ABSTRACT
Background. Central line-associated bloodstream infection (CLABSI) incidence among acute care hospitals (ACH) and in some patient care locations such as critical care (CC) units increased substantially nationwide during the COVID-19 pandemic. We compared California ACH CLABSI incidence by location before and during the pandemic to identify locations with high burden to inform targeted prevention efforts. Methods. Using California ACH (n=327) CLABSI standardized infection ratio (SIR) data fromthe NationalHealthcare Safety Network, we compared incidence during the second halves of 2019 (2019H2) and2020 (2020H2) to evaluate early pandemic changes, and during 2019 (pre-pandemic) and 2021 (pandemic) periods by hospital type, location type (e.g., CC), and patient care location (e.g., medical CC), excluding rehabilitation units. A mid-P exact test was applied to compare SIRs between study periods. Results. ACH CLABSI SIR increased statewide from 2019H2 to 2020H2 by 50.8% (0.65 to 0.98) and from 2019 to 2021 by 34.3% (0.67 to 0.90). Community hospitals < 125 beds had the highest SIR and percentage increase in 2021 as well as 2020H2. Of 9 location types and 58 patient care locations, CC units and medical and medical-surgical CC had significantly higher SIR in both comparisons (2020H2 versus 2019H2 and 2021 versus 2019);wards and medical wards in 2020H2 only, and step-down units and adult step-down in 2021 only. Trauma CC SIR was significantly higher only in 2020H2 compared to 2019H2, while surgical CC SIR was significantly higher in 2021 compared to 2019. Respiratory CC had the highest SIR (2.99, 95%CI 2.14-4.08) in 2021, but was not significantly higher when compared to 2019 (1.06, 95%CI 0.21-3.41). Conclusion. We observed an overall statewide increase in hospital CLABSI incidence, especially in CC locations, during the pandemic. Although the SIR increase relative to pre-pandemic was smaller in 2021 than in 2020H2, with some exceptions, most locations had persistently higher incidence. We will further assess associations between CLABSI incidence and antimicrobial resistance, device insertion dates, and hospital COVID-19 burden. We will use our findings to guide public health support for hospital infection prevention programs to reduce their CLABSI incidence.
ABSTRACT
Background. In February 2019, California (CA) experienced its first C. auris outbreak in Orange County (OC). The CA Department of Public Health (CDPH) and OC with the Centers for Disease Control and Prevention (CDC), mounted a successful containment response;by November 2019, cases were limited to low-level spread in OC long-term acute care hospitals (LTACH). In May 2020, C. auris cases began to surge in OC, followed by extensive spread in six other southern CA local health jurisdictions (LHJ). CDPH with LHJ and CDC, initiated an aggressive, interjurisdictional containment response. Methods. We carried out response and preventive point prevalence surveys (PPS), onsite infection prevention and control (IPC) assessments, and in-service trainings at outbreak and interconnected hospitals and skilled nursing facilities in six LHJ. Other regional activities included: epidemiologic investigation, contact and discharge tracking and screening;increasing laboratory testing capacity;screening patients admitted to and from LTACH;statewide healthcare facility (HCF) education and outreach;sending regional outbreak HCF lists to all HCF;and biweekly state-LHJ coordination calls. The Antibiotic Resistance (AR) Lab Network supported testing. Results. From May 2020-May 2021, we conducted screening at 226 HCF, and identified 1192 cases at 93 HCF, mostly through screening (n=1109, 93%) and at LTACH (n=906, 76%);we identified 113 (10%) cases at ACH, including 35 (31%) in COVID-19-burdened units. Cases peaked in August 2020 (n=93) and February 2021 (n=191) and have since declined, with C. auris resurgence mirroring COVID-19 incidence. We conducted 98 onsite IPC assessments, and identified multiple, improper IPC practices which had been implemented in response to COVID-19, including double-gloving and -gowning, extended use of gowns and gloves outside patient rooms, and cohorting according to COVID-19 status only. Figure 1. C. auris and COVID-19 Cases in California through May 2021, and C. auris Cases by Local Health Jurisdiction (LHJ) May 2020-May 2021 Conclusion. The C. auris resurgence in CA was likely a result of COVID-19-related practices and conditions. An aggressive, coordinated, interjurisdictional C. auris containment response, including proactive prevention activities at HCF interconnected with outbreak HCF, can help mitigate spread of C. auris and potentially other novel AR pathogens.
ABSTRACT
Background. Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices. Methods. A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq. Results. Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated;58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill;often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units;extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2). Conclusion. A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients.
ABSTRACT
On February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California. The patient was initially evaluated at hospital A on February 15;at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient's transfer to hospital B, a real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2;three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19;HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.