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Table 2 Official definitions of healthcare-associated coronavirus disease 2019 (COVID-19) cases and outbreaks

From: Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers

Country Definition of cases Definition of outbreak References
England Probable healthcare-associated COVID-19: a single inpatient who develops COVID-19 more than 7 days after hospital admission Two or more cases in a single setting are detected that have become symptomatic or detected on screening on or after day eight of hospital admission [86]
Canada Not reported LTCFs: a single laboratory-confirmed case of COVID-19 in a staff member (or resident) [87]
Ireland • Onset of compatible symptoms ≥ 7 days after admission
• Onset of compatible symptoms 3–6 after admission if epidemiologically linked to hospital exposure
• Onset of clinical features of COVID-19 on day 1 or 2 after admission are considered community acquired unless epidemiologically linked to hospital exposure during a recent hospital admission
• If onset of clinical features cannot be defined, a case by case assessment is required taking account of the date of sampling relative to the date of admission, the CT value of the test result and epidemiological evidence of a link to hospital exposure.
Not reported [88]
Switzerland • Patient with new onset of COVID-19 compatible signs and symptoms* at least 5 days after hospital admission and a positive PCR result and/or thorax CT scan suggestive of COVID-19
• For hospitals with universal admission screening: Patient with negative PCR on admission and new onset of COVID-19 compatible symptoms and/or a positive PCR result at least 5 days after hospital admission
Detection of ≥ 3 nosocomial COVID-19 cases with a possible epidemiological (temporal and local) link [89]
United States • NOT considered nursing home onset COVID-19:
• Residents who were known to have COVID-19 on admission to the facility and were placed into appropriate Transmission-Based Precautions to prevent transmission to others in the facility.
• Residents who were placed into Transmission-Based Precautions on admission and developed SARS-CoV-2 infection within 14 days after admission
Notification required in case of:
 Residents or HCP with suspected or confirmed COVID-19
 Residents with severe respiratory infection resulting in hospitalization or death
 ≥ 3 residents or HCP with new-onset respiratory symptoms within 72 h of each other
[90, 91]
European Centre for Disease Prevention and Control • Community-associated COVID-19 (CA-COVID-19): Symptoms present on admission or with onset on day 1 or 2 after admission
• Symptom onset on days 3-7 and a strong suspicion of community transmission..
• Indeterminate association (IA-COVID-19): Symptom onset on day 3-7 after admission, with insufficient information on the source of infection to assign to another category.
• Probable healthcare-associated COVID-19 (HA-COVID-19): Symptoms onset on day 8-14 after admission
• Symptom onset on day 3-7 and a strong suspicion of healthcare transmission.
• Definite HA-COVID-19: Symptom onset on day ≥14 after admission
Not provided Accessed December 26, 2020