Abstract
Background
The COVID-19 pandemic had a considerable impact on US healthcare systems, straining hospital resources, staff, and operations. However, a comprehensive assessment of the impact on healthcare associated infections (HAIs) across different hospitals with varying level of infectious disease (ID) physician expertise, resources, and infrastructure is lacking.
Methods
This retrospective longitudinal multi-center cohort study included central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), C. difficile infections (CDIs), and ventilator-associated events (VAEs) from 53 hospitals (academic and community) in Southeastern United States from January 1, 2018 to March 31, 2021. Segmented negative binomial regression generalized estimating equations models estimated changes in monthly incidence rates in the baseline (01/2018 – 02/2020) compared to the pandemic period (03/2020 – 03/2021, further divided into three pandemic phases).
Results
CLABSIs and VAEs increased by 24% and 34% respectively during the pandemic period. VAEs increased in all phases of the pandemic, while CLABSIs increased in later phases of the pandemic. CDI trend increased by 4.2% per month in the pandemic period. On stratifying the analysis by hospital characteristics, the impact of the pandemic on healthcare-associated infections was more significant in smaller sized and community hospitals. CAUTIs did not change significantly during the pandemic across all hospital types.
Conclusions
CLABSIs, VAEs, and CDIs increased significantly during the pandemic, especially in smaller community hospitals, most of which lack ID physician expertise. Future efforts should focus on better understanding challenges faced by community hospitals, strengthening infection prevention infrastructure, and expanding the ID workforce, particularly to community hospitals.
Keywords: SARS-COV-2, pandemic, infection prevention, healthcare associated infections, CLABSIs, CAUTI, Cdifficile, VAE
Contributor Information
Sonali D Advani, Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
Emily Sickbert-Bennett, Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US.
Rebekah Moehring, Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
Andrea Cromer, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
Yuliya Lokhnygina, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, US.
Elizabeth Dodds-Ashley, Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
Ibukunoluwa C Kalu, Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, US.
Lauren DiBiase, Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US.
David J Weber, Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US.
Deverick J Anderson, Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
Supplementary Material
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