Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Netw Open. 2020 Sep 1;3(9):e2020498. doi: 10.1001/jamanetworkopen.2020.20498.
Some patients are avoiding essential care for fear of contracting coronavirus disease 2019 (COVID-19) in hospitals. There are few data, however, on the risk of acquiring COVID-19 in US hospitals.
To assess the incidence of COVID-19 among patients hospitalized at a large US academic medical center in the 12 weeks after the first inpatient case was identified.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included all patients admitted to Brigham and Women's Hospital (Boston, Massachusetts) between March 7 and May 30, 2020. Follow-up occurred through June 17, 2020. Medical records for all patients who first tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction (RT-PCR) on hospital day 3 or later or within 14 days of discharge were reviewed.
A comprehensive infection control program was implemented that included dedicated COVID-19 units with airborne infection isolation rooms, personal protective equipment in accordance with US Centers for Disease Control and Prevention recommendations, personal protective equipment donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients.
Whether infection was community or hospital acquired based on timing of tests, clinical course, and exposures.
Over the 12-week period, 9149 patients (mean [SD] age, 46.1 [26.4] years; median [IQR] age, 51 years [30-67 years]; 5243 female [57.3%]) were admitted to the hospital, for whom 7394 SARS-CoV-2 RT-PCR tests were performed; 697 COVID-19 cases were confirmed, translating into 8656 days of COVID-19-related care. Twelve of the 697 hospitalized patients with COVID-19 (1.7%) first tested positive on hospital day 3 or later (median, 4 days; range, 3-15 days). Of these, only 1 case was deemed to be hospital acquired, most likely from a presymptomatic spouse who was visiting daily and diagnosed with COVID-19 before visitor restrictions and masking were implemented. Among 8370 patients with non-COVID-19-related hospitalizations discharged through June 17, 11 (0.1%) tested positive within 14 days (median time to diagnosis, 6 days; range, 1-14 days). Only 1 case was deemed likely to be hospital acquired, albeit with no known exposures.
In this cohort study of patients in a large academic medical center with rigorous infection control measures, nosocomial COVID-19 was rare during the height of the pandemic in the region. These findings may inform practices in other institutions and provide reassurance to patients concerned about contracting COVID-19 in hospitals.
由于担心在医院感染 2019 年冠状病毒病（COVID-19），一些患者正在回避基本治疗。但是，关于美国医院获得 COVID-19 的风险的数据很少。
评估首例住院患者确诊后 12 周内，一家大型美国学术医疗中心住院患者中 COVID-19 的发病率。
设计、地点和参与者：本队列研究纳入了 2020 年 3 月 7 日至 5 月 30 日期间在布莱根妇女医院（马萨诸塞州波士顿）住院的所有患者。随访至 2020 年 6 月 17 日。对所有在住院第 3 天或之后或出院后 14 天内首次通过逆转录聚合酶链反应（RT-PCR）检测出严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）阳性的患者的医疗记录进行了回顾。
实施了一项综合感染控制计划，包括配备空气传播感染隔离室的专用 COVID-19 病房、根据美国疾病控制与预防中心建议的个人防护设备、个人防护设备穿脱监测器、普遍戴口罩、限制访客以及对有症状和无症状患者进行广泛的 RT-PCR 检测。
根据测试时间、临床过程和暴露情况，判断感染是社区获得性还是医院获得性。
在 12 周的时间内，有 9149 名患者（平均[SD]年龄 46.1[26.4]岁；中位数[IQR]年龄 51 岁[30-67 岁]；5243 名女性[57.3%]）住院，共进行了 7394 次 SARS-CoV-2 RT-PCR 检测；确诊了 697 例 COVID-19 病例，转化为 8656 天的 COVID-19 相关护理。697 例住院 COVID-19 患者中有 12 例（1.7%）在住院第 3 天或之后首次检测呈阳性（中位数为 4 天；范围为 3-15 天）。其中，只有 1 例被认为是医院获得性的，最有可能是来自每日探访的无症状配偶，在实施访客限制和戴口罩之前被诊断出 COVID-19。在截至 6 月 17 日出院的 8370 名非 COVID-19 相关住院患者中，有 11 例（0.1%）在 14 天内检测呈阳性（中位时间至诊断，6 天；范围，1-14 天）。只有 1 例被认为可能是医院获得性的，尽管没有已知的暴露。
在该地区大流行高峰期，对一家拥有严格感染控制措施的大型学术医疗中心的患者进行的这项队列研究中，医院内 COVID-19 很少见。这些发现可能为其他机构的实践提供信息，并为担心在医院感染 COVID-19 的患者提供安慰。
