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SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe

Objectives: The National University Hospital (NUH) is a tertiary-care teaching hospital in Singapore with 60% of patients in 6–8-bed cubicles. NUH recently changed to a time-based deisolation criterion for immunocompetent COVID-19 patients in cohort wards who are afebrile and improved but did not me...

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Autores principales: Fauzi, Nazira Binte Muhammad, Sridhar, Revathi, Ching, Chan Hwang, Poh, Annie, Low, Isaac, Fisher, Dale, Somani, Jyoti
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10571124/
http://dx.doi.org/10.1017/ash.2023.17
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author Fauzi, Nazira Binte Muhammad
Sridhar, Revathi
Ching, Chan Hwang
Poh, Annie
Low, Isaac
Fisher, Dale
Somani, Jyoti
author_facet Fauzi, Nazira Binte Muhammad
Sridhar, Revathi
Ching, Chan Hwang
Poh, Annie
Low, Isaac
Fisher, Dale
Somani, Jyoti
author_sort Fauzi, Nazira Binte Muhammad
collection PubMed
description Objectives: The National University Hospital (NUH) is a tertiary-care teaching hospital in Singapore with 60% of patients in 6–8-bed cubicles. NUH recently changed to a time-based deisolation criterion for immunocompetent COVID-19 patients in cohort wards who are afebrile and improved but did not meet the antigen rapid test negative criteria at day 5–6 and who required continued hospital care. The MOH guidelines and studies of viral load trajectory from the SARS-CoV-2 δ (delta) variant suggest that by day 8 of infection, viral loads drop and the risk of transmission is low. We defined a cycle threshold (Ct) value ≥25 as the point at which virus cultures are negative. We assessed whether a time-based deisolation at day 8 correlated with Ct ≥25 during the SARS-CoV-2 ο (omicron) variant pandemic surge. Methods: Data for patients and staff with confirmed positive COVID-19 PCR between January to March 2022 were collected. These data comprised a convenience sample collected retrospectively by the epidemiology team and the obstetrics and gynecology team and were used to deisolate patients. Nasopharyngeal (NP) swabs were sent for PCR for all admissions, to confirm diagnosis, for deisolation and/or transfer, and for staff suspected to have COVID-19 as part of hospital staff policy. Results: Overall, 403 observations were obtained. For 145 NP swabs tested by SARS-CoV-2 PCR on day 1, the median Ct value was 19.55 (IQR, 9.01). The median Ct for 87 observations on day 2 was 15.95 (IQR, 3.45). The median Ct value for 14 observations on day 8 was 24.22 (IQR, 5.19). From day 9 to day 37, with 47 observations, the Ct was generally >25. Conclusions: During the SARS-CoV-2 ο (omicron) surge, NP swabs sent on day 8 had a median Ct value of 24.22. After day 8, the median Ct was >25. The discontinuation of isolation precautions on day 8 balances the use of dedicated COVID-19 beds with risk mitigation of transmission for recovered patients who require ongoing hospitalization. Small sample size and heterogeneous reasons for testing NP swabs after day 5 likely skewed our results and limits the generalizability of our results.
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spelling pubmed-105711242023-10-14 SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe Fauzi, Nazira Binte Muhammad Sridhar, Revathi Ching, Chan Hwang Poh, Annie Low, Isaac Fisher, Dale Somani, Jyoti Antimicrob Steward Healthc Epidemiol Covid-19 Objectives: The National University Hospital (NUH) is a tertiary-care teaching hospital in Singapore with 60% of patients in 6–8-bed cubicles. NUH recently changed to a time-based deisolation criterion for immunocompetent COVID-19 patients in cohort wards who are afebrile and improved but did not meet the antigen rapid test negative criteria at day 5–6 and who required continued hospital care. The MOH guidelines and studies of viral load trajectory from the SARS-CoV-2 δ (delta) variant suggest that by day 8 of infection, viral loads drop and the risk of transmission is low. We defined a cycle threshold (Ct) value ≥25 as the point at which virus cultures are negative. We assessed whether a time-based deisolation at day 8 correlated with Ct ≥25 during the SARS-CoV-2 ο (omicron) variant pandemic surge. Methods: Data for patients and staff with confirmed positive COVID-19 PCR between January to March 2022 were collected. These data comprised a convenience sample collected retrospectively by the epidemiology team and the obstetrics and gynecology team and were used to deisolate patients. Nasopharyngeal (NP) swabs were sent for PCR for all admissions, to confirm diagnosis, for deisolation and/or transfer, and for staff suspected to have COVID-19 as part of hospital staff policy. Results: Overall, 403 observations were obtained. For 145 NP swabs tested by SARS-CoV-2 PCR on day 1, the median Ct value was 19.55 (IQR, 9.01). The median Ct for 87 observations on day 2 was 15.95 (IQR, 3.45). The median Ct value for 14 observations on day 8 was 24.22 (IQR, 5.19). From day 9 to day 37, with 47 observations, the Ct was generally >25. Conclusions: During the SARS-CoV-2 ο (omicron) surge, NP swabs sent on day 8 had a median Ct value of 24.22. After day 8, the median Ct was >25. The discontinuation of isolation precautions on day 8 balances the use of dedicated COVID-19 beds with risk mitigation of transmission for recovered patients who require ongoing hospitalization. Small sample size and heterogeneous reasons for testing NP swabs after day 5 likely skewed our results and limits the generalizability of our results. Cambridge University Press 2023-03-16 /pmc/articles/PMC10571124/ http://dx.doi.org/10.1017/ash.2023.17 Text en © The Society for Healthcare Epidemiology of America 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Covid-19
Fauzi, Nazira Binte Muhammad
Sridhar, Revathi
Ching, Chan Hwang
Poh, Annie
Low, Isaac
Fisher, Dale
Somani, Jyoti
SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe
title SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe
title_full SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe
title_fullStr SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe
title_full_unstemmed SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe
title_short SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe
title_sort sg-apsic1204: time-based deisolation of generally asymptomatic immunocompetent covid-19 patients on day 8 of infection to clean wards is safe
topic Covid-19
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10571124/
http://dx.doi.org/10.1017/ash.2023.17
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