During the pandemic, health experts noticed health care settings were experiencing an uptick in health care-associated infections — but they didn’t know why.
According to a new U.S. study of more than five million hospitalizations between 2020 and 2022, the answer may not be poorer overall care or overwhelmed hospitals.
Instead, the study found the increase in health care-associated infections (HAIs) was largely among COVID-19 patients, with rates of HAIs among non-COVID-19 patients sticking close to the pre-pandemic baseline.
Researchers say this suggests COVID-19 patients are uniquely susceptible to new infections while receiving care at a health care facility compared to other patients, and health professionals should take this into account.
“Patients without COVID-19 had rates of HAIs that would be expected based on the incidence observed before the pandemic,” the study states.
“This analysis suggests that the greatest opportunity to improve outcomes may involve targeting additional resources to provide even greater attention to the hospitalized COVID-19 population.”
The study, which was published April 14 in the peer-reviewed journal JAMA Network Open, looked at data collected from 182 inpatient facilities across 21 states. All facilities were affiliated with HCA Healthcare, a company which runs for-profit health care facilities in numerous states in the U.S.
Researchers looked at all reported HAIs that occurred in these facilities between Jan. 1, 2019 and March 31, 2022, focusing on the occurrence of HAIs within the general patient population as well as the specific COVID-19 patient population.
A health care-associated infection is not an infection that sends you to the hospital — it’s a specific term for situations in which a person being treated at a health care facility, such as a hospital, develops a separate infection or issue while in the process of receiving treatment for their original problem.
For example, developing a urinary tract infection associated with the catheter a patient had while being treated for a separate issue would be classified as an HAI.
In this study, researchers stratified the HAIs into four categories: catheter-associated urinary tract infections (CAUTI); central line bloodstream infections (CLABSI)—in which a tube delivering blood, fluids or medication to the patient gets bacteria or germs in it; methicillin-resistant staphylococcus aureus (MRSA)—which is a super bug that causes infections that are difficult to treat; or C.difficile (CDIFF)—a bacteria that often occurs when you’ve been taking antibiotics.
In total, there were 313,200 COVID-19 patients in the dataset. The median age of these patients was 57 years old. In the same time period, these facilities saw 4,564,375 discharges of patients who did not have COVID-19.
The average length of stay for COVID-19 patients was 8.2 days, while the average length of stay for patients without COVID-19 was around 4.7 days.
Researchers found while HAIs went up during the pandemic overall, they did so as the number of patients expanded due to COVID-19. Between March and September 2020, the rate of the HAIs, excluding CDIFF, increased by 43 to 60 per cent.
But crucially, the rate of HAIs among patients without COVID-19 didn’t change much from the pre-pandemic baseline — the big increases were seen in COVID-19 patients.
The results also differed depending on the type of HAI.
The largest difference was in the occurrence of CLABSI — these bloodstream infections were seen at a significantly higher rate in inpatients with COVID-19, almost four times as high as those without the virus. The rate among inpatients without COVID-19 stayed similar to pre-pandemic levels, and were actually slightly lower than the rate seen in the first quarter of 2019.
The rate of catheter-associated infections was 2.7 times higher among COVID-19 patients compared to non-COVID patients, and MRSA was seen in COVID-19 patients at a rate triple that of non-COVID patients.
CDIFF was an outlier in that it had been decreasing steadily by quarter since the start of 2019, with 2019 levels higher than those seen after the pandemic started. The rate of infections only increased slightly to around nine cases per 100,000 people in the first quarter of 2022. This was the only HAI where the rate in the COVID-19 population was not significantly elevated compared to the non-COVID population.
Researchers noted the study is limited by a number of factors, including that they only looked at four common HAIs, and did not look at other infection sources that could have impacted the COVID-19 population specifically.
It’s unclear at this stage why COVID-19 patients might be more susceptible to these infections.
Researchers suggest it could be due to a combination of factors, such as their increased length of stay in the hospital, the fact staff working on COVID-19 patients may have been particularly overworked or reshuffled from their usual duties, or potentially some factor of the disease itself.
“A full understanding of the high vulnerability of the COVID-19 population to HAIs will be useful in guiding infection prevention practices in the future,” researchers wrote in the study. “The high occurrence of HAIs may be associated with inherent risk associated with the clinical condition of COVID-19 infection requiring hospitalization or it may be associated with care practices that introduce risk.”
Previous research has suggested infection prevention fell by the wayside during the more intense waves of COVID-19, but this study suggests health care professionals were largely maintaining the same level of care for preventing these infections for non-COVID patients as they were before.
With that confounding factor removed, researchers are hoping more can be done to isolate why COVID-19 patients may be more susceptible to HAIs, and what needs to be done within hospitals to make them safer for COVID-19 patients.
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