Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)

doi:10.1016/j.jhin.2020.07.013

Comparative Study

. 2020 Oct;106(2):376-384.

doi: 10.1016/j.jhin.2020.07.013. Epub 2020 Jul 21.

Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)

B Carter¹, J T Collins², F Barlow-Pay³, F Rickard⁴, E Bruce⁵, A Verduri⁶, T J Quinn⁷, E Mitchell⁸, A Price⁹, A Vilches-Moraga¹⁰, M J Stechman¹¹, R Short¹², A Einarsson¹³, P Braude⁸, S Moug¹⁴, P K Myint¹⁵, J Hewitt¹⁶, L Pearce¹⁷, K McCarthy¹⁸; COPE Study Collaborators

Collaborators, Affiliations

Collaborators

COPE Study Collaborators:
C Davey¹⁹, S Jones¹⁹, K Lunstone¹⁹, A Cavenagh¹⁹, C Silver¹⁹, T Telford¹⁹, R Simmons¹⁹, M Holloway²⁰, J Hesford²⁰, T El Jichi Mutasem²⁰, S Singh, D Paxton²⁰, W Harris²⁰, N Galbraith²¹, E Bhatti²¹, J Edwards²¹, S Duffy²¹, J Kelly²², C Murphy²², C Bisset²³, R Alexander²³, M Garcia²⁴, S Sangani²⁴, T Kneen²⁴, T Lee²⁴, A McGovern²⁵, G Guaraldi²⁶, E Clini²⁶

Affiliations

¹ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
² Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Cardiff, UK.
³ Royal Alexandra Hospital, Paisley, UK.
⁴ North Bristol NHS Trust, Bristol, UK.
⁵ Institute of Applied Health Sciences, University of Aberdeen, UK.
⁶ Hospital of Modena Policlinico, Modena, Italy.
⁷ Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
⁸ Department of Geriatric Medicine, North Bristol NHS Trust, Bristol, UK.
⁹ Salford Royal NHS Trust, Salford, UK.
¹⁰ Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
¹¹ Department of Surgery, University Hospital of Wales, Cardiff, UK.
¹² Forensic & Neurodevelopmental Sciences, King's College London, London, UK.
¹³ Woodend Hospital, Aberdeen, UK.
¹⁴ Department of Surgery, Royal Alexandra Hospital, Paisley, UK.
¹⁵ Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
¹⁶ Aneurin Bevan University Health Board, Cardiff, UK; Cardiff University, Cardiff, UK. Electronic address: hewittj2@cardiff.ac.uk.
¹⁷ Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK.
¹⁸ Department of Surgery, North Bristol NHS Trust, Bristol, UK.
¹⁹ Ysbyty Ystrad Fawr, UK.
²⁰ North Bristol Trust, UK.
²¹ Royal Alexandra Hospital, North Bristol Trust, Paisley, UK.
²² King's College London, UK.
²³ Inverclyde Royal Infirmary, UK.
²⁴ Salford Royal Infirmary, UK.
²⁵ Glasgow Royal Infirmary, UK.
²⁶ University Hospital of Modena Policlinico, Italy.

PMID: 32702463
PMCID: PMC7372282
DOI: 10.1016/j.jhin.2020.07.013

Comparative Study

Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)

B Carter et al. J Hosp Infect. 2020 Oct.

. 2020 Oct;106(2):376-384.

doi: 10.1016/j.jhin.2020.07.013. Epub 2020 Jul 21.

Authors

Collaborators

COPE Study Collaborators:
C Davey¹⁹, S Jones¹⁹, K Lunstone¹⁹, A Cavenagh¹⁹, C Silver¹⁹, T Telford¹⁹, R Simmons¹⁹, M Holloway²⁰, J Hesford²⁰, T El Jichi Mutasem²⁰, S Singh, D Paxton²⁰, W Harris²⁰, N Galbraith²¹, E Bhatti²¹, J Edwards²¹, S Duffy²¹, J Kelly²², C Murphy²², C Bisset²³, R Alexander²³, M Garcia²⁴, S Sangani²⁴, T Kneen²⁴, T Lee²⁴, A McGovern²⁵, G Guaraldi²⁶, E Clini²⁶

Affiliations

¹ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
² Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Cardiff, UK.
³ Royal Alexandra Hospital, Paisley, UK.
⁴ North Bristol NHS Trust, Bristol, UK.
⁵ Institute of Applied Health Sciences, University of Aberdeen, UK.
⁶ Hospital of Modena Policlinico, Modena, Italy.
⁷ Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
⁸ Department of Geriatric Medicine, North Bristol NHS Trust, Bristol, UK.
⁹ Salford Royal NHS Trust, Salford, UK.
¹⁰ Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
¹¹ Department of Surgery, University Hospital of Wales, Cardiff, UK.
¹² Forensic & Neurodevelopmental Sciences, King's College London, London, UK.
¹³ Woodend Hospital, Aberdeen, UK.
¹⁴ Department of Surgery, Royal Alexandra Hospital, Paisley, UK.
¹⁵ Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
¹⁶ Aneurin Bevan University Health Board, Cardiff, UK; Cardiff University, Cardiff, UK. Electronic address: hewittj2@cardiff.ac.uk.
¹⁷ Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK.
¹⁸ Department of Surgery, North Bristol NHS Trust, Bristol, UK.
¹⁹ Ysbyty Ystrad Fawr, UK.
²⁰ North Bristol Trust, UK.
²¹ Royal Alexandra Hospital, North Bristol Trust, Paisley, UK.
²² King's College London, UK.
²³ Inverclyde Royal Infirmary, UK.
²⁴ Salford Royal Infirmary, UK.
²⁵ Glasgow Royal Infirmary, UK.
²⁶ University Hospital of Modena Policlinico, Italy.

PMID: 32702463
PMCID: PMC7372282
DOI: 10.1016/j.jhin.2020.07.013

Abstract

Background: Hospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality.

Aim: To identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection.

Methods: The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities.

Findings: The study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28^th, 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51-0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47-1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37-0.66).

Conclusion: The minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding.

Keywords: COVID-19; Community-acquired infection; Nosocomial infection.

PubMed Disclaimer

Figures

**Figure 1**
Kaplan–Meier survival plot of nosocomial versus community infection of COVID-19 patients.

**Figure 2**
Kaplan–Meier survivor plot for time-to-discharge for nosocomial versus community infection of COVID-19 patients.

See this image and copyright information in PMC

Cited by

Prevalence and correlates of knowledge and practices regarding infection prevention and control, and triage in primary healthcare settings: A cross-sectional study in Bangladesh.
Talukder A, Roy A, Islam MN, Chowdhury MAK, Sarker M, Chowdhury M, Chowdhury IA, Hasan M, Latif AHMM. Talukder A, et al. Infect Prev Pract. 2022 Nov 18;5(1):100258. doi: 10.1016/j.infpip.2022.100258. eCollection 2023 Mar. Infect Prev Pract. 2022. PMID: 36478873 Free PMC article.
Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians.
Delfino-Pereira P, Pires MC, Gomes VMR, Nogueira MCA, Lima MCPB, Schwarzbold AV, Maurílio AO, Scotton ALBA, Costa ASM, Farace BL, de Castro BM, Cimini CCR, Silveira DV, Ponce D, Pereira EC, Roesch EW, Manenti ERF, Cenci EPA, Dos Santos FC, Anschau F, Aranha FG, Bartolazzi F, Nascimento GF, Vianna HR, d'Arc Lyra Batista J, de Alvarenga JC, Carvalho JDSN, Machado-Rugolo J, Ruschel KB, Menezes LSM, de Castro LC, Nasi LA, Floriani MA, Souza MD, Souza-Silva MVR, Carneiro M, Bicalho MAC, de Godoy MF, Guimarães-Júnior MH, Ziegelmann PK, Assaf PL, Martelli PJL, Finger RG, Francisco SC, Araújo SF, Oliveira TF, de Oliveira TC, Lage TM, Muller V, Ramires YC, Ferrari TCA, Marcolino MS. Delfino-Pereira P, et al. Int J Infect Dis. 2023 May;130:31-37. doi: 10.1016/j.ijid.2023.02.012. Epub 2023 Feb 21. Int J Infect Dis. 2023. PMID: 36813081 Free PMC article.
Hospital acquired COVID-19 infections amongst patients before the rollout of COVID-19 vaccinations, a scoping review.
Ngandu NK, Mmotsa TM, Dassaye R, Thabetha A, Odendaal W, Langdown N, Ndwandwe D. Ngandu NK, et al. BMC Infect Dis. 2022 Feb 10;22(1):140. doi: 10.1186/s12879-022-07128-5. BMC Infect Dis. 2022. PMID: 35144556 Free PMC article.
How SARS-CoV-2 Infection Impacts the Management of Patients with Vulvar Cancer: Experience in a Third-Level Hospital of Southern Italy.
Della Corte L, Cafasso V, Boccia D, Morra I, De Angelis C, De Placido S, Giampaolino P, Di Carlo C, Bifulco G. Della Corte L, et al. J Pers Med. 2023 Jan 29;13(2):240. doi: 10.3390/jpm13020240. J Pers Med. 2023. PMID: 36836474 Free PMC article.
Hospital-acquired coronavirus disease 2019 (COVID-19) among patients of two acute-care hospitals: Implications for surveillance.
Trick WE, Santos CAQ, Welbel S, Tseng M, Zhang H, Donceras O, Martinez AI, Lin MY. Trick WE, et al. Infect Control Hosp Epidemiol. 2022 Dec;43(12):1761-1766. doi: 10.1017/ice.2021.510. Epub 2022 Apr 19. Infect Control Hosp Epidemiol. 2022. PMID: 35438067 Free PMC article.

See all "Cited by" articles

References

1. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. - PMC - PubMed
1. World Health Organization . May 5 2020. Coronavirus disease 2019 (COVID-19) situation report 105.https://www.who.int/docs/default-source/coronaviruse/situation-reports/2... Available at: [last accessed May 2020]
1. Wee L.E., Conceicao E.P., Sim X.Y.J., Aung M.K., Tan K.Y., Wong H.M. Minimising intra-hospital transmission of COVID-19: the role of social distancing. J Hosp Infect. 2020 Apr 12;(20):30191–30192. doi: 10.1016/j.jhin.2020.04.016. pii: S0195-6701, [Epub ahead of print] - DOI - PMC - PubMed
1. Wong S.C., Kwong R.T.S., Wu T.C., Chan J.W.M., Chu M.Y., Lee S.Y. Risk of nosocomial infection of coronavirus disease 2019: an experience in a general ward setting in Hong Kong. J Hosp Infect. 2020;105(2):119–127. - PMC - PubMed
1. Yu J., Ouyang W., Chua M.L.K., Xie C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. 2020 doi: 10.1001/jamaoncol.2020.0980. [Epub ahead of print] - DOI - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Miscellaneous
- NCI CPTAC Assay Portal

[1] Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. - PMC - PubMed

[2] Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. - PMC - PubMed

[3] World Health Organization . May 5 2020. Coronavirus disease 2019 (COVID-19) situation report 105.https://www.who.int/docs/default-source/coronaviruse/situation-reports/2... Available at: [last accessed May 2020]

[4] World Health Organization . May 5 2020. Coronavirus disease 2019 (COVID-19) situation report 105.https://www.who.int/docs/default-source/coronaviruse/situation-reports/2... Available at: [last accessed May 2020]

[5] Wee L.E., Conceicao E.P., Sim X.Y.J., Aung M.K., Tan K.Y., Wong H.M. Minimising intra-hospital transmission of COVID-19: the role of social distancing. J Hosp Infect. 2020 Apr 12;(20):30191–30192. doi: 10.1016/j.jhin.2020.04.016. pii: S0195-6701, [Epub ahead of print] - DOI - PMC - PubMed

[6] Wee L.E., Conceicao E.P., Sim X.Y.J., Aung M.K., Tan K.Y., Wong H.M. Minimising intra-hospital transmission of COVID-19: the role of social distancing. J Hosp Infect. 2020 Apr 12;(20):30191–30192. doi: 10.1016/j.jhin.2020.04.016. pii: S0195-6701, [Epub ahead of print] - DOI - PMC - PubMed

[7] Wong S.C., Kwong R.T.S., Wu T.C., Chan J.W.M., Chu M.Y., Lee S.Y. Risk of nosocomial infection of coronavirus disease 2019: an experience in a general ward setting in Hong Kong. J Hosp Infect. 2020;105(2):119–127. - PMC - PubMed

[8] Wong S.C., Kwong R.T.S., Wu T.C., Chan J.W.M., Chu M.Y., Lee S.Y. Risk of nosocomial infection of coronavirus disease 2019: an experience in a general ward setting in Hong Kong. J Hosp Infect. 2020;105(2):119–127. - PMC - PubMed

[9] Yu J., Ouyang W., Chua M.L.K., Xie C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. 2020 doi: 10.1001/jamaoncol.2020.0980. [Epub ahead of print] - DOI - PMC - PubMed

[10] Yu J., Ouyang W., Chua M.L.K., Xie C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. 2020 doi: 10.1001/jamaoncol.2020.0980. [Epub ahead of print] - DOI - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)

Collaborators

Affiliations

Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)

Authors

Collaborators

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Related information

LinkOut - more resources

Full Text Sources

Miscellaneous