New data compares infection rates before and during pandemic
After years of steady reductions in healthcare-associated infections, significantly higher rates of four out of six routinely tracked infections were observed in hospitals in the United States, according to a new U.S. Centers for Disease Control and Prevention (CDC) analysis of data from the National Healthcare Safety Network (NHSN) published in the journal Infection Control & Hospital Epidemiology.
Increases were attributed to factors related to the novel coronavirus (COVID-19) pandemic, including more and sicker patients requiring more frequent and longer use of catheters and ventilators as well as staffing and supply challenges.
For the analysis, researchers used data collected through NHSN, which is used by nearly all U.S. hospitals to fulfill local, state, or federal infection reporting requirements. Major increases were found in 2020 compared to 2019 in four serious infection types: central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events, and antibiotic resistant staph infections. The largest increases were bloodstream infections associated with central line catheters that are inserted into large blood vessels to provide medication and other fluids over long periods. Rates of central line infections were 46 percent to 47 percent higher in the third and fourth quarters of 2020 compared to 2019.
With dramatic increases in the frequency and duration of ventilator use, rates of ventilator-associated infections increase by 45 percent in the fourth quarter of 2020 compared to 2019. The CDC analysis found sharp increases in standardized infection rates, indicating that the increases were not simply a reflection of more devices being used.
The study found that two other types of infection remained steady or declined during COVID-19. Surgical-site infections rates did not increase as fewer elective surgeries were performed, largely in operating rooms with uninterrupted infection control processes that were separate from COVID-19 wards. In addition, no increase was found in Clostridioides Difficile (C. diff), a serious bacterial infection that occurs after antibiotic use. The researchers said lower rates of C. diff may be a result of increased focus on hand hygiene, environmental cleaning, patient isolation, and use of personal protective equipment.
“Basic infection control practices must be hardwired into practice so that they are less vulnerable when the healthcare system is stressed,” the authors said in the study. “One approach might be to designate clinical staff to be added to the hospital epidemiology team to allow for rapid expansion of effort to support a pandemic response.”