Credit CDC
#17,708
As much as people hated wearing face masks, and using other NPIs (non-pharmaceutical interventions) during the first two years of the COVID pandemic, it not only lowered the risks of being infected with the coronavirus, it substantially lowered the transmission of other community acquired infections as well.
As the following chart from a 2022 MMWR report illustrates, seasonal influenza flat-lined in 2020 and for most of 2021.
In the fall of 2020 we expected to see the return of our bi-annual uptick in AFM cases which began to increase in 2014 (see chart below) following a surge in EV-D68 infections around the world (see CDC MMWR/Vital Signs: Acute Flaccid Myelitis (2020 Edition).We saw similar reductions in community transmission of RSV, Scarlet Fever, Pertussis and many other respiratory diseases.
But with everyone masked, and many schools closed, our AFM epidemic never materialized in 2020, nor did it return in 2022, even after the masks came off. Whether this is a permanent pattern change remains to be seen.
But since the masks went away we've seen the return of influenza, RSV, Scarlet Fever, and Pertussis epidemics, all of which provides pretty good anecdotal evidence of the effectiveness of face masks in preventing a variety of respiratory diseases.
While it makes sense that hospitals which used strict infection prevention and control (IPC) procedures would have seen reduced HAIs (Hospital Acquired Infections), we've also seen reports that the increased use of antibiotics during the pandemic made matters worse (see CDC: COVID-19 Reverses Progress in Fight Against Antimicrobial Resistance in U.S.).
Today we've a study - published in the AJIC (American Journal of Infection Control) which documents the impacts of enhanced IPC practices on various HAIs at a comprehensive cancer center (M.D. Anderson) in Texas.
While not all HAIs were reduced - and COVID wards saw significantly higher rates of HAI and nosocomial infection than non-COVID wards - these pandemic interventions led to a `. . . significant decrease in many healthcare-associated infections (HAIs) and a reduction in respiratory viral infections (RVIs)'.
The full study is behind a paywall, but we have the following press release, after which you'll find the link to the Abstract and study. I'll have a postscript after the break.
NEWS RELEASE 5-OCT-2023
Study shows enhanced pandemic-related infection prevention and control practices reduced incidence of healthcare-associated infections
Findings published today in AJIC Peer-Reviewed Publication
ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL
A new study conducted by researchers at The University of Texas MD Anderson Cancer Center suggests that enhanced infection prevention and control (IPC) measures implemented to address the COVID-19 pandemic contributed to a significant decrease in many healthcare-associated infections (HAIs) and a reduction in respiratory viral infections (RVIs). The findings, published today in the American Journal of Infection Control (AJIC), provide some of the first evidence that strict pandemic-related IPC interventions reduced HAI rates among vulnerable patient populations.
“Previous, large-scale studies revealed an alarming increase in some HAIs during the pandemic, which may be partly attributed to the necessary, dramatic shift in institutional IPC priorities,” said Roy F. Chemaly, M.D., MPH, Chair of Infectious Diseases, Infection Control, and Employee Health at MD Anderson, and the lead author on the published study. “Our findings suggest that enhanced and targeted IPC measures enabled our facility to avoid these increases and, in several cases, significantly reduce the incidence of HAIs among our patient population during the pandemic.”
Beginning in March 2020, M.D. Anderson deployed enhanced IPC practices to reduce the spread of SARS-CoV-2, including high-level personal protective equipment, universal masking, enhanced environmental disinfection, and visitor restrictions, among others.
Dr. Chemaly and colleagues calculated the incidence rates (IRs) of six HAIs among the approximately 30,000 patients admitted annually at the cancer center from September 2016 through March 2022: C. difficile infection (C. diff), multidrug-resistant organisms (MDROs), respiratory viral infections (RVIs) and three device-related infections -- catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), and ventilator-associated events (VAE). The researchers then compared IRs for all HAIs for the 42 months prior to the pandemic (September 2016-February 2020) and the 25 months after the pandemic onset (March 2020-March 2022), as well as during the time of COVID-19 surges and in COVID-19-designated wards at the 767-bed facility.
Results show that the incidences of laboratory-identified C. diff (Li-CDI), CLABSI, and total RVIs at MD Anderson decreased significantly since the start of the COVID-19 pandemic. Rates of MDROs were unchanged except among patients on COVID-19 wards, and rates of other device-related infections remained stable.
Specifically:“The encouraging findings from this study suggest that prioritizing and investing in evidence-based IPC practices can reduce HAIs, even among particularly vulnerable populations during extreme situations such as the COVID-19 pandemic,” said Patricia Jackson, RN, BSN, MA, CIC, FAPIC, 2023 APIC president.
- The incidence of Li-CDI significantly decreased after the onset of the pandemic, from 6.58 cases per 10,000 patient days to 4.31, with a statistically significant incidence rate ratio (IRR) of 0.65. The Li-CDI rates were similar between surge and non-surge periods (0.43 during surge vs. 0.44 during non-surge periods).
- The total IR of nosocomial RVIs significantly decreased from the pre-pandemic to the pandemic period, from 5.24 to 1.90 per 1,000 admissions, with an IRR of 0.36. The IR did not change significantly between surge and non-surge periods. When evaluated individually, the IRs of SARS-CoV-2 and nosocomial respiratory syncytial virus (RSV) infections were significantly higher during the surge period, while the IR of nosocomial influenza infection was comparatively lower.
- The overall IRs of nosocomial MDROs were similar from the pre-pandemic to the pandemic period (0.66-0.74 with an IRR of 1.22) and did not significantly change between surge and non-surge periods (0.16 vs. 0.14). Notably, the overall IR of MDROs in the COVID-19 wards was more than five times higher than in the other inpatient wards (1.99 vs. 0.35 with an IRR of 5.77).
- The rate of CLABSI significantly decreased during the pandemic, from 0.51 to 0.32 per 1,000 catheter days (IRR of 0.63). Notably, MD Anderson recorded 100% CLABSI bundle compliance in September 2022, with central line placement and maintenance completed exclusively by trained and experienced staff.
- The rates of CAUTI (0.75-0.66; IRR of 0.88) and VAE (3.10-1.82; IRR 0.60) did not significantly change between the pre-pandemic and pandemic periods.
Rita Wilson Dib, MD,Amy Spallone, MD, Fareed Khawaja, MBBS. Adina Feldman, MPH, Sherry Cantu, MPH, Roy F. Chemaly, MD, MPHPublished:October 04, 2023DOI:https://doi.org/10.1016/j.ajic.2023.08.019Highlights
• Hospital-acquired infections impacted by measures taken during the COVID-19 pandemic.
• Rate of nosocomial respiratory viral infections decreased during the COVID-19 pandemic.
• Significant decrease in incidence of CLABSIs since the start of the COVID-19 pandemic.
• Incidence rate of multidrug-resistant organisms higher on COVID-19 than other wards.
As we've discussed often (see here, here, and here), every year we draw a little closer to an oft-predicted `post-antibiotic era', where something as simple as a scraped knee, or elective surgery, could prove deadly.
In the 2019 report, the last year comprehensive healthcare and community data were available to calculate, CDC estimated that more than 2.8 million antimicrobial-resistant infections occur in the U.S. each year, with more than 35,000 people dying as a result.
While I cover AMR topics occasionally in this blog, I can heartily recommend CIDRAP's Antimicrobial Stewardship Project as the best place to learn about the growing global threat of AMR.
