Healthcare-associated infection rates rose in 2020 amid pandemic

Infection control practices took a backseat to COVID-19 precautions as health systems struggled to treat a barrage of patients while keeping health personnel safe, according to a report on Centers for Disease Control and Prevention data unveiled Thursday.

Rates of serious healthcare-associated infections increased in 2020 compared to the prior year, reveals a study using data from the National Healthcare Safety Network published in the journal Infection Control & Hospital Epidemiology.

Pre-pandemic methods used to decrease infections were not followed as rigorously last year due to a shortage of personal protective equipment and a shift in priorities, said Dr. Mary Hayden, chief of Chicago-based Rush University Medical Center’s infectious diseases division and president of the Society for Healthcare Epidemiology of America’s board of directors. The epidemiology society publishes Infection Control & Hospital Epidemiology.

“When we were doing things not according to the absolute best practices, because of the stresses and limitations imposed by COVID-19, we saw these increases,” Hayden said. “In some ways that’s a positive thing, because it suggests that what we were doing before was effective.”

To determine the impact of the pandemic on infections in hospitals, researchers calculated national and state-level standardized infection ratios for each quarter, focusing on central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events and antibiotic resistant staph infections.

Blood infections associated with central line catheters increased the most: Rates were 46% to 47% higher in the third and fourth quarters of 2020 compared to 2019.

Ventilator-associated infections rates increased by 45% in the fourth quarter of 2020, which the CDC found was not merely a reflection of a dramatic uptick in devices being used to treat COVID-19 patients. Near the end of 2020, rates of catheter-associated urinary tract infections increased by nearly 20%.

Influxes of patients spending long periods in the hospital as well as shortages in staffing and personal protective equipment made paying close attention to infection control protocols challenging, said Dr. Arjun Srinivasan, associate director for healthcare-associated infection prevention programs in the CDC’s division of healthcare quality promotion.

“This is not a reflection of people failing. This is a reflection of systems that were not as strong as they needed to be to prevent these infections,” Srinivasan said. “The question then becomes: How do we fix the system? How do we make it so that, if there is another stress like this, our system will be ready to respond?”

Although most major infection rates rose in 2020, the study found that the rat3es of surgical-site infections and Clostridioides difficile, a bacterial infection occurring after antibiotic use, remained the same as in 2019 or declined.

The study attributes the steady rate of surgical-site infections to hospitals performing fewer elective surgeries and mostly conducting them in operating rooms with infection control processes that were separate from COVID-19 wards.

Lower rates of C. diff. infections likely were the result of increased focus on hygiene and fewer antibiotics prescribed in outpatient settings, Srinivasan said.

Environmental cleaning was probably not as well-executed during the early days of the pandemic as hand washing was, Hayden said.

Before long term solutions such as assigning extra workers to focus on infection control can be implemented to address future crises, health systems need to work together to share practices that have helped in the short term, Srinivasan said.

Despite the study’s findings, patients should not be concerned about infections when seeking medical care, Hayden said. Safety practices have improved over the course of the pandemic and hospitals know how to more effectively keep workers and patients safe, she said.

Even for hospitals experiencing a surge of COVID-19 patients, healthcare-associated infection levels are likely lower now than they were in 2020, and closer to 2019 levels, Hayden said.

“We know a lot more about COVID-19 than we did in the beginning,” Hayden said. “We’ve been very flexible in adopting measures and modifying our measures over time as we learn more.”


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