Hospital-Acquired Infections and Spread of Multi-Drug-Resistant Organisms Declined During COVID-19 Pandemic

Considering inconclusive studies on the impact of the COVID-19 pandemic and associated public health measures on the spread of hospital-acquired infections (HAIs) and multi-drug-resistant organisms (MDROs), a group of investigators sought to assess this association in a tertiary hospital serving a large population. The study results, published in BMC Infectious Diseases, indicate that HAIs and MDROs significantly declined during the COVID-19 era when compared to pre-pandemic levels.¹

Hand hygiene compliance is a major factor that contributes to the reduction of hospital-acquired infections or multi-drug-resistant organisms. | Image Credit: © Pixel-Shot | stock.adobe.com

These observed reductions in spread can be attributed to the continuous adherence to and enhancement of infection prevention and control (IPAC) measures. Some of these measures include widespread usage of masks, isolating patients with COVID-19 in dedicated units, and enhancing awareness of hand hygiene compliance (HHC). These measures are effective at disease control, but MDROs and HAIs have remained a persistent burden in health care facilities.¹

For trial enrollment, all patients who were admitted to this hospital from January 2016 to December 2021 were evaluated for MDROs and HAIs incidence. Measures outcomes included the rare of hospital-acquired MDROS and HAIs, expressed as the number of patients who newly acquired an infection per 10,000 hospital days (HD). Furthermore, direct audits were utilized to measure compliance with hand hygiene, a major factor that can contribute to the spread of HAIs. The “pre-COVID-19 pandemic era” was determined to be January 2016 to February 2020, with the “COVID-19 pandemic era” spanning March 2020 to December 2021.¹

Notably, HHC rates remained stable at 70%, while noncompliance with glove use was consistently measured at 40% across the pre-pandemic and pandemic periods. Clostridioides difficile infections (CDI) and overall MDRO rates were lower during COVID-19 (18.8 per 10,000 HD) compared with pre-COVID-19 pandemic (22.9 per 10,000 HD, p = .001). Contrastingly, rates of carbapenem-resistant enterobacterales (CRE) significantly increased during the COVID-19 pandemic, compared with before the pandemic.¹

Hospital-acquired-blood stream infection (HA-BSI) rate was observed to be higher during the COVID-19 period (29.7 per 10,000 HD) compared with the pre-pandemic period (27.3 per 10,000 HD), with a large difference (p = .006). In addition, rates of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumani (CRAB) significantly decreased compared to pre-pandemic rates.¹

The investigators also conducted a comparable analysis, seeking to examine the infection rates during influenza and non-influenza seasons, given influenza remains a major respiratory disease of concern. However, the findings indicated no notable differences in infection rates between these seasons.¹

This finding, deemed remarkable by the study authors, was thought to be attributed to multiple factors. Trials from both Israel et al and Stangerup et al have examined how the compliance of health care workers towards enhanced IPAC measures may have led to the same decline in MDROs and CDI not being observed during influenza season. The investigators and previous trial authors speculate that increased apprehension around the newly identified virus may have played a large role.^1,2,3

Furthermore, the COVID-19 pandemic posed various novel challenges, including the emergence of variants with differing severity and characteristics of transmission that differ in complexity with influenza strains. The continued emergence of these variants may have sustained vigilance and adherence to infection prevention measures.^2,3

The study authors also propose that the relatively brief length of the influenza season—compared with the prolonged duration of COVID-19 prevalence—could have allowed for insufficient time for the consolidation and initiation of alterations in health care workers’ behaviors. “These changes would need time to be translated into measurable differences in the rates of MDROs or HAIs,” the investigators wrote.¹

“The lack of improved HHC suggests that factors like PPE use, enhanced environmental cleaning, and potentially reduced antibiotic consumption may have contributed to lower rates of such infections. However, further detailed studies are needed to explore the specific factors involved in this decline,” the study authors concluded.¹

REFERENCES

1. Dabaja-Younis H, Silman Z, Tarabeia J, et al. The impact of the COVID-19 pandemic on hospital-acquired infections and multi-drug resistant organisms, in comparison to seasonal influenza. BMC Infect Dis. 2024;24:1364. doi:10.1186/s12879-024-09240-0

2. Israel S, Harpaz K, Radvogin E, et al. Dramatically improved hand hygiene performance rates at time of coronavirus pandemic. Clin Microbiol Infect. 2020;26(11):1566-1568. doi:10.1016/j.cmi.2020.06.002

3. Stangerup M, Hansen MB, Hansen R, et al. Hand hygiene compliance of health care workers before and during the COVID-19 pandemic: A long-term follow-up study. Am J Infect Control. 2021;49(9):1118-1122. doi:10.1016/j.ajic.2021.06.014