Data supports maintaining standard cleaning / disinfection procedures , and anytime those are minimized it could create an opportunity for transmission . The key is to collaborate with busy healthcare workers to help them navigate evolving scientific guidance and streamline practices so standard cleaning / disinfection can be incorporated into their complex workflow .”
— Elizabeth Monsees , PhD , MBA , RN , CIC , FAPIC
inappropriately , transmission of resistant and non-resistant agents from surfaces to individuals can occur .”
She continues , “ IPs are keenly aware that SARS-CoV-2 is an important and concerning pathogen but the recent guidance change should not minimize the performance of standard cleaning / disinfection practices . As consumers of healthcare or as healthcare workers , it ’ s important to be aware that other bacteria and viruses are present . In fact , healthcare facilities are seeing patients with respiratory syncytial virus ( RSV ) and other respiratory viruses , much earlier than typically presented . Recently , the CDC has reported on pan-resistant fungal pathogens like Candida auris which can cause significant disease and can be tremendously difficult to treat . Striking a balance between prevention and control while battling SARS-CoV-2 is certainly concerning . Data supports maintaining standard cleaning / disinfection procedures , and anytime those are minimized it could create an opportunity for transmission . The key is to collaborate with busy healthcare workers to help them navigate evolving scientific guidance and streamline practices so standard cleaning / disinfection can be incorporated into their complex workflow .”
Neglecting Other Pathogens at Our Peril ?
There are two primary concerns relating to hygiene theater . The first of which is any de-emphasis on cleaning and disinfection as a response to SARS-CoV-2 transmission being seen as primarily an airborne challenge , which could allow ESKAPE and other pathogens of concern to dominate in healthcare facilities . The second issue is that improper or inferior cleaning and use of disinfectants can make resistance worse among antibiotic / antimicrobial-resistant organisms ( AAROs ).
Of note , clinicians are recognizing that a preoccupation with SARS-CoV-2 / COVID-19 over the last 18 months or so has allowed healthcare-acquired infection rates to creep up again .
After years of steady reductions in HAIs , significantly higher rates of four out of six routinely tracked infections were observed in U . S . hospitals , according to a CDC analysis of data from the National Healthcare Safety Network ( NHSN ). 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 .
“ 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 Arjun Srinivasan , MD , CDC ’ s associate director of Healthcare-Associated Infection Prevention Programs , in a statement . “ Strengthening infection prevention and control capacities works . This information emphasizes the importance of building stronger , deeper and broader infection control resources throughout healthcare that will not only improve our ability to protect patients in future pandemics but will also improve patient care every day .”
For this analysis , researchers used data collected through NHSN , 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 .
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 .
“ 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 ,” wrote Tara N . Palmore , MD , and David K . Henderson , MD , of the National Institutes of Health , in an editorial that accompanied 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 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 wards . In addition , no increase was found in Clostridioides difficile . The study 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 .
As the paper by Weiner-Lastinger , et al . ( 2021 ) acknowledges , “ The year 2020 marked an unprecedented time for hospitals , many of which were faced with extraordinary circumstances of increased patient caseload , staffing challenges , and other operational changes that limited the implementation and effectiveness of standard infection prevention practices . A regular review of HAI surveillance data is critical for hospitals to identify gaps in prevention and address any observed increases in HAIs . Infection prevention staff should continue to reinforce infection prevention practices in their facilities and consider the importance of building resiliency in their programs to withstand future public health emergencies .” They note , “ Hospital infection prevention staff also had to focus primarily on the pandemic . Infection prevention staff were inundated with COVID-19 problems and issues that simply had to be addressed emergently . For this reason , much of the effort typically given to traditional hospital infection prevention and control activities received less intense scrutiny than during non-pandemic times .”
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