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The role of real-time, on-site, whole-genome sequencing of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in guiding the management of hospital outbreaks of coronavirus disease 2019 (COVID-19)

Published online by Cambridge University Press:  09 September 2022

Tina M. Marinelli Open the ORCID record for Tina M. Marinelli [Opens in a new window] ,
Leanne Dolan ,
Frances Jenkins ,
Andie Lee ,
Rebecca J. Davis ,
Simeon Crawford Open the ORCID record for Simeon Crawford [Opens in a new window] ,
Blake Nield ,
Amrita Ronnachit  and
Sebastiaan J. Van Hal Open the ORCID record for Sebastiaan J. Van Hal [Opens in a new window]
Tina M. Marinelli*
Affiliation:
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
Leanne Dolan
Affiliation:
Infection Prevention and Control Unit, Royal Prince Alfred Hospital, Sydney, Australia
Frances Jenkins
Affiliation:
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
Andie Lee
Affiliation:
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia Department of Medicine, The University of Sydney, Sydney, Australia
Rebecca J. Davis
Affiliation:
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia Department of Medicine, The University of Sydney, Sydney, Australia
Simeon Crawford
Affiliation:
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
Blake Nield
Affiliation:
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
Amrita Ronnachit
Affiliation:
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia Department of Medicine, The University of Sydney, Sydney, Australia
Sebastiaan J. Van Hal
Affiliation:
Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia Department of Medicine, The University of Sydney, Sydney, Australia
*
Author for correspondence: Dr Tina M. Marinelli, E-mail: Tina.marinelli@health.nsw.gov.au
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Abstract

Objective:

We aimed to demonstrate the role of real-time, on-site, whole-genome sequencing (WGS) of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the management of hospital outbreaks of coronavirus disease 2019 (COVID-19).

Design:

This retrospective study was undertaken at our institutions in Sydney, New South Wales, Australia, between July 2021 and April 2022. We included SARS-CoV-2 outbreaks due to SARS-CoV-2 δ (delta) and ο (omicron) variants. All unexpected SARS-CoV-2–positive cases identified within the hospital were managed by the infection control team. An outbreak was defined as 2 or more cases acquired on a single ward. We included only outbreaks with 2 or more suspected transmission events in which WGS was utilized to assist with outbreak assessment and management.

Results:

We studied 8 outbreaks involving 266 patients and 486 staff, of whom 73 (27.4%) and 39 (8.0%), respectively, tested positive for SARS-CoV-2 during the outbreak management. WGS was used to evaluate the source of the outbreak, to establish transmission chains, to highlight deficiencies in infection control practices, and to delineate between community and healthcare acquired infection.

Conclusions:

Real-time, on-site WGS combined with epidemiologic assessment is a useful tool to guide management of hospital SARS-CoV-2 outbreaks. WGS allowed us (1) to establish likely transmission events due to personal protective equipment (PPE) breaches; (2) to detect inadequacies in infection control infrastructure including ventilation; and (3) to confirm multiple viral introductions during periods of high community SARS-CoV-2 transmission. Insights gained from WGS-guides outbreak management directly influenced policy including modifying PPE requirements, instituting routine inpatient SARS-CoV-2 surveillance, and confirmatory SARS-CoV-2 testing prior to placing patients in a cohort setting.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 7 , July 2023 , pp. 1116 - 1120
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Copyright
© Royal Prince Alfred Hospital, 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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