2020 has not been a good year for infection control


Nosocomial infections (HAIs) in acute care hospitals skyrocketed during the COVID-19 pandemic in 2020, potentially erasing years of progress in the fight against these infections, the researchers said.

Significant increases in national standardized infection rates for central catheter-associated blood infections, catheter-associated urinary tract infections, ventilation-related events and methicillin resistance Staphylococcus aureus Bacteremia (MRSA) were noted in 2020 compared to 2019, reported Lindsey Weiner-Lastinger, MPH, of the CDC, and colleagues.

Notably, blood infections associated with central catheters saw the largest increases, although ventilator-associated events also saw significant increases throughout 2020, which was not surprising given the number of COVID patients. requiring intensive care, the authors wrote in Infection control and hospital epidemiology.

A number of factors have contributed to these increases, including more patients requiring the use of catheters and ventilators, as well as staffing and supply issues in hospitals, the team noted.

“COVID-19 has created a perfect storm for antibiotic resistance and nosocomial infections in healthcare facilities,” said Arjun Srinivasan, MD, associate director of healthcare associated infection prevention programs at CDC, in a statement. communicated. “This information underscores the importance of creating stronger, deeper, and broader infection control resources across healthcare, which will not only improve our ability to protect patients in future pandemics, but improve. also patient care every day. “

From 2015 to 2019, “significant and consistent reductions” were observed in the incidence of central line-associated blood infections, catheter-associated urinary tract infections, and Clostridioides difficile laboratory-identified infection events (ICDs), noted Weiner-Lastinger and colleagues, with a decrease in laboratory-identified events of MRSA bacteremia since 2010.

To assess the impact of the pandemic on the incidence of HAIs, the authors looked at quarterly data from CDC National Health Care Safety Network (NHSN), described as the largest HAI surveillance system in the United States and used by almost all US hospitals to report HAIs. Infections that occurred in 2019 and 2020 were included, as were those reported to the Patient Safety component of the NHSN as of April 1, 2021.

The largest year-over-year increases were in blood infections associated with central catheters, the incidence of which increased from 46% to 47% in the third and fourth quarters of 2020 compared to 2019. Events associated with ventilation increased by 45% in the fourth quarter of 2020, while laboratory-identified MRSA bacteremia events increased by 34% in the fourth quarter.

Unsurprisingly, urinary catheter and central catheter use was higher from Q2 to Q4 2020, while ventilator use was highest in all four quarters, the authors said.

However, not all infections have increased during the pandemic. a accompanying editorial by Tara Palmore, MD, and David Henderson, MD, both of the NIH Clinical Center in Bethesda, Maryland, noted that the rates of surgical site infections and CDI had not increased in 2020.

“We hypothesize that the prevention of surgical site infections relies on practices rooted in antimicrobial management, the preoperative arena and the operating room, which have not been as directly affected by the diversion of resources. hospital infection control centers towards COVID-19, ”they wrote.

Palmore and Henderson also hypothesized that lower outpatient prescriptions for antimicrobials may have played a role in lowering CDI rates.

The limitations included the fact that the data for the fourth quarter of 2020 may have been incomplete, as well as the fact that the analysis was limited to reporting hospitals in 2019 and 2020, so those opening new units in 2020 did not have to. not been included. In addition, the incidence of HAIs has only been studied in hospitals, and not in critical access or long-term care facilities.

A CDC press release said the findings underscore the need for hospitals to continue to strengthen infection prevention and control practices and to continuously monitor and review hospital-acquired infection surveillance data.

“CDC will continue to invest in healthcare infection prevention, training all healthcare providers, and ensure that healthcare facilities and state and local healthcare partners have actionable data. to ensure that those in need of health care during the pandemic and beyond can receive care safely. “, says the press release.

  • Molly Walker is associate editor and covers infectious diseases for MedPage Today. She is the recipient of the J2 Achievement Award 2020 for her COVID-19 coverage. To follow

Disclosures

Weiner-Lastinger and his colleagues did not disclose any conflict of interest.

Palmore and Henderson did not disclose any conflict of interest.



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