Department of Legal and Forensic Medicine, Health Science Department (DISSAL), University of Genova, 16132 Genova, Italy.
Department of Health Sciences, Section of Biostatistics, University of Genova, 16132 Genova, Italy.
Int J Environ Res Public Health. 2022 Dec 14;19(24):16764. doi: 10.3390/ijerph192416764.
Healthcare-related SARS-CoV-2 infection is an issue of particular concern during the pandemic. It has important repercussions on the National Health System, which represents a source of medical-legal health disputes. In the healthcare context, there are reports of negative screening at hospital admission (via nasopharyngeal swabs) and subsequent diagnosis of SARS-CoV-2 infection during hospitalization. Such cases cannot be considered a priori of healthcare-related infections but require extensive in-depth evaluation. In this study, we propose an empirical classification to frame cases of SARS-CoV-2 infection diagnosed in the hospital (first negative admission swab, with subsequent positive test during hospitalization). The classification is based on five categories: nosocomial, probably nosocomial, indeterminate, probably community, and community cases. We analyzed patients who died after testing positive for SARS-CoV-2 during hospitalization (with initial negative screening) in the largest hospital in Northwest Italy from February 2020 to 31 December 2021. A total of 383 cases were tracked and are listed as follows: 41 cases (11%) were classified as nosocomial (i.e., 3.2% of COVID-19 deaths). In contrast, 71 cases (19%) were classified as probably nosocomial, 69 (18%) were indeterminate (i.e., the clinical, radiological, and laboratory characteristics did not provide information on the genesis of the infection), 166 (43%) were classified as probably community cases, and 36 (9%) were defined as community cases. Deceased patients with nosocomial SARS-CoV-2 infection constituted the following: 3.23% (41/1266) with respect to the total number of COVID-19 deaths, 1.1% (41/3789) with respect to those who entered the hospital with a negative swab and 0.82% (41/4672) with respect to the total of deaths from any cause of death. In this paper we discuss the topic and issues of nosocomial COVID-19 in hospitalized patients and address the medicolegal implications.
医疗相关的 SARS-CoV-2 感染是大流行期间特别关注的问题。它对国家卫生系统有重要影响，是医疗法律健康纠纷的来源。在医疗保健环境中，有报道称在住院时（通过鼻咽拭子）进行了负面筛查，随后在住院期间诊断出 SARS-CoV-2 感染。这些病例不能被视为医疗相关感染，但需要进行广泛深入的评估。在本研究中，我们提出了一种经验分类方法，以框架在医院诊断出的 SARS-CoV-2 感染病例（首次入院时的阴性拭子，随后在住院期间检测呈阳性）。该分类基于五个类别：医院获得性、可能医院获得性、不确定、可能社区和社区病例。我们分析了 2020 年 2 月至 2021 年 12 月 31 日意大利西北部最大医院住院期间 SARS-CoV-2 检测呈阳性（初始筛查阴性）后死亡的患者。共跟踪了 383 例病例，并列出如下：41 例（11%）被归类为医院获得性（即 COVID-19 死亡的 3.2%）。相比之下，71 例（19%）被归类为可能医院获得性，69 例（18%）不确定（即临床、放射学和实验室特征未提供感染来源的信息），166 例（43%）被归类为可能社区病例，36 例（9%）被定义为社区病例。医院获得性 SARS-CoV-2 感染死亡患者包括：在 COVID-19 死亡总数中占 3.23%（41/1266），在入院时拭子阴性的患者中占 1.1%（41/3789），在任何死亡原因的死亡总数中占 0.82%（41/4672）。本文我们讨论了住院患者医院获得性 COVID-19 的主题和问题，并探讨了医疗法律方面的影响。
