Impact of COVID-19 on HAIs

Editor's Note

To provide flexibility to healthcare workers responding to the COVID-19 crisis, the Centers for Medicare & Medicaid Services (CMS) waived reporting requirements for healthcare associated infections (HAIs) through June 2020.

Using the experience of hospitals in New York City and St Louis, Missouri, the authors provide commentary on the potential infection prevention impact of COVID-19 on HAI rates.

The highest impact is expected to be on central line associated blood stream infection (CLABSI) rates. Two of the author’s facilities have seen rate increases—Hospital A had a 420% increase to 5.38 cases per 1,000 central line days, and Hospital B had a 327% increase to 3.79 cases per 1,000 central line days.

Smaller increases have been seen in the number of catheter associated urinary tract infection (CAUTI) cases at two facilities. Hospital A saw a 179% increase to 1.31 cases per 1,000 urinary catheter days, and Hospital B saw a 57% increase to 1.77 cases per 1,000 urinary catheter days.

The impact on surgical site infections (SSIs) is relatively unknown. In the short term, the major decrease in surgical procedures may lead to artificially low SSI rates. However, there are still urgent and emergency cases being performed, and they will be at higher risk of SSIs.

Clostridioides difficile has seen a small decrease. Hospital A had a 51% decrease to 0.61 cases per 10,000 patient days, and Hospital B had a 45% decrease to 1.07 cases per 10,000 patient days. The possibility of COVID-19 contact transmission has necessitated a focus on environmental cleaning that has the added benefit of decreasing organisms spread via contact transmission.

The combination of ventilator associated conditions (VAC) and infection-related VAC and possible into one tiered definition may lead to a juxtaposition—an increase in numbers of VAC are anticipated, but the number of cases that meet the definition of pneumonia is unclear.

Two new metrics that require monitoring are patients with hospital-acquired COVID-19 and healthcare personnel with occupationally-acquired COVID-19. These definitions are not well defined yet, but determining these definitions, particularly HAI COVID-19, should be a priority for the infection prevention field, the authors say.