Routine molecular point-of-care testing for SARS-CoV-2 reduces hospital-acquired COVID-19

Robert Livingstone; Hlaing Lin; Nathan J Brendish; Stephen Poole; Alex R Tanner; Florina Borca; Trevor Smith; Matthew Stammers; Tristan W Clark

doi:10.1016/j.jinf.2022.01.034

Routine molecular point-of-care testing for SARS-CoV-2 reduces hospital-acquired COVID-19

J Infect. 2022 Apr;84(4):558-565. doi: 10.1016/j.jinf.2022.01.034. Epub 2022 Jan 31.

Authors

Robert Livingstone¹, Hlaing Lin², Nathan J Brendish³, Stephen Poole³, Alex R Tanner⁴, Florina Borca⁵, Trevor Smith⁶, Matthew Stammers⁷, Tristan W Clark⁸

Affiliations

¹ Division B, Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK. Electronic address: robert.livingstone@nhs.net.
² Division B, Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK; UHS Digital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
³ School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁴ Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵ UHS Digital, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
⁶ Division B, Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK.
⁷ Division B, Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK; UHS Digital, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
⁸ School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Post-Doctoral Fellowship Programme, UK.

Abstract

Objectives: Risk of hospital-acquired COVID-19 (HA-COVID-19) infection is increased by cohorting infected and non-infected patients together in assessment areas, whist awaiting laboratory PCR results. Molecular point-of-care tests (mPOCT) reduce time to results and improve patient flow but the impact on HA-COVID-19 is unknown.

Methods: In this pre and post implementation study patients were evaluated across two time periods: March 1st to August 13th 2020, prior to the introduction of mPOCT in medical admissions areas, and 14th August 2020 to 1st April 2021, after mPOCT introduction. The primary outcome was proportion of HA-COVID-19 infection among all COVID-19 positive patients. Secondary outcome measures included time to SARS-CoV-2 results, length of time spent in the medical assessment area and comparison of local, regional and national proportions of HA-COVID-19.

Results: 1988 patients were admitted through the acute medicine admission cohorting area and tested for SARS-CoV-2 prior to introducing mPOCT and 4640 afterwards. Median (IQR) time to SARS-CoV-2 result was 6.5 (2.1-17.9) hours prior to introducing mPOCT and 1.0 (0.8-1.3) hours afterwards (p < 0.0001). Median (IQR) duration in the assessment cohort area was 12.0 (4.8-20.6) hours prior to introduction of POCT and 3.2 (2.0-5.6) hours afterwards (p < 0.0001). The proportion of hospital-acquired COVID-19 cases was 108 (16.5%) of 654 prior to introducing mPOCT compared with 168 (9.4%) of 1782 afterwards, (HR 0.55, 95%CI 0.43-0.70; p < 0.0001). In the period following the introduction of mPOCT up to 1st April 2021 the median proportion of HA-COVID-19 was 13.6% (95%CI 8.2-18.9%) locally, compared with 43.8% (95%CI 37.8-49.9%) for all acute NHS trusts regionally and 30.9% (95%CI 28.4-33.5%) for all NHS trusts nationally.

Conclusions: Routine mPOCT for SARS-CoV-2 was associated with reduced time to results, time spent in admission cohort areas, and hospital-acquired COVID-19, compared to laboratory PCR.

Keywords: COVID-19; Hospital acquired infection; Point-of-care testing; SARS-CoV-2.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / diagnosis
Cohort Studies
Cross Infection* / diagnosis
Hospitals
Humans
Point-of-Care Testing
SARS-CoV-2