Covid pandemic reverses years of progress in efforts to make hospitals safe for patients

By Adrianna Rodriguez

With extensive funding and training, federal agencies and health care systems have spent years working together to reduce hospital-acquired infections and increase overall patient safety in the U.S..

From 2018 to 2019, there was up to an 18% decrease in central line-associated bloodstream infections, catheter-associated urinary tract infections and certain surgical site infections among acute care hospitals, according to the Centers for Disease Control and Prevention.

A new study from the agency shows the COVID-19 pandemic threatens to undo that progress.

An analysis of the CDC’s National Healthcare Safety Network found four out of the six routinely tracked infections saw major increases in 2020, according to the study published Thursday in the peer-reviewed journal Infection Control & Hospital Epidemiology.

“As COVID has done in so many other areas, it has had unintended impacts in all of our health care delivery and that extends to health care associated infections,” study spokesperson Dr. Arjun Srinivasan, associate director for the CDC’s Healthcare Associated Infection Prevention Programs, told USA TODAY.

The largest increases were seen in bloodstream infections associated with central line catheters that are inserted into large blood vessels to provide medication and other fluids. The report showed rates of central line infections were 46% and 47% higher in the third and fourth quarters of 2020 compared with 2019.

Because of the Covid-19 pandemic, hospitals were forced to bypass many of their safety protocols in the last 18 months.

The study showed an increase in catheter-associated urinary tract infections, antibiotic resistant staph infections and ventilator-associated infections, which increased by 45% in the fourth quarter.

Though the study did not specifically look at mortality rates, Srinivasan said approximately 20% of these infections can lead to major complication or death.

The influx of COVID-19 patients and increased use of medical devices during the pandemic created the perfect opportunity for hospital-associated infections to prosper, said David P. Calfee, an infectious disease doctor at Weill Cornell Medicine and editor of the journal Infection Control & Hospital Epidemiology, where the study was published. Calfee is not affiliated with the study.

“This is data coming from a very much unprecedented time in modern health care where there were extreme stresses placed on our systems,” he said. “All of these things on a good day put individuals at an increased risk of infection, and this was happening in a setting of tremendous increases in the number of critically ill patients.”

Patients were not only sicker but were also hospitalized longer, Calfee said, increasing the chances of acquiring an infection in the hospital setting. Most of these patients were on immune-suppressing steroids, which were used throughout the pandemic to treat COVID-19 but could have made the body more vulnerable to other pathogens.

Though health care institutions spent years training personnel to reduce hospital acquired infections, experts said many of these practices may have fallen by the wayside as facilities faced shortages in staff, space and safety equipment.

“Infection control practices in COVID-19 wards often adapted to shortages of personal protective equipment, responded to fear of health care personnel, and did not always lend themselves to better infection prevention,” Drs. Tara N. Palmore and David K. Henderson of the National Institutes of Health said in an editorial that accompanied the study.

The findings aren’t intended to heap blame on health care workers, Srinivasan stressed.

“This report is not in any way a comment on the tireless efforts of health care workers that take care of people day in and day out under extraordinarily difficult circumstances,” he said. “These are complex problems and require multifaceted solutions.”

Experts said health care facilities must create crisis infection control practices and hardwire them for future pandemics to avoid losing progress when the system is stressed. Srinivasan said the CDC is working closely with hospitals and health systems to figure it out.

“The question of a pandemic was never if, but when, and the when is now,” he said.
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Credit: USA Today