Bak, A., Mugglestone, M.A., Ratnaraja, N.V., Wilson, Jennie ORCID: https://orcid.org/0000-0002-4713-9662, Rivett, L., Stoneham, S.M., Bostock, J., Moses, S.E., Price, J.R., Weinbren, M., Loveday, Heather ORCID: https://orcid.org/0000-0003-2259-8149, Islam, J. and Wilson, A.P.R. (2021) SARS-CoV-2 routes of transmission and recommendations for preventing acquisition: joint British Infection Association (BIA), Healthcare Infection Society (HIS), Infection Prevention Society (IPS) and Royal College of Pathologists (RCPath) guidance. Journal of Hospital Infection, 114. pp. 79-103. ISSN 0195-6701

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Abstract

The pandemic of the coronavirus disease 2019 (COVID-19),
caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged amid uncertainty about the dynamics of transmission and the possible management options for COVID-19 patients. This resulted in confusion for healthcare workers (HCWs) and hospital managers who often received conflicting advice on how to organise care and manage infected individuals without increasing the risk of transmission to HCWs and other patients. Advice for the public has also been confusing and apparently sometimes contradictory, which sometimes resulted in overuse of Personal Protective Equipment(PPE) in the general population as well as in healthcare workers. As evidence from the first wave has emerged, we are now in a position to summarise it and provide guidance on how to prevent SARS-CoV-2 transmission whilst preserving essential resources. This article is the first of two guidance documents
produced jointly by the Healthcare Infection Society, British Infection Association, Infection Prevention Society and Royal College of Pathologists. This guidance article describes routes of SARS-CoV-2 transmission, which will allow the public and healthcare professionals to understand how SARS-CoV-2 transmission occurs. By determining how likely transmission can occur via a given route, we can extrapolate the evidence for infection prevention and control (IPC) and apply this knowledge to optimise protection from SARS-CoV-2 infection.
At the time of writing (April 2021), new variants of SARS-CoV-2 emerged, raising concerns whether the virus could make current vaccines ineffective. The evidence strongly suggests that these variants have a transmission potential higher than the original virus thus, strict adherence to IPC measures is still required in breaking the chain of SARS-CoV-2 transmission.
Further review may be required as more evidence about these
variants becomes available.
On review of the evidence, the COVID-19 Rapid Guidance
Working Party considers the different transmission routes as
follows:
droplet transmission: probable
transmission via fomites: possible
airborne transmission: possible (in some circumstances,
e.g., aerosol generating procedures (AGPs)
transmission via ocular surface: possible
vertical transmission: unlikely
transmission from different body fluids (other than respiratory secretions and saliva): unlikely
transmission from blood transfusion and transplantation
organs: unlikely
The Working Party concludes that transmission most often
occurs following close contact, especially where PPE is not
worn, as reflected in high transmission rates between family
members, friends, and co-workers. At the moment it is not
possible to determine the distance or the duration over which transmission can occur, although these vary depending on circumstances (e.g. the shorter the distance, the shorter the duration of contact will be required, but also on environmental and other factors). Transmission from COVID-19 patients to HCWs in hospitals is low, except in a small number of cases where HCWs cared for undiagnosed COVID-19 patients and did
not use appropriate PPE. Even in these cases, transmission
usually occurs during AGPs. Transmission in care homes appears to be very high and anecdotal evidence suggests that there were difficulties in obtaining appropriate PPE and observing social distancing during the pandemic. The published literature is not comprehensive enough to make recommendations for this setting. However, considering there is no IPC guidance specific for care homes, we suggest that staff in these institutions follow the recommendations for persons working in health and care settings listed below and that they explore aspects specific to their local institutions to address the barriers which prevent
them in doing so, e.g. inability to maintain social distancing.

Item Type:	Article
Identifier:	10.1016/j.jhin.2021.04.027
Additional Information:	This paper was made 'Free' access on publication by Elsevier and so is REF compatible although deposit of the AAM was outside the 3 month limit. https://www.journalofhospitalinfection.com/issue/S0195-6701(21)X0006-0
Keywords:	SARS-CoV-2, COVID-19, infection prevention, guidelines, infectious diseases, droplet transmission, aerosol transmission, infectious disease transmission
Subjects:	Medicine and health > Health promotion and public health > Infection prevention Medicine and health
Related URLs:	Publisher
Depositing User:	Jennie Wilson
Date Deposited:	07 Sep 2021 11:12
Last Modified:	04 Nov 2024 11:03
URI:	https://repository.uwl.ac.uk/id/eprint/8227

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