Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

Lyall, Marcus J.; Lone, Nazir

doi:10.1136/emermed-2020-210030

Cited by 12 publications

(12 citation statements)

References 14 publications

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“…Additionally, during COVID-19 surges, many elective admissions were canceled, resulting in higher acuity patient populations. [20] Limitations of this study include use of NHSN-reported HAI events. Variations in surveillance and reporting may affect NHSN HAI data, especially when infection prevention activities are constrained.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections

Baker

Sands

Huang

et al. 2021

Clinical Infectious Diseases

206

155

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Background The profound changes wrought by COVID-19 on routine hospital operations may have influenced performance on hospital measures, including healthcare-associated infections (HAIs). We aimed to evaluate the association between COVID-19 surges and HAI and cluster rates. Methods In 148 HCA Healthcare-affiliated hospitals, 3/1/2020-9/30/2020, and a subset of hospitals with microbiology and cluster data through 12/31/2020, we evaluated the association between COVID-19 surges and HAIs, hospital-onset pathogens, and cluster rates using negative binomial mixed models. To account for local variation in COVID-19 pandemic surge timing, we included the number of discharges with a laboratory-confirmed COVID-19 diagnosis per staffed bed per month. Results Central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as COVID-19 burden increased. There were 60% (95% CI, 23-108%) more CLABSI, 43% (95% CI, 8-90%) more CAUTI, and 44% (95% CI, 10-88%) more cases of MRSA bacteremia than expected over 7 months based on predicted HAIs had there not been COVID-19 cases. Clostridioides difficile infection was not significantly associated with COVID-19 burden. Microbiology data from 81 of the hospitals corroborated the findings. Notably, rates of hospital-onset bloodstream infections and multidrug resistant organisms, including MRSA, vancomycin-resistant enterococcus and Gram-negative organisms were each significantly associated with COVID-19 surges. Finally, clusters of hospital-onset pathogens increased as the COVID-19 burden increased. Conclusion COVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.

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Section: Discussionmentioning

confidence: 99%

The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections

Baker

Sands

Huang

et al. 2021

Clinical Infectious Diseases

206

155

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“…[3][4][5][6][7] Historically, in the healthcare system, this disproportionate strain is noticed in both the emergency room and the intensive care unit with increased adverse patient outcomes. [7][8][9][10] This is quite tangible given the current Coronavirus disease 2019 (COVID- 19) pandemic, which has resulted in over 5 million deaths worldwide and has become a MCD of biological origin. 3,[6][7][8][9][10][11][12] Highlighted during the COVID-19 pandemic, elderly populations are among the most vulnerable populations impacted by MCDs due to their decreased mobility and comorbid conditions.…”

mentioning

confidence: 99%

“…[7][8][9][10] This is quite tangible given the current Coronavirus disease 2019 (COVID- 19) pandemic, which has resulted in over 5 million deaths worldwide and has become a MCD of biological origin. 3,[6][7][8][9][10][11][12] Highlighted during the COVID-19 pandemic, elderly populations are among the most vulnerable populations impacted by MCDs due to their decreased mobility and comorbid conditions. [13][14][15][16] Furthermore, individuals with disabilities and/or denoted to be in a high-risk group delay their presentation to seek medical care, even in the presence of worsening conditions.…”

mentioning

confidence: 99%

“…[27][28][29][30][31][32][33][34][35] In this, the COVID-19 pandemic represents a sustained MCD that influenced multiple aspects of healthcare, which has been uniquely felt at the intensive care level. [8][9][10][11]27,29 Classically, length of stay (LOS), number of ICU days, death rate, mechanical ventilation days, readmission rates and complication frequency are used to evaluate critically ill patient outcomes. [9][10][11]29,31,[34][35][36] However, given the resource utilization needs during the COVID-19 pandemic, the economic burden is also of grave importance.…”

mentioning

confidence: 99%

“…[8][9][10][11]27,29 Classically, length of stay (LOS), number of ICU days, death rate, mechanical ventilation days, readmission rates and complication frequency are used to evaluate critically ill patient outcomes. [9][10][11]29,31,[34][35][36] However, given the resource utilization needs during the COVID-19 pandemic, the economic burden is also of grave importance. The American Hospital Association estimated the financial impact of lost revenue to America's hospitals and healthcare systems at $202.6 billion.…”

mentioning

confidence: 99%

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Effect of Coronavirus Disease 2019 (Covid-19), a Nationwide Mass Casualty Disaster on Intensive Care Units: Clinical Outcomes and Associated Cost-of-Care

Henning

Thomas

Shore

et al. 2022

Disaster med. public health prep.

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OBJECTIVE: The COVID-19 pandemic resulted in millions of deaths worldwide and is considered a significant mass-casualty disaster (MCD). The surge of patients and scarcity of resources negatively impacted hospitals, patients, and medical practice. We hypothesized ICUs during this MCD had a higher acuity of illness and subsequently had increased lengths of stay (LOS), complication rates, death rates, and costs of care. The purpose of this study was to investigate those outcomes. METHODS: This was a multicenter, retrospective study that compared intensive care admissions in 2020 to those in 2019 to evaluate patient outcomes and cost of care. Data were obtained from the Vizient Clinical Data Base/Resource Manager. RESULTS: Data included the number of ICU admissions, patient outcomes, case mix index, and summary of cost reports. Quality outcomes were also collected. 1,304,981 patients from 333 hospitals were included. For all medical centers, there was a significant increase in LOS index, ICU LOS, complication rate, case mix index, total cost, and direct cost index. CONCLUSION: The MCD caused by COVID-19 was associated with increased adverse outcomes and cost-of-care for ICU patients.

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

et al. 2023

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ImportanceThe reported incidence of many health care–associated infections (HAIs) increased during the COVID-19 pandemic; however, it is unclear whether this is due to increased patient risk or to increased pressure on the health care system.ObjectiveTo assess HAI occurrence among patients admitted to hospitals with and without COVID-19.Design, Setting, and ParticipantsA cross-sectional retrospective analysis of inpatients discharged both with and without laboratory-confirmed COVID-19 infection was conducted. Data were obtained between January 1, 2019, and March 31, 2022, from community hospitals affiliated with a large health care system in the US.ExposureCOVID-19 infection.Main Outcomes and MeasuresOccurrence of central line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and Clostridioides difficile infection as reported to the National Healthcare Safety Network.ResultsAmong nearly 5 million hospitalizations in 182 hospitals between 2020 and 2022, the occurrence of health care–associated infections (HAIs) was high among the 313 200 COVID-19 inpatients (median [SD] age, 57 [27.3] years; 56.0% women). Incidence per 100 000 patient-days showed higher HAIs among those with COVID-19 compared with those without. For CLABSI, the incidence for the full 9 quarters of the study was nearly 4-fold higher among the COVID-19 population than the non–COVID-19 population (25.4 vs 6.9). For CAUTI, the incidence in the COVID-19 population was 2.7-fold higher in the COVID-19 population (16.5 vs 6.1), and for MRSA, 3.0-fold higher (11.2 vs 3.7). Quarterly trends were compared with the same quarter in 2019. The greatest increase in the incidence of HAI in comparison with the same quarter in 2019 for the entire population occurred in quarter 3 of 2020 for CLABSI (11.0 vs 7.3), quarter 4 of 2021 for CAUTI (7.8 vs 6.8), and quarter 3 of 2021 for MRSA (5.2 vs 3.9). When limited to the non–COVID-19 population, the increase in CLABSI incidence vs the 2019 incidence was eliminated, and the quarterly rates of MRSA and CAUTI were lower vs the prepandemic 2019 comparator quarter.Conclusions and RelevanceIn this cross-sectional study of hospitals during the pandemic, HAI occurrence among inpatients without COVID-19 was similar to that during 2019 despite additional pressures for infection control and health care professionals. The findings suggest that patients with COVID-19 may be more susceptible to HAIs and may require additional prevention measures.

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Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

Cited by 12 publications

References 14 publications

The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections

The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections

Effect of Coronavirus Disease 2019 (Covid-19), a Nationwide Mass Casualty Disaster on Intensive Care Units: Clinical Outcomes and Associated Cost-of-Care

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

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