Modelling the synergy between single-occupancy and PPE in controlling COVID-19 outbreaks on hospital wards

Publication date: Dec 25, 2024

Background: Outbreaks of respiratory pathogens on hospital wards present a major challenge for control of hospital-acquired infections. When illness presentation is mild or infection is asymptomatic, isolation of recognised cases may be insufficient to prevent outbreaks, as unrecognised cases may be common. In such scenarios, structural controls such as the design of wards with single-occupancy patient rooms, or routine precautions such as the use of N95 respirators by healthcare staff can play an important role in preventing and mitigating outbreaks. Methods: This study applies an agent-based extension of the Wells-Riley model of airborne pathogen exposure to simulate COVID-19 outbreaks on hospital wards. We simulated the impact of single- versus double-occupancy patient rooms on secondary attack rates and the sizes of outbreaks resulting from introduction of unrecognised cases. We further simulated the impact of N95 respirator use by nurses during patient care activities, assuming an efficacy of 90% for protection and source control. Results: In our simulations, the size of outbreaks recorded at day 14 was markedly lower in wards with only single-occupancy rooms, compared to double-occupancy rooms (with means of 15.2 and 25.1 infections, respectively). We found that nurses working on wards were more likely to acquire infection than patients. Higher patient room occupancy was associated with increased outbreak size, with a larger relative impact on patients than staff. N95 respirators were effective at mitigating outbreaks, with higher impacts in wards with single-occupancy patient rooms. Conclusions: Single-occupancy rooms can greatly decrease the risk of hospital acquired airborne infection for patients. We show that single-occupancy hospital rooms can also reduce the number of healthcare workers infected during an outbreak of an airborne respiratory virus, but not to the same relative extent as patients. Due to the structural constraints limiting transmission between patients in different rooms, outbreaks were driven by transmission events involving nurses, which were effectively mitigated through the use of N95 respirators. Taken together, our results suggest that single-occupancy rooms are effective at reducing outbreak sizes. However, they are insufficient by themselves to prevent large outbreaks without mitigation efforts focused on limiting the potential for transmission involving healthcare workers, such as the use of N95 respirators.

PDF

Concepts Keywords
Healthfacilityguidelines Double
Influenza Healthcare
Nasa Hospital
Surveillance Infection
Medrxiv
N95
Nurses
Occupancy
Outbreaks
Patient
Preprint
Rooms
Single
Transmission
Wards

Semantics

Type Source Name
disease MESH COVID-19
disease MESH infections
disease IDO infection
drug DRUGBANK Etoperidone
disease IDO role
disease IDO pathogen
disease MESH Infectious Diseases
disease MESH Influenza
drug DRUGBANK Trestolone
disease IDO contact tracing
drug DRUGBANK Indoleacetic acid
disease MESH pathogen transmission
disease IDO process
drug DRUGBANK Medical air
drug DRUGBANK Acetylcholine
disease MESH secondary infections
disease MESH viral shedding
disease IDO secondary infection
disease IDO contagiousness
disease IDO intervention
disease MESH ARC
drug DRUGBANK 3 7 11 15-Tetramethyl-Hexadecan-1-Ol
disease MESH Hospital Infection
disease MESH emergency
drug DRUGBANK Spectinomycin
drug DRUGBANK Vancomycin
drug DRUGBANK Enterococcus faecium
disease MESH respiratory infections
disease IDO facility
drug DRUGBANK Coenzyme M
disease MESH asymptomatic infections
disease MESH measles
pathway KEGG Measles
disease IDO host

Download Document

(Visited 1 times, 1 visits today)