In 2021 , when it became clear that our outcomes and HAI rates had suffered during that time period , there was a great deal of attention re-focused back on HAI prevention and at the same time we were experiencing some relief from the initial onslaught of the COVID-19 pandemic .” — Deborah Yokoe , MD , MPH , FSHEA
While these are relatively modest decreases , they represent progress compared to recent years when Lastinger , et al . ( 2023 ) examined NHSN data to assess the impact of COVID-19 on the incidence of HAI during 2021 . They found that standardized infection ratios ( SIRs ) in ACHs were significantly higher than those during the pre-pandemic period , particularly during 2021-Q1 and 2021-Q3 . As the researchers acknowledged , “ During 2021-Q1 , all-time highs of COVID-19 – associated hospitalizations were recorded throughout the country . Although large increases were noted in CLABSI , VAE , and MRSA bacteremia in 2021-Q1 , the increase in the CAUTI SIR was modest . Improvements in CLABSI , CAUTI , VAE , and MRSA bacteremia SIRs were observed in 2021-Q2 , coincident with the dramatic reduction in nationwide COVID-19 hospitalizations . However , as the severe acute respiratory coronavirus virus 2 ( SARS-CoV-2 ) δ ( delta ) variant emerged in 2021-Q3 , dramatic increases in SIRs were observed again .”
Lastinger , et al . ( 2023 ) continue , “ Changes in most SIRs were driven by changes in the number of reported HAIs , with several factors contributing to such changes . First , device-associated HAIs were likely affected by the continued alteration of hospital practices that occurred throughout the pandemic . Modifications of CLABSI prevention practices during 2020 are well documented , and prevention practices likely continued to be altered during 2021 . By contrast , the modest increase in CAUTI SIRs may be related to the fact that catheter removal , a primary approach to CAUTI prevention , was still possible even during times of stress on the healthcare system . Conversely , pandemic-related improvements in hand hygiene , PPE practices , and environmental cleaning may have contributed to the decreases observed in the CDI SIR . Colon surgeries and abdominal hysterectomies were not typically performed as part of COVID-19 care , and process flows in the operating room remained relatively unchanged during this time . This finding may explain the lack of significant changes observed in SSI SIRs .”
They add further , “ Different patients may have been admitted to healthcare settings in 2021 compared to the pre-pandemic period , and the increases in SIRs may be explained by changes in the proportion of
patients with different characteristics ( race or ethnicity and comorbidities ). Although some characteristics ( patient location ) were controlled for in the device-associated HAI SIRs , the risk-adjustment models may not have adjusted for all relevant characteristics . In addition , increases in SIRs could have been due to increased patient morbidity from COVID-19 .”
The 2022 data indicate that 3,951 acutecare hospitals reported to NHSN , accounting for 36,448,691 hospital admissions . The average number of beds at these facilities was 129 , and the average number of ICU beds was 14 . The average number of full-time epidemiologists at these facilities was 0.44 . General hospitals ( 3,396 / 85.95 percent ) comprised the greatest number of facilities reporting to the NHSN .
As we know , SIR is a summary statistic that can be used to track HAI prevention progress over time ; lower SIRs are better . Here ’ s a look at the number of events ( infections ) and SIRs for all hospitals reporting on three main HAIs :
• Observed CLABSIs : 23,389 ; 0.836
• Observed CAUTIs : 20,237 ; 0.697
• Observed VAE : 32,631 ; 1.188
According to the data , on the state level compared to itself from 2021 and 2022 :
• 31 states performed better on at least two infection types
• 17 states performed better on at least three infection types
• 6 states performed better on at least four infection types
• 3 states performed worse on two or more infection types
• 1 state performed worse on at least three infection types
Deborah Yokoe , MD , MPH , FSHEA , immediate past-president of the Society for Healthcare Epidemiology of America ( SHEA ) recognizes the hard work that acute-care facilities – under the leadership of healthcare epidemiologists and infection preventionists – have undertaken to shift attention that was focused on responding to the COVID-19 pandemic back to broader infection prevention initiatives that protect patients – and healthcare personnel – from a wide range of infections .
Yokoe says the multi-factorial nature of the COVID-19 pandemic presented the perfect storm that challenged all healthcare facilities when it came to maintaining their equilibrium regarding HAI prevention .
“ We saw worsened patient outcomes and HAI rates starting with the onset of the COVID-19 pandemic ,” Yokoe affirms . “ Patients with COVID-19 infection were at higher risk for some of these HAIs , including central line-associated infections , catheter-associated urinary tract infections , and certainly for ventilator-associated events . Because they were often so sick , they required invasive medical devices , and were complicated patients to take care of . So , just having many patients with COVID-19 in the hospital increased HAI rates , and in addition , all the pressures and consequences of dealing with the pandemic on the massive level that we did starting in 2020 and into 2021 impacted HAI risks for all patients . There were times where we had limited access to supplies , including PPE , hand hygiene products , and surface cleaners and disinfectants , which challenged our ability to care for our patients and their environment . This was compounded by the number of patients that we had in our hospitals , limited hospital beds , and limited staffing , as well as illness , losses , and burnout among some of our workforce ; all those issues placed immense stress on the whole healthcare system . So , in addition to taking care of very sick patients , we were also dealing with some limitations in resources and redirecting some of the energy , time and effort that we had previously been focusing on HAI prevention to deal with all the consequences of COVID-19 .”
Yokoe continues , “ In 2021 , when it became clear that our outcomes and HAI rates had suffered during that time period , there was a great deal of attention re-focused back on HAI prevention and at the same time we were experiencing some relief from the initial onslaught of the COVID-19 pandemic . I think that 2021 report made very clear the impacts of diverting resources away from fundamental , foundational HAI prevention , on patient safety and HAI prevention , and emphasized the importance of having resources and looking to the expertise of groups like healthcare epidemiologists , infection preventionists and antimicrobial stewards to guide the way in using evidence-based best practices . Following the recommendations in the Compendium , and then getting the many stakeholders that are necessary to optimize our HAI prevention efforts together to work in a coordinated way around HAI prevention , have been two of the major reasons that we ’ ve seen improvements in outcomes in the 2022 data .”
Thomas R . Talbot , MD , MPH , FSHEA , president of SHEA and chief hospital epidemiologist at Vanderbilt University Medical Center , points out that many of
14 • www . healthcarehygienemagazine . com • january 2024