If there is an ongoing MRSA outbreak or high or increasing MRSA infection rates , the guidance says hospitals should consider not discontinuing contact precautions for MRSA-colonized or -infected patients .
Facilities should ensure excellent infection prevention and control practices and promote adherence with standard precautions . ”
— Kyle Popovich , MD , MS for all patients in adult ICUs to reduce endemic MRSA clinical cultures . Also , facilities should consider post-discharge colonization of MRSA carriers to reduce post-discharge MRSA infection and readmission .
Turning to community-acquired MRSA ( CA-MRSA ), Popovich pointed out that recent studies have found an increasing proportion of hospital-onset invasive MRSA infections that were caused by community strains . Researchers have found that MRSA colonization and infection is occurring more frequently in those without classic healthcare risk factors , and that community exposures ( such as injection drug use , correctional-facility exposure , crowding and unstable housing ) need to be considered .
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In her presentation , “ Beating Back HAIs ,” Margaret Dudeck , MPH , lead of the NHSN Acute Care Analytics Team , Surveillance Branch , DHQP at the Centers for Disease Control and Prevention ( CDC ), reviewed data from the National Healthcare Safety Network ( NHSN ) and how by 2019 , HAIs were near or exceeding the 2020 HAI targets established by the Department of Health and Human Services ( HHS ).
“ Just prior to the pandemic , we saw that central line-associated bloodstream infections ( CLABSIs ) continued to decrease , while catheter-associated urinary tract infections ( CAUTIs ) had just met the target and dipped slightly below it by 2019 ,” Dudeck explained . “ MRSA has taken a bit more time and had not really neared that target but was slowly decreasing . And Clostridium difficile had definitely exceeded the target by that time . We entered 2020 and I think it ’ s an understatement to say it was the year of unprecedented challenges . There were stresses on the healthcare system and deaths in nursing homes , and in a commentary in the American Journal of Infection Control , there were some predictions of what may happen to HAIs due to the COVID-19 pandemic . In the very early part of the pandemic , NHSN began collecting data on hospital capacity and hospitalizations , and we saw regional and state-wide differences emerge . Hospitals reported more ICU beds than they did in the previous year , upwards of 50 percent to 60 percent in some parts of the U . S . while others were not as impacted at the same time , and so they were not reporting increases in the number of ICU beds . We also had more than 600 hospitals report through NHSN that they were experiencing immediate shortages of healthcare personnel , including nurses , environmental services staff and other healthcare personnel .”
Dudeck continued , “ We did run some estimates of COVID hospitalizations and found the first peak occurred in April 2020 and that 19 percent of all inpatients at that time were hospitalized with COVID-19 . Cases and hospitalizations did decline , as we
know , but then they began to increase again in mid-June in certain regions after stay-at-home restrictions were lifted . So , taking our first look at what was happening with HAIs , we started with CLABSIs , and those gave us the first indication there was a problem . CLABSI rates increased , shifting to some higher SIRs and higher than normal outliers . We also looked at various unit types to understand at the national level what we were seeing relating to these increases . From April through June , we looked at the CLABSI standardized infection ratios and changes in those across the country in different regions , and everyone was experiencing different rates at different times , although not all of them were statistically significant . All regions experienced an increase in CLABSIs , and the SIR percent change ranged from 4.5 percent to 61.3 percent .”
Pointing to the first comprehensive examination of HAIs during the COVID-19 pandemic , Dudek reported that HAI incidence was measured using SIR , and then 2020 SIRs were compared to 2019 SIRs by calendar quarters at state and national levels .
“ We focused on the HAIs that I think we ’ re all used to following , including CLABSI , CAUTI , VAE , SSI , MRSA bacteremia and C . difficile infection ( CDI ),” Dudeck explained . “ We also explored other patient safety-related topics – such as device utilization , community-onset MRSA bacteremia rates , patient length of stay and time-to-infection — to help inform us about what was going on with these data . Nationally , among acute-care hospitals , there were significant increases observed in 2020 vs . 2019 for CLABSI , CAUTI , VAE and MRSA bacteremia . We also identified significant increases in device utilization during this time , and of course , patients with an HAI had longer lengths of stay in 2020 than they did in 2019 . Larger CLABSI increases were seen nationally in ICUs than in wards , and MRSA SIR increases were attributed to a decrease in patient days in Q2 and an increase in events Q3-4 .”
Dudeck continued , “ Looking at the pathogens that were attributed to causing CLABSIs , we identified an increase in the proportion that had Coag-negative Staph or Enterococcus faecalis . These increases occurred in ICUs and wards and there were substantially higher proportions of E . faecalis in November and December 2020 compared to the beginning of that year .”
Dudeck summarized the year from the CDC ’ s national and state HAI progress report , noting that critical access hospitals , long-term acute-care and rehab facilities were not impacted as much or in the same way as acute-care facilities have been .
“ The challenges continued in 2021 , of course ,” Dudeck acknowledged . “ During the second year of the pandemic , there was elevated HAI incidence and device use during periods of high COVID-19 hospitalization in the first three quarters of 2021 . There was a 149 percent increase in the number of VAEs reported to NHSN in Q3 of 2021 than Q3 of 2019 , from the same set of hospitals .”
She continued , “ These increases are such a strong contrast to the success that we have seen previously in reducing HAIs . CLABSI increased at an annual level among all reporters , and sets us back to where we were in about 2016 . With CAUTI we started to notice some slight increases but not quite as dramatic as CLABSI . MRSA is going way up , and CDI continued to decrease but at a slower pace than it had previously . Regarding ventilator-associated events , this is an event that it does not have an HHS goal associated with it , but we do have standardized infection ratios and VAE incidents had been steady between 2015 to 2019 , and of course , as we ’ ve seen from the data , we have