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

Preview

PDF SARS-CoV-2 transmission guidance resubmission v1.pdf - Accepted Version Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (1MB) | Preview

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:	21 Aug 2024 10:33
URI:	https://repository.uwl.ac.uk/id/eprint/8227

Downloads

Actions (login required)

View Item