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CLABSIs Provide a Snapshot of How COVID-19 Impacted HAIs , Clinical Capacity
By Kelly M . Pyrek
At the one-year mark of the pandemic , we are beginning to get a better sense of the impact of COVID-19 on U . S . healthcare facilities from a data perspective . Sapiano and Dudeck ( 2021 ) report time-series estimates of the critical hospital capacity indicators from April 1 to July 14 , 2020 using data from the CDC ’ s National Healthcare Safety Network ( NHSN )’ s module for collecting hospital COVID-19 data . The investigators say that NHSN hospital capacity estimates served as important indicators of the pandemic ’ s magnitude , spread and impact , providing quantitative guidance for the public health response .
The researchers found that during the
NHSN hospital capacity estimates served as important indicators of the pandemic ’ s magnitude , spread and impact , providing quantitative guidance for the public health response .
• pandemic ’ s April peak in the U . S ., among an estimated 431,000 total inpatients , 84,000 ( 19 percent ) had COVID-19 . Although the number of inpatients with COVID-19 decreased from April to July , the proportion of occupied inpatient beds increased steadily . COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased . The proportion of inpatients with COVID-19 on ventilators decreased from April to July .
According to Sapiano and Dudeck ( 2021 ), 6,256 hospitals were enrolled and active in NHSN for HAI reporting , with 4,576 hospitals ( 73.1 percent ) reporting COVID-19 data at least once on or prior to July 14 , 2020 . The number of consistently reporting hospitals ( reporting an average of five of seven days over the period ) was 2,171 ( 34.7 percent ) in April but was higher in May at 3,579 ( 57.2 percent ) and June – July ( combined because data end in mid-July ) at 3,382 ( 54.1 percent ). When split by facility type , consistent reporting was strongest among ACHs with 100 or more beds , with about 60 percent or more consistently reporting in May and June – July . Overall , reporting was lower among smaller hospitals including CAHs , women ’ s and children ’ s hospitals , LTACHs , and IPFs . Coverage was even between urban and rural areas .
The researchers report that the number of inpatient beds occupied in the U . S . increased steadily from 431,195 on April 10 to 540,491 on July 10 . Over the same period , the number of inpatient beds occupied by patients with COVID-19 decreased from a national high of 84,149 on April 10 to 62,880 on July 10 ,
Red blood cells enmeshed in a fibrinous matrix on the luminal surface of an indwelling vascular catheter . Courtesy of Janice Haney Carr / CDC
with a low around 43,158 on June 5 . New York had the most daily hospitalized patients , followed by New Jersey , Illinois , Massachusetts , Pennsylvania , Michigan and California . During late June and early July , the increase in national inpatient beds occupied by patients with COVID-19 was driven by cases in California , Florida , Texas , Arizona and Georgia .
According to Sapiano and Dudeck ( 2021 ), the number of ventilators in use by patients with COVID-19 showed strong contrast between states at the start and at the end of the period . New York had the highest number of ventilated patients with COVID-19 with 3,600 on April 24 , but this fell to 216 on July 10 . During the latter part of the period , increases occurred in ventilated patients with COVID-19 in Texas , California , Florida , Arizona and Georgia . As the researchers note , “ The ratios of patients on ventilators and in the ICU to all inpatients may be used as an indicator of patient severity . The ratio fell from 0.20 on April 24 to 0.12 on July 10 , suggesting that the number of ventilated patients with COVID-19 compared to the number of inpatients with COVID-19 was lower in mid-July than in late April . A similar decrease was evident in the ratio of patients with COVID-19 in an ICU bed to all inpatients with COVID-19 , which dropped from 0.27 on June 12 to 0.23 on July 10 . The ratio of patients with COVID-19 on a ventilator to patients with COVID-19 in an ICU bed was unchanged from 0.56 on June 12 to 0.54 on July 10 .”
NHSN data also provide a snapshot of hospital capacity early in the pandemic . As Sapiano and Dudeck ( 2021 ) explain , “ Initially , many hospitals postponed elective admissions and emergency department visits decreased . As the pandemic continued into June and July of 2020 , hospital occupancy increased nationally ; at the same time , the outbreak progressed into regions that had lifted stay-at-home orders . The highest burden for treatment of patients with COVID-19 fell on ACHs with more than 100 beds that treated 88.1 percent of all inpatients with confirmed or suspected COVID-19 and 94.1 percent of all ventilators in use by patients with COVID-19 on April 24 , 2020 . Although smaller ACHs and CAHs had relatively small proportions of patients with COVID-19 , tracking the impact in these facilities was important for the allocation of therapeutics and supplies , particularly for CAHs that may be the only practical option for underserved rural populations .”