By Alexandra Mae Jones, CTVNews.ca Editor
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Toronto, Ontario (CTV Network) — During the pandemic, health experts noticed that healthcare facilities were experiencing an increase in hospital-acquired infections — but they weren’t sure why.
According to a new US study of more than five million hospitalizations between 2020 and 2022, the answer may not be lower quality overall care or overwhelmed hospitals.
Instead, the study found that the rise in healthcare-associated infections (HAIs) was largely in COVID-19 patients, with HAI rates among non-COVID-19 patients remaining close to the pre-pandemic baseline.
The researchers say this suggests that COVID-19 patients are particularly susceptible to new infections when receiving care in a healthcare setting compared to other patients, and healthcare professionals should take this into account.
“Patients without COVID-19 had IASS rates that would be expected based on observed incidence before the pandemic,” the study states.
“This analysis suggests that the greatest opportunity to improve outcomes may involve targeting additional resources to give even greater attention to the hospitalized COVID-19 population.”
The study, which was published April 14 in the peer-reviewed journal JAMA Network Open, looked at data collected from 182 hospitals in 21 states. All facilities were affiliated with HCA Healthcare, a company that operates for-profit healthcare facilities in many US states.
The researchers reviewed all reported HAIs that occurred at these facilities between January 1, 2019 and March 31, 2022, focusing on the occurrence of HAIs in the general patient population as well as in the specific patient population. patients with COVID-19.
A health care-associated infection is not an infection that sends you to the hospital – it is a specific term for situations in which someone being treated in a health care setting, such as a hospital, develops an infection or a separate problem during the process of receiving treatment for their original problem.
For example, the development of a catheter-associated urinary tract infection that a patient had while being treated for a separate problem would be classified as an HAI.
In this study, researchers stratified HAIs into four categories: catheter-associated urinary tract infections (CAUTI); central line bloodstream infections (CLABSI) – in which a tube delivering blood, fluids or medication to the patient contains bacteria or germs; Methicillin-resistant Staphylococcus aureus (MRSA), which is a super bug that causes hard-to-treat infections; or C.difficile (CDIFF)—a bacteria that often occurs when you take antibiotics.
In total, there were 313,200 COVID-19 patients in the dataset. The median age of these patients was 57 years. During the same period, these facilities saw 4,564,375 discharges of patients who did not have COVID-19.
The average length of stay for COVID-19 patients was 8.2 days, while the average length of stay for patients without COVID-19 was around 4.7 days.
The researchers found that while HAIs increased during the pandemic as a whole, they did so as the number of patients increased due to COVID-19. Between March and September 2020, the rate of IASS, excluding CDIFF, increased from 43 to 60%.
Importantly, the HAI rate among patients without COVID-19 did not change much from the pre-pandemic baseline – the large increases were seen in COVID-19 patients.
The results also differed by type of IAS.
The biggest difference was in the occurrence of CLABSI – these bloodstream infections were seen at a significantly higher rate in hospitalized patients with COVID-19, nearly four times higher than those without the virus. The rate among hospitalized patients without COVID-19 remained similar to pre-pandemic levels and was actually slightly lower than the rate seen in the first quarter of 2019.
The rate of catheter-associated infections was 2.7 times higher in COVID-19 patients than in non-COVID patients, and MRSA was seen in COVID-19 patients at three times the rate of patients no COVID.
The CDIFF was an outlier in that it had declined steadily by quarter since the start of 2019, with 2019 levels above those seen after the start of the pandemic. The rate of infections increased only slightly to about nine cases per 100,000 people in the first quarter of 2022. This was the only IASS where the rate in the COVID-19 population was not significantly elevated compared to the non-COVID population.
The researchers noted that the study is limited by a number of factors, including that they only looked at four common IASS and did not look at other sources of infection that might have had a specific impact on the COVID-19 population.
It is unclear at this point why COVID-19 patients might be more susceptible to these infections.
The researchers suggest this could be due to a combination of factors, such as their increased length of hospital stay, the fact that staff working on COVID-19 patients may have been particularly overworked or reshuffled from their usual tasks, or potentially some factor in the disease itself.
“A comprehensive understanding of the high vulnerability of the COVID-19 population to HAIs will be helpful in guiding infection prevention practices in the future,” the researchers wrote in the study. “The high frequency of HAIs may be associated with an inherent risk associated with the clinical status of COVID-19 infection requiring hospitalization or it may be associated with care practices that introduce risk.”
Previous research has suggested that infection prevention was abandoned during more intense waves of COVID-19, but this study suggests that healthcare professionals maintained largely the same level of care to prevent these infections for patients not COVID than before.
Once this confounder is removed, the researchers hope that more can be done to isolate why COVID-19 patients may be more susceptible to HAIs, and what needs to be done in hospitals to make them safer for COVID-19 patients. 19.
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