Healthcare-associated infections in Veterans Affairs acute-care and long-term healthcare facilities during the coronavirus disease 2019 (COVID-19) pandemic

Abstract

Objective: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infections (HAIs) reported from 128 acute care and 132 long-term care Veterans Affairs (VA) facilities. Methods: Central line-associated bloodstream infections (CLABSIs), ventilator-associated events (VAEs), catheter-associated urinary tract infections (CAUTIs), and methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infections and rates reported from each facility monthly to a centralized database before the pandemic (February 2019 through January 2020) and during the pandemic (July 2020 through June 2021) were compared. Results: Nationwide VA COVID-19 admissions peaked in January 2021. Significant increases in the rates of CLABSIs, VAEs, and MRSA all-site HAIs (but not MRSA CLABSIs) were observed during the pandemic period in acute care facilities. There was no significant change in CAUTI rates and C. difficile rates significantly decreased. There were no significant increases in HAIs in long-term care facilities. Conclusions: The COVID-19 pandemic had a differential impact on HAIs of various types in VA acute care with many rates increasing. The decrease in CDI HAIs may be due, in part, to evolving diagnostic testing. The minimal impact of COVID-19 in VA long-term facilities may reflect differences in patient numbers and acuity and early recognition of the impact the pandemic had on nursing home residents leading to increased vigilance and optimization of infection prevention and control practices in that setting. These data support the need for building and sustaining conventional infection prevention and c ontrol strategies before and during a pandemic.

Health Care–Associated Infections Among Hospitalized Patients With COVID-19, March 2020-March 2022

“…A follow-up analysis demonstrated that HAI rates continued to increase through the third quarter of 2021 . Similarly, a report from the VA Health Care system documented increases in the occurrence of CLABSI and ventilator-associated adverse events and a simultaneous decrease in CDIFF during the pandemic, although there was no reported change in CAUTI or MRSA CLABSIs . In the HCA Healthcare (HCA) system in 2021, data from 82 hospitals indicated an increase in HAIs as well as clusters of infection, and these increases correlated with surges in volume of patients with COVID-19 at the hospital level …”

“…2 Similarly, a report from the VA Health Care system documented increases in the occurrence of CLABSI and ventilator-associated adverse events and a simultaneous decrease in CDIFF during the pandemic, although there was no reported change in CAUTI or MRSA CLABSIs. 3 In the HCA Healthcare (HCA) system in 2021, data from 82 hospitals indicated an increase in HAIs as well as clusters of infection, and these increases correlated with surges in volume of patients with COVID-19 at the hospital level. 4 While this evidence indicates that the occurrence of HAIs increased during the COVID-19 pandemic, it is unclear whether this was due to the increased strain on available hospital resources or increased susceptibility of patients with COVID-19.…”

The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review

“… 24 Similarly, a retrospective study of CLABSIs in the USA found that in hospitals where >10% of admitted patients had COVID-19 there were significantly higher rates of CLABSIs compared with hospitals where COVID-19 accounted for <5% of admissions. 25 VAPs increased across Europe 26–28 and North 8 , 9 , 17 and Latin America. 6 Conversely, in the USA CAUTIs increased only slightly in 2020 and 2021 1 , 17 while Clostridioides difficile infections decreased 8 , 17 , 29 and SSIs remained stable.…”

Update on Sepsis Epidemiology in the Era of COVID-19

“…The incidence of hospital-onset Closridioides difficile infections may be decreasing. [89][90][91][92][93][94][95][96] COVID-19 may predispose patients to ventilator-associated events although the extent to which this is due to complications of care vs progression of preexisting disease needs further elucidation. 97 Finally, researchers have found unexpected and marked decreases in the incidence of several non-COVID disease processes such as acute coronary syndromes and premature births during the pandemic era which may be related to delayed care but have not yet been fully explained, suggesting that stability of previous epidemiologic trends should not be presumed for any disease process, including sepsis.…”