Journal Club

When the Pandemic Is Over: Managing Disruptions of Other Hospital Safety Interventions

Reviewed by Nirav Patel, MD

In a recent article in Infection Control & Hospital Epidemiology, Fakih and collaborators demonstrated another challenge that hospitals will have to manage as they address care delivery post pandemic, namely continuing efforts to systematize the prevention of device-associated infections. Utilizing a health system dataset covering 78 primarily community hospitals, the investigators looked at 12 months of data prepandemic and 6 months of data after pandemic onset. They evaluated both utilization of devices as well as infection rates for central line–associated blood stream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs).

Over 795,000 central line–days and 817,000 urinary catheter–days were included in the study overall. CLABSI rates increased significantly during the pandemic, from 0.56 to 0.85 per 1,000 line-days (P < .001). Hospitals that had a higher burden of COVID-19 patients had higher infection rates than those with a lesser burden of COVID-19 patients during the same time period. Organisms also changed with a 130% increase in coagulase-negative Staphylococcus infections and a 57% increase in candidal infections compared to baseline. Interestingly, there was no significant change noted for CAUTIs compared to prepandemic.

Hospitals struggle with maintaining low device-related infection rates and this challenge has been exacerbated by the pandemic. The authors note the importance of hardwiring processes to maximize safety for patients and that hospitals that have highly reliable processes will more likely be able to mitigate the disruptive impact of events such as the pandemic. Further investigation will be needed to assess the impact on other safety and quality focus areas, but based on this study, strengthening processes will likely benefit patient safety.

(Fakih et al. Infect Control Hosp Epidemiol. Published online: February 19, 2021.)