J Hosp Infect. 2021 Jun 4:S0195-6701(21)00220-6. doi: 10.1016/j.jhin.2021.05.016. Online ahead of print.
BACKGROUND: Hospital-onset COVID-19 infections (HOCI) are associated with excess morbidity and mortality in patients and healthcare workers.
AIM: To explore and describe the current literature in HOCI surveillance.
METHODS: Medline, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Register of Controlled Trials, and MedRxiv were searched up to November 30, 2020 using broad search criteria. Articles of HOCI surveillance systems were included. Data describing HOCI definitions, HOCI incidence, types of HOCI identification surveillance systems, and level of system implementation were extracted.
FINDINGS: 292 citations were identified. Nine studies in HOCI surveillance were included. Six studies reported proportion of HOCI among hospitalised COVID-19 patients, which ranged from 0 to 15.2%. Six studies provided HOCI case definitions. Standardised national definitions provided by the UK and US government were identified. Four studies included healthcare workers in the surveillance. One study articulated a multimodal strategy of infection prevention and control practices including HOCI surveillance. All identified HOCI surveillance systems were implemented at institutional level, with eight studies focusing on all hospital inpatients and one study focusing on patients in emergency department. Multiple types of surveillance were identified. Four studies reported automated surveillance, of which one included real-time analysis, and one included genomic data. Overall, the study quality was limited by the observational nature with short follow-up periods.
CONCLUSIONS: HOCI case definitions and surveillance methods were developed pragmatically. Whilst standardised case definitions and surveillance systems are ideal for integration with existing routine surveillance activities and adoption in different settings, we acknowledged the difficulties in establishing such standards in short-term.