02:02 pm, 25 Jan 2022
The Centers for Disease Control and Prevention (CDC) confirm that after years of decline, US hospitals saw a significant increase in healthcare-associated infections (HAIs) in 2020, largely as a result of the COVID-19 pandemic. Since Q1 of 2020, the Covid-19 burden on frontline personnel in hospitals has led to reduced reporting of HAI’s – this is dangerous. The greatest learning during these unprecedented times was for Hospital’s to urgently invest in human capital and digital resources for hospital-wide systems to ensure effective data management for HAI’s.
An informal Twitter poll on April 4, 2020, received 220 responses from the infection prevention and hospital epidemiology community with 79.1% of participants confirming they spent more than 75% of their time on COVID-19 response efforts! Expectedly, this had a negative impact on HAI surveillance and reporting. The pandemic’s impact on traditional infection prevention efforts included:
• reduced personnel for infection prevention efforts
• reduced surveillance efforts;
• reduced data collection and analysis for action;
• limited real-time data reporting and feedback; and
• stock issues for personal protective equipment (PPE)
A retrospective study of 78 U.S. hospitals comparing 12 months before and 6 months during the COVID-19 pandemic showed a 51% increase in central line-associated bloodstream infections (CLABSIs). A greater COVID-19 burden correlated with increased CLABSI rates. The standardized infection ratio was 2.38 times higher in months with COVID-19 patients. Those with COVID-19 experienced greater than five times the number of CLABSIs and higher associated mortality compared with those without COVID-19 (53.8% vs. 24%).
While the increased HAI rates could be attributed to the increase in very ill patients who needed devices such as ventilators and catheters, and were hospitalized longer, the strain on hospital resources also played a role.
The World Health Organisation (WHO) in its publication, Practical guidelines for infection control in health care facilities, dated 4th August 2005 stated, “A breach in infection control practices facilitates transmission of infection from patients to health care workers, other patients and attendants. It is therefore important for all health care workers, patients, their family members, friends and close contacts to adhere to the infection control guidelines strictly. It is also imperative for health care administrators to ensure implementation of the infection control programme in health care facilities.”
A Data and Systems Driven approach
We have learnt that it is critical for Hospitals to train expert personnel, develop effective plans and infrastructure to quickly respond to future pandemic threats and strengthen infection prevention programs. These are some possible steps CEO’s may take:
- Appoint and train dedicated infection control personnel or “infection preventionists” and ensure data literacy skills of such personnel
- Review and adapt Hospital Policies and SOP’s on data management for infection prevention – will this change during a pandemic?
- Adopt digital technology and tools to automate and ensure data flows and analysis to generate insight
- Use such data driven insight for best practices in infection prevention and control
- Ensure sufficient PPE’s – digital track and trace system must be in place
With the steps listed above, data management and insight for infection control will become Data and Systems Driven and less dependent on personnel or ad-hoc decisions. The next pandemic if it happens, and the ensuing strain on our Hospitals and front-liners, must not result in a breach of infection control and prevention practices.