The news is disturbing, but not surprising for staff watching waves of patients stranded in hospitals in 2020 because there were no vaccines and few effective treatments; in 2021 as vaccines are abandoned. “We really had a perfect storm when it came to healthcare-associated infections and Covid,” said Arjun Srinivasan, a doctor and associate director of the CDC’s program to prevent these infections.
During the first waves, he points out, patients who are most likely to be admitted to hospitals with severe Covid were older, with chronic conditions, possibly immunocompromised – and as a result are more likely to find themselves in intensive care unit and need ventilation ducts to take in breathing and ports in their blood to deliver medication. In so many patients, healthcare workers were stretched, at greater risk of missing preventative tasks – and with PPE in such a shortage, at greater risk of unconsciously transmitting pathogens between patients. “So at the same time, you have more patients than you’ve ever had, you have fewer staff than you normally would have to care for,” Srinivasan said. “Normal care systems are falling apart because you just have too much demand for care and you don’t have enough health care providers to provide it.”
Last year there was an unpleasant expectation that this would happen. In November, a team of researchers from New York and St. Louis forecast in American Journal of Infection Control that as Covid progresses, people with fewer acute illnesses or delayed surgery will be less likely to be hospitalized. They predict that this will lead to an increase in patients with severe illness who will need such interventions that lead to nosocomial infections. They base this prediction on early signals from their own institutions: In the first three months of the pandemic in the United States, centrally associated blood flow infections increased by 420% in one hospital and 327% in another, compared with the previous 15 months.
“At my institution, Kovid came to us in mid-March 2020, and April was the worst month of nosocomial infections in the history of our hospital,” said Kathleen M. McMullan, senior manager for infection prevention and occupational health at Christian. Hospital and Northwest Healthcare in St. Louis and the first author of this study. “Talking to colleagues at the national level, we heard that they are also dealing with this, and we thought, ‘We need to resolve this.’
The team also predicts that certain categories of infections, such as those lingering in surgical incisions, will decrease as selective operations have been postponed. Their instincts were firm. New CDC data show that the only types of nosocomial infections that have declined last year are surgical site infections after colon surgery or hysterectomy (the type that requires an open incision, not laparoscopic ones), and This is difficult, a devastating intestinal infection that increases when broad-spectrum antibiotics upset the balance of intestinal bacteria.
All of this made sense given the conditions the hospitals endured during the first wave, McMullan said: “There were so many patients, not many more health workers and so much fear – not feeling comfortable, wanting to get in and getting out quickly. from the patient’s room. “
The data found by the CDC coincides with what McMullan and her colleagues observed and then predicted. But she says she actually can underrepresented nosocomial infections across the country, as patient care work in this first wave was so intense that the Federal Center for Medicare and Medicaid Services allowed hospitals to suspend mandatory reporting between April and June.
There is a particularly foreboding signal in the CDC data. One of the infections that increased, growing by a third between the end of 2019 and the end of last year, was bacteremia – a spread of infectious bacteria in the blood that can lead to sepsis and septic shock – caused by MRSA. This was the only drug-resistant infection to appear in their data, as it is among the infections that the CMS requires to be reported. (MRSA and all staphylococcal bacteria live on the skin, so piercing it with a catheter or incision can carry the bacteria into the body.)