Ragozzino, et al. (2024) say that implementation of isolation precautions for patients with suspected coronavirus disease 2019 (COVID-19) and pending test results is resource-intensive. Due to the limited availability of single-bed rooms at their institution, the investigators isolated patients with suspected COVID-19 together with patients without suspected COVID-19 on-site in multiple-bed rooms until SARS-CoV-2-test results were available.

They evaluated the likelihood of SARS-CoV-2 transmission to individuals sharing the room with patients isolated on-site. This observational study was performed at the University Hospital Basel, Switzerland, from 03/20 − 11/20. Secondary attack rates were compared between patients hospitalized in multiple-bed rooms and exposed to individuals subjected to on-site isolation precautions (on-site isolation group), and patients exposed to individuals initially not identified as having COVID-19, and not placed under isolation precautions until the diagnosis was suspected (control group). Transmission events were confirmed by whole-genome sequencing.

Among 1,218 patients with suspected COVID-19, 67 (5.5%) tested positive for SARS-CoV-2. Of these, 21 were isolated on-site potentially exposing 27 patients sharing the same room. Median contact time was 12 hours (interquartile range 7–18 hours). SARS-CoV-2 transmission was identified in none of the patients in the on-site isolation group vs. 10/63 (15.9%) in the control group (p = 0.03). Isolation on-site of suspected COVID-19-patients in multiple-bed rooms avoided single-room occupancy and subsequent in-hospital relocation for many patients without confirmed SARS-CoV-2-infection. The absence of secondary transmission among the exposed patients in the on-site isolation group allows for assessment of the risk/benefit ratio of this strategy given the limitation of a small sample size.

The investigators conclude that, "Isolation on-site of suspected COVID-19-patients in multiple-bed rooms could be a feasible and safe strategy. It avoids single-room occupancy and subsequent in-hospital relocation for many patients, ensuring a better quality of care and significant cost reductions for the healthcare system. Further, specifically designed prospective studies in a larger clinical context and with the current circulating SARS-CoV-2 variants are needed to document the efficacy of this strategy. Thereafter, an additional intriguing question would be whether COVID-19 patients can be isolated on-site during the entire length of stay."

Reference: Ragozzino S, et al. Secondary attack rate following on-site isolation of patients with suspected COVID-19 in multiple-bed rooms. Antimicrobial Resistance & Infection Control. Volume 13, article number 73 (2024).