‘Perfect storm’ increased healthcare-associated infections during pandemic

By Christopher Cheney

There has been a significant increase in healthcare-associated infections (HAI) during the coronavirus pandemic, a recent research article found.

From 2015 to 2019, there were decreases in the prevalence of central-line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and Clostridiodes difficile infections (CDI). Since 2010, there have been significant year-to-year decreases in methicillin-resistant Staphylococcus aureus (MRSA).

The recent research article, which was published by Infection Control & Hospital Epidemiology, examined national- and state-level standardized infection ratios (SIR) for each quarter in 2020 compared to each quarter in 2019. SIRs were determined for each HAI by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data.

The study includes several key data points.

  • CLABSI: SIRs were significantly higher in the second, third and fourth quarters of 2020 compared to 2019. The largest increased SIRs occurred in the third and fourth quarters (46% to 47%).
  • CAUTI: The national CAUTI SIR increased steadily throughout 2020. In the fourth quarter of 2020, the CAUTI SIR increased 19%.
  • Ventilator-associated events (VAE): The national VAE SIR increased throughout 2020, with the largest increase occurring in the fourth quarter (45%).
  • MRSA bacteremia: In the second quarter of 2020, the national MRSA bacteremia SIR increased 12% compared to the second quarter of 2019.

“This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics,” the research article’s co-authors wrote.

Interpreting the data

The characteristics of the coronavirus pandemic that drove increases in CLABSIs, CAUTIs, VAEs and antibiotic resistant staph infections were “clearly multifactorial,” says Arjun Srinivasan, MD, associate director for healthcare-associated infection programs at the Centers for Disease Control and Prevention (CDC).

“There are issues that drove the increases both with respect to the patients themselves and the healthcare delivery system, which were both put under enormous stress. When we look at the patients who were most likely to be hospitalized with COVID, they tended to be patients who were older with significant comorbidities. So, those were the patients who were at the highest risk to have healthcare-associated infections because they have underlying, predisposing factors,” he says.

The healthcare system was under unprecedented strain, Srinivasan says.

“There were large numbers of patients presenting for care. There was very high acuity of illness. There were shortages of staffing—we had staffing problems because staff themselves were getting COVID or they were exposed and unable to work. So, we didn’t have enough people to take care of the patients. Then, we also had some significant shortages of personal protective equipment—the things that we need to deliver and provide safe care. You had a perfect storm of very high-risk patients meeting a healthcare system under unprecedented pressure. Those are the factors that resulted in what we saw,” he says.

There is hope to reverse the increases in HAIs during the ongoing pandemic, Srinivasan says.

“The first thing is to be aware of the data. What has been wonderful to see is that hospitals have continued to monitor these infections and to report them to the CDC, even though for the first six months of 2020, they did not have to report them. The Centers for Medicare & Medicaid Services gave hospitals permission to stop reporting because they were under a lot of strain. But 80% to 90% of hospitals kept reporting. So, assessing and monitoring this information and knowing that you have this problem is absolutely the first step toward correcting it,” he says.

The other part of reversing the trend is a more challenging because we are still faced with the same set of challenges, Srinivasan says. “Granted, the supplies of personal protective equipment have gotten better, but the large number of patients getting ill and the comorbidities that those patients have remains a challenge. The strain on the healthcare system remains a challenge. Fortunately, we have many healthcare workers who are vaccinated, so hopefully that helps with some of the staffing issues.”

The increase in HAIs should not discourage patients from going to a hospital when they need acute care, he says.

“There have been more infections in hospitals than there were two years ago. At the same time, we know that people have needed hospital care for COVID. There is no doubt that many people have had their lives saved because they went to a hospital in a timely manner when they got sick and were able to get treatment for COVID. There are always risks associated with seeking medical care, and some of those risks are infections. Yes, there have been more infections over the past year, but when you need to be in a hospital, we want you to go to a hospital. That is a place where there are people dedicated to making you better and saving your life. So, we do not want this data to scare people away from getting the care that they need.”

The CDC is hopeful that the increases in HAIs during the coronavirus pandemic will be reversed once the crisis state of the pandemic has passed, Srinivasan says.

“Our hope is that these increased infections are situational due to the unusual circumstances that arose during the pandemic. Once the pandemic has passed, we expect that as hospitals return to their normal state that we will see these infections go back down to where they were. We are going to be focusing on this area—making sure that we are doing everything to rebuild that firm foundation that we had. There were policies and procedures that were in place that resulted in the decreases in these infections.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders. This article first ran on HealthLeaders Media.

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COVID-19, Infection Control, Patient Safety