COVID-19 increased the number of healthcare-acquired infections

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A new report shows the coronavirus pandemic had a direct increase on the number of healthcare-acquired infections in hospitals nationwide.

Increases were attributed to factors related to the 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, the report said.

With dramatic increases in the frequency and duration of ventilator use, rates of ventilator-associated infections increased by 45% in the fourth quarter of 2020, compared to 2019. The Centers for Disease Control and Prevention analysis found sharp increases in standardized infection rates, indicating that the increases were not simply a reflection of more devices being used.

"Infection control practices in COVID-19 wards often adapted to shortages of personal protective equipment, responded to fear of healthcare personnel, and did not always lend themselves to better infection prevention," said Drs. Tara N. Palmore and David K. Henderson of the National Institutes of Health, in an editorial accompanying the study. "The success of the previous several years, with steady declines in rates of these (healthcare-associated) and device-related infections, further accentuated the upswings that occurred in 2020." 

The largest increases were for 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% to 47% higher in the third and fourth quarters of 2020, compared to 2019, according to the study. 

From 2019 to 2020, major increases were also found in catheter-associated urinary tract infections, ventilator-associated events and antibiotic resistant staph infections. 

The study was published Thursday in the Society for Healthcare Epidemiology of America, citing data from the National Healthcare Safety Network and CDC. 

"COVID-19 created a perfect storm for antibiotic resistance and healthcare-associated infections in healthcare settings. Prior to the pandemic, public health – in partnership with hospitals – successfully drove down these infections for several years across U.S. hospitals," said Dr. Arjun Srinivasan, the CDC's Associate Director of Healthcare Associated Infection Prevention Programs. 

WHY THIS MATTERS

The increase comes after years of steady reductions in healthcare-associated infections. 

"In a coronavirus disease ward in 2020, preventing a catheter-associated urinary tract infection was probably not always the foremost consideration of healthcare staff," the report said. 

All available resources were directed at minimizing the risks of COVID-19 transmission in the hospital, they said. 

"Nurses and doctors were trying to save the lives of surges of critically ill infectious patients while juggling shortages of respirators and, at times, shortages of gowns, gloves and disinfectant wipes as well," the authors said in their commentary. "Sometimes these efforts went terribly wrong." 

THE LARGER TREND

For this analysis, researchers used data collected through the National Healthcare Safety Network, the nation's largest healthcare-associated infection surveillance system, which is used by nearly all U.S. hospitals to fulfill local, state or federal infection reporting requirements. 

As of 2018, the percentage of hospitals achieving zero infections had declined dramatically since 2015, according to a 2018 Leapfrog report.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com