CDC’s findings are a setback for the national effort to encourage hospitals and their clinical laboratories to reduce the number of nosocomial infections and practice better antimicrobial stewardship
Nosocomial infections—also known as hospital-acquired infections—increased during the COVID-19 pandemic. That’s according to a Centers for Disease Control and Prevention (CDC) report that showed increases in several HAIs, including a 14% jump in Methicillin-resistant Staphylococcus aureus (MRSA) from 2020 to 2021.
The CDC’s 2021 National and State Healthcare-Associated Infections Progress Report suggests that “the pandemic may have permanently damaged the ability of hospitals to prevent their patients from contracting infections while in the hospital,” according to healthcare columnist David Burda in an article he penned for 4Sight Health titled, “Hospital Infection Regression.”
Clinical laboratory testing is part of a concerted effort in the US to reduce HAIs in acute care hospitals. Additionally, diagnostic testing is vital to antimicrobial stewardship, which is designed to help physicians prescribe to patients only those antibiotics that are appropriate and reduce the chance for antimicrobial resistance (AMR).
So, it’s disturbing to see a setback in both HAIs and antimicrobial stewardship in the wake of the COVID-19 pandemic. Burda called the CDC’s findings a “regression” that “gives new meaning to the term long COVID.”
“I think, without any proof, doctors, nurses, medical technicians, and other clinicians who provide direct patient care regressed in terms of infection control best practices,” wrote healthcare journalist David Burda in his column for 4Sight Health. Clinical laboratories that processed COVID-19 tests during the pandemic can attest to the burnout. (Photo copyright: 4Sight Health.)
CDC Report Reveals Increase in Hospital Acquired Infections
The CDC used standardized infection ratios (SIRs) in its report to detail changes in nosocomial infections. CDC calculates SIRs by dividing the number of observed infections by the number of predicted infections.
“In 2021, the nation and the world continued to experience unprecedented challenges due to the COVID-19 pandemic, which impacted surveillance for and incidence of HAIs,” the CDC explained in its report.
“Compared to pre-pandemic years, hospitals across the nation experienced higher than usual hospitalizations and shortages in healthcare personnel and equipment, which may have resulted in deterioration in multiple patient safety metrics since the beginning of the pandemic,” the CDC added.
In his 4Sight Health article, Burda noted that physicians and other care providers may have “regressed” in their infection control practices due to severe pressures during the COVID-19 pandemic. “I also think the traveling nurse and temporary staff situation had something to do with it. Who has time to learn or follow the infection control policies and protocols at every hospital when you’re moving from one hospital to the next every few weeks?” he added.
The CDC explored HAIs in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, and long-term acute care hospitals. According to the federal agency’s report, at acute care hospitals, increases in nosocomial infections from 2020 to 2021 include the following:
- 14% rise in MRSA bloodstream events.
- 12% rise in ventilator-associated events (VAE).
- 11% rise in abdominal hysterectomy surgical site infections (SSI).
- 7% rise in central line-associated bloodstream infections (CLABSI).
- 5% rise in catheter-associated urinary tract infections (CAUTI).
On a positive note, the report noted these findings as well:
- 3% decline in hospital onset Clostridioides difficile (C. diff) infections.
- No significant change in colon surgery SSIs.
In its review of state-level data, CDC noted:
- 27 states performed better on at least two types of infection.
- 30 states performed worse on at least two infection types.
In response to the CDC’s report, the American Hospital Association (AHA) wrote, “In acute care hospitals, the increases seen in some HAIs in 2021 contrast with the success in reducing these infections prior to the pandemic. Despite the challenges of the COVID-19 pandemic, acute care hospitals performed significantly better than the 2015 national baseline in preventing CLABSI, CAUTI, SSIs following colon surgeries, and C. difficile infections.”
The AHA recommended that hospitals “continue to reinforce prevention practices and review HAI surveillance data to identify areas for improvement.”
Dangers of Antimicrobial Resistance
According to CDC data, in the US there are 2.8 million antimicrobial infections each year, and more than 35,000 people die as a result. Dark Daily has reported extensively on the growing danger of antibiotic resistance and outlined the importance of clinical laboratory involvement in hospital antimicrobial stewardship programs.
In “During Pandemic, Clinical Laboratories Should Be Alert for Drug Resistant Infections That Pose High Risk to COVID-19 Patients,” we covered a study conducted at the University of Minnesota which highlighted the continuing need for microbiologists and clinical laboratories to stay alert for COVID-19 patients with drug-resistant infections following a CDC report on 941 confirmed and probable Candida auris cases that had been reported in 13 states, with an additional 1,830 patients that had been found to be colonized with the multidrug-resistant fungus.
And in “Leapfrog Group Report Shows Hospitals Failing to Eliminate Hospital-Acquired Infections; Medical Laboratories Can Help Providers’ Antimicrobial Stewardship Programs,” we wrote about how healthcare leaders were concerned about a Leapfrog Group report that indicated hospitals are finding it increasingly difficult to completely remove infections. The report states that the number of hospitals reporting zero infections has declined significantly since 2015.
New Joint Commission Antibiotic Standards
The Joint Commission’s expansion of antibiotic stewardship standards, which went into effect on January 1, 2023, could help hospitals reduce nosocomial infections and fight antimicrobial resistance.
“The updated standards come at a vital time. Data shows that the COVID-19 pandemic has resulted in increased antibiotic use and a backslide in stewardship efforts,” wrote David Hyun, MD, Antibiotic Resistance Project Director of the Pew Charitable Trusts, in an article he penned for PEW titled, “Expanded Antibiotic Stewardship Standards for Hospitals Will Help Combat Superbugs.”
Pew conducted research related to the requirements and found “significant room for improvement in adoption and implementation of stewardship practices” in acute care hospitals, Hyun wrote.
The Joint Commission’s new and revised requirements for antibiotic stewardship for hospitals include:
- Allocate financial resources for staffing and IT to support the antimicrobial stewardship program.
- Implement evidence-based guidelines to improve antibiotic use for infections such as urinary tract c. diff. community-acquired pneumonia.
- Evaluate the program using evidenced-based criteria.
“New antibiotic stewardship standards should help limit the emergence and spread of new drug-resistant superbugs,” Hyun noted.
Clinical Laboratories Need to Deepen Involvement
By testing patients and quickly reporting results to physicians, hospital-based and independent medical laboratories play an important role in appropriate antibiotic use and elimination of HAIs.
Heightened involvement by microbiologists and other medical laboratory professionals is key to success in light of recent setbacks in elimination of HAIs and antimicrobial resistance due to the SARS-CoV-2 outbreak.
—Donna Marie Pocius
Related Information:
2021 National and State Healthcare-Associated Infections Progress Report
CDC Reports Increase in Certain Healthcare Associated Infections in 2021
Drug Resistance National Estimates
R3 Report: Requirement, Rationale, Reference—New and Revised Requirements for Antibiotic Stewardship