# Proposed new definition for hospital-acquired SARS-CoV-2 infections: results of a confirmatory factor analysis

## TL;DR

This study proposes a new definition for hospital-acquired SARS-CoV-2 infections using a statistical model that includes regional outbreak data.

## Contribution

The study introduces a novel approach using regional incidence as a proxy variable to better define hospital-acquired SARS-CoV-2 infections.

## Key findings

- The proposed model for HA-SIs shows good fit indices (CFI.scaled = 0.959, RMSEA = 0.049).
- The model is adaptable to specific regional outbreaks and aligns with recent scientific literature.
- The model unifies significant variables for HA-SI onset identified in recent studies.

## Abstract

The present study aims to develop and discuss an extension of hospital-acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections (HA-SIs) definition which goes beyond the use of time parameters alone.

A confirmatory factor analysis was carried out to test a suitable definition for HA-SI.

A two-center cohort study was carried out at two tertiary public hospitals in the German state of lower Saxony. The study involved a population of 366 laboratory-confirmed SARS-CoV-2-infected inpatients enrolled between March 2020 and August 2023.

The proposed model shows adequate fit indices (CFI.scaled = 0.959, RMSEA = 0.049). A descriptive comparison with existing classifications revealed strong features of our model, particularly its adaptability to specific regional outbreaks.

The use of the regional incidence as a proxy variable to better define HA-SI cases represents a pragmatic and novel approach. The model aligns well with the latest scientific results in the literature. This work successfully unifies, within a single model, variables which the recent literature described as significant for the onset of HA-SI. Further potential improvements and adaptations of the model and its applications, such as automating the categorization process (in terms of hospital acquisition) or employing a comparable model for hospital-acquired influenza classification, are subjects open for discussion.