Stirrup, Oliver; Blackstone, James; Mapp, Fiona; MacNeil, Alyson; Panca, Monica; Holmes, Alison; Machin, Nicholas; Shin, Gee Yen; Mahungu, Tabitha; Saeed, Kordo; +41 more... Saluja, Tranprit; Taha, Yusri; Mahida, Nikunj; Pope, Cassie; Chawla, Anu; Cutino-Moguel, Maria-Teresa; Tamuri, Asif; Williams, Rachel; Darby, Alistair; Robertson, David L; Flaviani, Flavia; Nastouli, Eleni; Robson, Samuel; Smith, Darren; Loose, Matthew; Laing, Kenneth; Monahan, Irene; Kele, Beatrix; Haldenby, Sam; George, Ryan; Bashton, Matthew; Witney, Adam A; Byott, Matthew; Coll, Francesc; Chapman, Michael; Peacock, Sharon J; COG-UK HOCI Investigators; COVID-19 Genomics UK (COG-UK) consortium; Hughes, Joseph; Nebbia, Gaia; Partridge, David G; Parker, Matthew; Price, James Richard; Peters, Christine; Roy, Sunando; Snell, Luke B; de Silva, Thushan I; Thomson, Emma; Flowers, Paul; Copas, Andrew; Breuer, Judith; (2022) Effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control for hospital-onset COVID-19 infection: Multicentre, prospective study. eLife, 11. e78427-. ISSN 2050-084X DOI: https://doi.org/10.7554/eLife.78427
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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' (<48 hr) and 4 weeks of 'longer-turnaround' (5-10 days) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital-onset COVID-19 infections (HOCIs; detected ≥48 hr from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on the incidence of probable/definite hospital-acquired infections (HAIs), was evaluated. RESULTS: A total of 2170 HOCI cases were recorded from October 2020 to 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. CONCLUSIONS: 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: NCT04405934.
Item Type | Article |
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Faculty and Department |
Faculty of Infectious and Tropical Diseases > Department of Infection Biology Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
Research Centre | Covid-19 Research |
PubMed ID | 36098502 |
Elements ID | 194836 |
Official URL | http://dx.doi.org/10.7554/elife.78427 |
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Filename: Stirrup_etal_2022_Effectiveness-of-rapid-sars-cov.pdf
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