Data show that despite the heroic and unceasing efforts of infection prevention teams and frontline workers during the past two years , the rates of CLABSIs and several other healthcareassociated infections have substantially worsened during the COVID-19 pandemic , reversing years of progressive improvement .”
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 .”
Other researchers have documented the trend as well .
Fakih , et al . ( 2021 ) sought to evaluate the impact of COVID-19 pandemic on CLABSIs and other HAIs in hospitals . The investigators performed a retrospective study in 78 U . S . 12 months before COVID-19 and 6 months during the COVID-19 pandemic . During the two study periods , there were 795,022 central-line days . Compared to the period before the COVID-19 pandemic , CLABSI rates increased by 51.0 percent during the pandemic period from 0.56 to 0.85 per 1,000 line-days , and by 62.9 percent from 1.00 to 1.64 per 10,000 patient days . This trend was mainly observed in the intensive care units ( ICUs ) where CLABSI rates increased by 71 percent from 0.68 to 1.16 per 1,000 line-days , and by 90.7 percent from 2.95 to 5.63 per 10,000 patient days .
The researchers found that hospitals with monthly COVID-19 patients representing more than 10 percent of admissions had an NHSN device SIR for CLABSI that was 2.38 times higher than hospitals with less than 5 percent prevalence during the pandemic period . Coagulase-negative Staphylococcus CLABSIs increased by 130 percent from 0.07 to 0.17 events per 1,000 line-days , and Candida spp by 56.9 percent from 0.14 to 0.21 per 1,000 line-days . In contrast , no significant changes were identified for CAUTI ( 0.86 vs 0.77 per 1,000 catheter-days . The researchers conclude that “ The COVID-19 pandemic was associated with substantial increases in CLABSIs . Our findings underscore the importance of hardwiring processes for optimal line care and regular feedback on performance to maintain a safe environment .”
During months when patients with active COVID-19 represented more than 10 percent of admissions , the CLABSI dSIR was 2.38 times higher ( dSIR , 1.58 ) than in months when COVID-19 prevalence among hospitalized patients was less than 5 percent ( dSIR , 0.67 ). The researchers detected no significant differences in CAUTI dSIR based on monthly COVID-19 prevalence . In total , 219 CLABSI events occurred between March and August 2020 ; of these , 24 percent occurred in patients hospitalized with COVID-19 . Also , two additional patients were identified with COVID-19 after their CLABSI event . The average time to CLABSI from COVID-19 diagnosis was 18.0 days ( median , 15.0 ). During the six months evaluated during the pandemic , 18,048 patients diagnosed with COVID-19 were admitted to the 76 of the 78 hospitals ( with available data on patient-based COVID-19 prevalence ), constituting 5.1 percent of all admissions . Proportionately , COVID-19 patients had > more than five times more CLABSI events than non – COVID-19 patients . A significant difference was observed in mortality between patients with CLABSI for those with COVID-19 ( 53.8 percent ) and without COVID-19 ( 24 percent ) during that period .
From a microbiology perspective , the researchers found 344 organisms associated with CLABSI events in the 12 months before the COVID-19 pandemic , while 236 organisms were associated with CLABSI events , and 237 organisms were associated with CAUTI events during the 6 months during the COVID-19 pandemic . Gram-positive CLABSIs increased by 80.6 percent from 0.27 to 0.48 events per 1,000 line-days . Specifically , coagulase-negative Staphylococcus CLABSIs increased by 130 percent from 0.07 to 0.17 events per 1,000 line-days , and Candida spp infections increased by 56.9 percent from 0.14 to 0.21 per 1,000 line-days .
As Fakih , et al . ( 2021 ) note , “ Based on central-line days , CLABSI rates increased by more than two-thirds within the ICUs , whereas the events per 10,000 patient days almost doubled . Recent studies have reported large increases in CLABSI events and a higher likelihood for secondary bloodstream infections in COVID-19 patients requiring intensive care . To reduce healthcare worker exposure to patients and to preserve personal protective equipment , the frequency of contact with patients may have changed during the pandemic . Moreover , patients admitted during the pandemic were more likely to require critical care support and to need it for a longer period , potentially putting them at greater risk for CLABSI . The proportion of COVID-19 patients with CLABSI events was five times greater than for non – COVID-19 patients during the pandemic period . Additionally , the average time from COVID-19 diagnosis to developing CLABSI was about 18 days , indicating that the CLABSI events occurred in COVID-19 patients with prolonged hospitalization . Although the increases in CLABSI events did not reach statistical significance in non – ICUs , we expect that similar challenges in infection prevention were encountered .
“ Data show that despite the heroic and unceasing efforts of infection prevention teams and frontline workers during the past two years , the rates of CLABSIs and several other healthcare-associated infections have substantially worsened during the COVID-19 pandemic , reversing years of progressive improvement ,” said Deborah Yokoe , MD , MPH , SHEA ’ s chair of the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals : 2022 Updates . “ These infections seriously threaten patients ’ lives and recovery , and the rising rates are further evidence for the need to build more resilient systems of care . The Compendium is foundational for helping hospitals do this .”
An integral risk-reduction strategy for CLABSI is anchored in the optimal maintenance of the device , some experts say . As Marschall , Mermel and Fakih observe , “ In the pre-pandemic period , CLABSI prevention strategies were hardwired at our hospitals leading
26 september 2022 •
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