The study examined the effect of the COVID-19 pandemic on specific types of infections, including MRSA and CDIs.
The COVID-19 pandemic and its impact on hospital policies and staffing significantly affected the number of hospital-acquired infections (HAIs) at 2 hospitals in the same healthcare system in Illinois between September 2017 and December 2020, according to a recent examinationentitled “Impact of COVID-19 on Hospital Acquired Infections,” published in American Journal of Infection Control.
Halverson et al performed this study to investigate the effect of the COVID-19 pandemic on specific types of infections, including device-related infections, catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), methicillin resistant Staphylococcus aureus (MRSA), and Clostridiodes infections (CDIs).
The investigators predicted that “device-related infections, catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) would increase due to the change in the complexity of hospitalized patients and the safety practices implemented to reduce COVID-19 transmission risk to healthcare providers (ie enter patient rooms less frequently), “wrote Halverson et al.” It was also predicted that methicillin resistant Staphylococcus aureus (MRSA) and Clostridiodes infections (CDIs) would decrease due to increased environmental degradation. “
Premium pay hours (the total total number of overtime hours and overtime hours), specifically non-permanent employees, floating nurses and overtime, significantly associated with increased HAI levels. The authors noted in the study that “previous studies have found that COVID-19 patients and COVID-19 designated devices are more likely to have more HAIs than COVID-19 negative patients and non-COVID-19 devices. “
In particular, both hospitals showed significant increases in HAIs during the COVID-19 pandemic despite their differences: the first hospital was a 159-bed in a suburban hospital, and the second hospital was an academic training hospital with 894 beds.
The data [Figure 1] from the 2 hospitals together showed a significant increase in CLABSI per. 1000 patient days and 1000 unit days during the pandemic (P <0.01, P <0.05). There was also a significant increase in the total number of infections per 1000 patient days (P <0.05) and a tendency for a significant increase in CAUTI per 1000 patient days (P = 0.052). Examination of the staff measures showed significant increases in the percentage of hours that were premium pay (P <0.005), RN pr. patient days (P <0.0005), office hours (P <0.01), and percentage of the premium salary that was bureau hours (P <0.0001).
Because more covariates [Figure 2] significantly correlated with both individual and combined HAI rate during COVID-19, Halverson et al. a multivariate linear regression “to determine whether the non-clinical factors for staff and COVID-19 cases and deaths in the area significantly correlated with the HAI increases,” they wrote. They adjusted for the percentage of COVID-19 cases and deaths in Illinois and county levels, and they noted that the percentage of premium wage hours was significantly associated with an increase in overall HAI rates. “Each 1% increase in premium wage hours resulted in 0.13 total HAIs when adjusted for Illinois-level COVID-19 cases and deaths, and 0.13 HAIs when adjusted for county-level data. (P “This was higher than in the non-COVID period, where each 1% increase in premium wage hours resulted in 0.077 total HAIs,” they found. These results correlate with the results of one examination previously covered by ICT®.
The authors did not include site-of-surgery infections in the study due to the significant change in surgical volume caused by the pandemic. Patients admitted to rehabilitation, psychiatry, childbirth, and maternal and infant units were also not included in the study results.
Halverson et al admit that the results, although important, are limited in what they offer for policy change in addition to increasing clinical practice monitoring. However, “Our finding that premium pay hours, and in particular agency hours, allows for further research and potential policy changes related to onboarding and continuing education,” they wrote. Further investigation is warranted with an increased sample size and more hospitals.
An Article from ICT® discusses the recommendations of the Association for Professionals in Infection Control and Epidemiology (APIC) COVID-19 Task Force to prevent the increase in HAIs during a future pandemic.
With a persistent shortage of staff in the medical field, it is crucial to ensure that there is proper training and education in place for the staff. Infection prevention experts need to be able to audit and collaborate with staff to help reduce the increased infection rates. The authors suggest that “increased awareness of device bundle compliance, device necessity, and observations of IP practices, including hand hygiene and cleaning, should occur, especially during a pandemic increase, when staff are flexed to work in alternative locations or when the number of agencies increases. “while these patients had a high degree of complexity and often had multiple units, care was pooled to reduce staff meetings with patients, and thorough unit care may have been rejected.”