Hospital-Acquired SARS-CoV-2 InfectionLessons for Public Health

Hospital-Acquired SARS-CoV-2 Infection This Viewpoint reviews the rare incidence of nosocomial SARS-CoV-2 infection and discusses ways it can be minimized, including use of surgical masks, proper ventilation, physical distancing, eye protection, regular testing, and the availability of sick leave for health care workers. JAMA_current

From the outset of the coronavirus disease 2019 (COVID-19) pandemic, it was clear that hospitals were an important setting for viral transmission. A review of 2 early case series in China estimated that 44% of 179 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were hospital acquired.¹ An illustrative example of the devastating potential for health care transmission of SARS-CoV-2 came from St Augustine’s Hospital in Durban, South Africa, a facility with 469 beds, including 18 wards, 6 intensive care units, and 735 clinical staff.²

Through a detailed epidemiologic study supplemented by phylogenetic analyses, investigators documented how a single unsuspected case of SARS-CoV-2 led to 6 major clusters involving 5 hospital wards and an outside nursing home and dialysis unit, with infection ultimately confirmed among 80 staff members and 39 patients, 15 of whom died.²

Mounting evidence supports the effectiveness of a relatively simple intervention in reducing hospital transmission of SARS-CoV-2: universal use of surgical masks by health care workers and patients. This intervention appears to be effective, despite a relative inability to completely physically distance within the hospital. A study of 21 000 health care workers found that nosocomial-acquired SARS-CoV-2 infections decreased significantly after implementation of a universal masking policy, whereas community-acquired cases continued to increase, consistent with the overall community incidence.^{3 ...}

^{Findings suggest that overall hospital transmission of SARS-CoV-2 in the setting of universal masking is likely rare, even during periods of high community prevalence. This has at least 2 important implications. First, it is imperative for the public to understand that hospitals with well-implemented universal masking policies are overwhelmingly safe, and public health messaging should emphasize that avoidance or delay of needed and urgent health care is not necessary. Second, despite the politicization of masking, this is an important and compelling proof of concept for the broader use of universal masking in crowded indoor settings, even with good ventilation. High-quality studies in other contexts can inform the extent to which efficacy differs with cloth masks or face coverings more typically used outside of hospital settings relative to surgical masks (and in some cases, especially during aerosol-generating procedures, use of N95 respirators) in hospitals. Masking will become even more important as the COVID-19 crisis continues into the upcoming influenza season in the northern hemisphere. ...}