Hospital-acquired COVID-19 infections rare and dropping, study suggests

By Rebecca Pifer for Healthcare Dive

Dive Brief:

  • Over the pandemic, many patients have avoided going to the hospital unless absolutely necessary, citing fears of contracting COVID-19. But a new study suggests those fears may have been overblown.
  • Rates of acquiring COVID-19 during a hospital stay are low, with only about 1.8% of patients contracting the virus during their stay during the highest weekly pre-omicron peak of cases in December 2020, according to a new study by Epic Research.
  • And that rate appears to be decreasing. The data, which covers about a third of the U.S. population, found in-hospital cases of COVID-19 rose and fell in similar patterns to the number of patients admitted due to COVID-19 infection. But in the last half of 2021, the rate of patients who contracted the virus in a hospital rose at only half the rate as overall COVID-19 admissions, likely due to increased vaccination rates among hospital staff, patients and visitors, researchers said.

Dive Insight:

When the pandemic first hit the U.S. in early 2020, people avoided healthcare facilities in droves, as an influx of COVID-19 patients coupled with a lack of protective gear for healthcare workers and uncertain guidance about avoiding viral spread inflated worries about contracting COVID-19 in hospitals.

Despite the widespread concerns, a new study investigating the frequency with which patients developed COVID-19 while hospitalized found the rate of in-hospital transmission is relatively low, and seems to be dropping as vaccinations become more widespread.

Tracking the spread of COVID-19 inside healthcare facilities in the U.S. is difficult, as HHS only reports data on COVID-19’s spread in hospitals on a state-by-state basis. The new study, published Monday in Epic Research, a journal maintained by EHR giant Epic, used a dataset of more than 126 million patients from 156 organizations that use Epic’s software, including almost 900 hospitals.

Researchers looked at patients who tested negative on the day of or the day after admission, then tested positive six or more days later. They chose that timeframe to try to exclude patients who may have entered the hospital already positive for COVID-19.

Two research teams worked independently on the analysis before arriving to the same conclusion: Even at COVID-19’s peak in late 2020 — before the highly infectious omicron variant sent cases skyrocketing once again late 2021 — only about 1.8% of patients, equating to about 172 individual patients, acquired COVID-19 during a hospital stay the week of Dec. 6.

Researchers noted there is some uncertainty to their findings. The number of in-facility COVID-19 contractions could be an overcount, as the COVID-19 test at admission could be a false negative; or an undercount, as some patients could have been discharged before they tested positive for COVID-19 contracted at the hospital.

Though the weekly rate of hospital-developed COVID-19 compared to total coronavirus hospitalizations is low, it paints a different picture when compounded to the full scope of the pandemic, growing in both volume and severity.

The Centers for Disease Control and Prevention, along with federal and state agencies, has issued guidelines for hospitals to follow to avoid accidentally transmitting COVID-19 from patient to patient. And major U.S. hospitals have also strongly encouraged their workers to get vaccinated, especially following a Biden administration mandate that all staff working in facilities that accept Medicare and Medicaid funding be vaccinated in the first quarter of this year.

Despite those measures, analyses of in-facility transmission suggest hospitals have more work to do to cut down on in-facility transmission, which can be a factor in the life or death of an inpatient.

In November, a Kaiser Health News analysis of federal and state records found more than 10,000 patients were diagnosed with COVID-19 in a U.S. hospital in 2020 after being admitted for an unrelated health need. That’s at a rate of 1.7%, a touch lower than the highest rate found in the Epic analysis.

KHN stressed their rate of infection was also likely an undercount.

That data showed about 21% of the patients (who were mostly 65 and older) who contracted the virus in a hospital from April to September in 2020 died, compared to about 8% of other Medicare patients who died in a hospital in the same period.


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