COVID-19 Infection Measures Linked to Lower Rates of MRSA, CLABSI

By Lisa Rapaport

November 16, 2020

(Reuters Health) - Hospital infection prevention and control efforts implemented in response to the COVID-19 pandemic are associated with reduced rates of hospital-acquired infections, a recent study suggests.

Researchers examined data on hospital-acquired infection rates at one health system in Singapore from February to August 2020, to the rates in the two years prior to the pandemic, from January 2018 to January 2020. Infection prevention and control strategies implemented due to COVID-19 included increased segregation of patients with respiratory symptoms, universal mask requirements, and increased adherence to standard protocols such as hand hygiene policies.

Healthcare-associated respiratory infection rates declined from 9.69 per 10,000 patient-days during the two years before the pandemic to 0.83 cases per 10,000 patient-days during the pandemic (incidence rate ratio 0.08).

Methicillin-resistant Staphylococcus aureus (MRSA) infection rates and central line associated bloodstream infection (CLABSI) rates also declined significantly (IRR 0.54 and 0.24, respectively).

Rates of other healthcare-associated infections remained stable during the pandemic, the study also found.

"Increased focus on hand hygiene, given the possibility of contact transmission of SARS-CoV-2, as well as decreased bed density brought about by improved patient segregation, could potentially decrease the spread of multidrug resistant organisms (MDROs) via contact transmission from infected and colonized patients," said senior study author Dr. Ling Moi Lin, director of infection prevention and epidemiology at Singapore General Hospital and director of infection prevention at SingHealth.

"Across our healthcare system, the introduction of visitor screening, improved segregation of patients with respiratory symptoms, and mandatory sick leave for symptomatic staff resulted in an unprecedented decrease in healthcare-acquired respiratory viral infections," Dr. Lin said by email.

Enhanced infection prevention and control measures implemented during the pandemic also included increased cleaning and disinfection efforts as well as continuous monitoring of hand hygiene and consumption of protective equipment like surgical masks, disposable gloves, and N95 respirators.

During the pandemic, rates of MRSA decreased to 6.4 cases per 10,000 patient-days from 11.7 per 10,000 patient-days over the two years prior to the pandemic. The rate of MRSA bacteremia also dropped from 0.36 cases to 0.11 cases per 10,000 patient-days.

CLABSI rates dropped from 0.83 incidents per 1,000 device-days before the pandemic to 0.20 incidents per 1,000 device-days during the pandemic.

Catheter-associated urinary tract infections (CAUTI) were stable throughout the study period at 1.8 incidents per 1,000 device-days.

One limitation of the study is that it was done at a single healthcare system, and results might not be generalizable to other settings, the study team notes in the American Journal of Infection Control.

Even so, the results suggest that efforts to reduce COVID-19 transmission may also be used to curb the spread of other infections in hospitals, said Dr. Leonard Mermel of the Warren Alpert Medical School of Brown University in Providence, Rhode Island.

"Certainly, greater PPE compliance and hand hygiene compliance would be expected to reduce healthcare associated infections," Dr. Mermel, who wasn't involved in the study, said by email. "But with COVID, enhanced cleaning of the environment and high-touch surfaces may have reduced healthcare associated infection risk."

Universal masking is probably the biggest intervention that's new to the COVID-19 pandemic and has a major impact on the transmission of SARS-CoV-2 as well as other respiratory viruses, said Dr. Chanu Rhee of Brigham and Women's Hospital and Harvard Medical School in Boston. Enhanced screening of visitors and restrictions on the number of visitors likely also played a key role, Dr. Rhee, who wasn't involved in the study, said by email.

"My take-home message is that this study shows there is room for improving infection control practices in the hospital and therefore reducing rates of healthcare-associated infections," Dr. Rhee said.

SOURCE: American Journal of Infection Control, online November 2, 2020.


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