence of more transmissible SARS-CoV-2 variants, PPE use in all hospital wards might still be most effective in preventing nosocomial transmission. Regular screening and contact tracing of HCWs are also effective interventions, but critically depend on the sensitivity of the diagnostic test used.

Item Type: Preprint
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 07 Apr 2021 09:41
Last Modified: 18 Jan 2023 22:54
DOI: 10.1101/2021.02.26.21252327
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