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The news is dismaying, but not surprising to officials who saw waves of patients swamp hospitals – in 2020, because there were no vaccines and few effective treatments; in 2021, because vaccines are refused. “We really had a perfect storm when it came to nosocomial infections and Covid,” says Arjun Srinivasan, physician and associate director of the CDC’s program for the prevention of these infections.
In the first waves, he points out, the patients most likely to enter hospitals with severe Covid were older, chronically ill, possibly immunocompromised – and therefore more likely to end up in a unit. intensive care and needing ventilation tubes to take over. breathing and ports in their bloodstream to administer drugs. With so many patients, healthcare workers were overwhelmed, more likely to skip preventive tasks – and with PPE so rare, more likely to unknowingly carry pathogens between patients. “So at the same time, you have more patients than ever before, you have less staff than you would normally have to take care of them,” says Srinivasan. “Normal health care delivery systems are breaking down because you just have too many demands for care and not enough health care providers to provide them. “
Last year, this was expected to happen. In November, a team of researchers from New York and St. Louis predicted in the American Journal of Infection Control that as Covid progressed, people with less acute illnesses or postponable surgeries would be less likely to check in at hospitals. They predicted that this would lead to an increase in the number of critically ill patients who would need the type of interventions that would lead to infections in hospital. They based this prediction on early signals from their own institutions: In the first three months of the U.S. pandemic, blood infections associated with central catheters increased 420% in one hospital and 327% in another, compared to in the previous 15 months.
“At my facility, Covid arrived in mid-March 2020, and April was the worst month of hospital infections in our hospital’s history,” says Kathleen M. McMullen, Senior Infection Prevention and Control Officer of Occupational Health at Christian Hospital and Northwest Healthcare in St. Louis and first author of this study. “Speaking with colleagues nationwide, we heard that they were also facing this problem and we said to ourselves, ‘We have to get this out. “”
The team also predicted that certain categories of infections, such as those that settle in surgical incisions, would decrease as elective surgeries are postponed. Their instincts were strong. New CDC data shows that the only types of hospital infections to decline last year were surgical site infections after colon surgery or hysterectomy (the type that requires an open incision, not those performed laparoscopically), as well as It’s hard, the pernicious gut infection that arises when broad-spectrum antibiotics upset the balance of gut bacteria.
It all made sense, given the conditions hospitals endured during that first wave, says McMullen: “There were so many patients, not many more healthcare workers, and so much fear – of not being. comfortable, wanting to get in and out of a patient’s room quickly.
The data uncovered by the CDC matches what McMullen and his colleagues observed and then predicted. But she says it can actually under-represent hospital infections across the country because the work of caring for patients during that 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 disturbing signal in the CDC data. One of the infections that rose, increasing by a third between the end of 2019 and the end of last year, was bacteremia, the spread of infectious bacteria in the blood, which can lead to sepsis and septic shock, caused by MRSA. This was the only drug-resistant infection appearing in their data, as it is one of the infections CMS requires to be reported. (MRSA and all staph bacteria live on the skin, so puncturing it with a catheter or incision can lead the bacteria inside the body.)
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