The Disproportionate Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare-Associated Infections in Community Hospitals: Need for Expanding the Infectious Disease Workforce

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.

The factors associated with the trend in incidence of Bacteraemia and associated mortality over 30 years

“…The increase in vascular catheter-associated BSIs is undoubtedly related to increased use, and possibly due to an extension in peripheral line change rules to 96 h after insertion in the last 5 years [ 25 ], or to an increase in temporary nursing staff recruitment [ 26 ]. Markedly, the appearance of the SARS-CoV-2 pandemic in the last year, was associated with an increase in vascular catheter BSI in the ICU [ 27 ].…”

Prevalence of hospital-associated infections and its association with discharge destinations and hospital readmissions in Brussels, Belgium, from 2008 to 2020: A hospital-based, cross-sectional study

“…Interestingly, the clear increase of all HAIs with the exception of SSIs in 2020 is indicative of the COVID-19 pandemic during which the risk of HAI rose 23 and many nonurgent elective surgeries were postponed. 24 Identical patterns were described in the United States, 25,26 and in the countrywide HABSI surveillance. 27 A similar trend applied to the case fatality risk, which was the highest in 2020 (21.05%).…”

Advancing health equity through action in antimicrobial stewardship and healthcare epidemiology

“…Patients in smaller community hospitals, particularly in the Southeastern United States, were disproportionately affected by CDI, catheter-associated urinary tract infections (CAUTIs), and CLABSIs during the height of the COVID-19 pandemic. 58 Children living in rural counties (compared to children living in urban counties) have increased rates of inappropriate antibiotic use. 59 To address these geographic differences in HAIs and antibiotic prescribing quality, improving access to ID expertise (local or telehealth) is warranted to serve smaller rural community hospitals.…”