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The Disproportionate Impact of COVID-19 Pandemic on Healthcare-Associated Infections in Community Hospitals: Need for Expanding the Infectious Disease Workforce.
Advani, Sonali D; Sickbert-Bennett, Emily; Moehring, Rebekah; Cromer, Andrea; Lokhnygina, Yuliya; Dodds-Ashley, Elizabeth; Kalu, Ibukunoluwa C; DiBiase, Lauren; Weber, David J; Anderson, Deverick J.
  • Advani SD; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US.
  • Sickbert-Bennett E; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
  • Moehring R; Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US.
  • Cromer A; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US.
  • Lokhnygina Y; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
  • Dodds-Ashley E; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
  • Kalu IC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, US.
  • DiBiase L; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US.
  • Weber DJ; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US.
  • Anderson DJ; Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, US.
Clin Infect Dis ; 2022 Aug 23.
Article in English | MEDLINE | ID: covidwho-2227086
ABSTRACT

BACKGROUND:

The COVID-19 pandemic had a considerable impact on US healthcare systems, straining hospital resources, staff, and operations. However, a comprehensive assessment of the impact on healthcare associated infections (HAIs) across different hospitals with varying level of infectious disease (ID) physician expertise, resources, and infrastructure is lacking.

METHODS:

This retrospective longitudinal multi-center cohort study included central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), C. difficile infections (CDIs), and ventilator-associated events (VAEs) from 53 hospitals (academic and community) in Southeastern United States from January 1, 2018 to March 31, 2021. Segmented negative binomial regression generalized estimating equations models estimated changes in monthly incidence rates in the baseline (01/2018 - 02/2020) compared to the pandemic period (03/2020 - 03/2021, further divided into three pandemic phases).

RESULTS:

CLABSIs and VAEs increased by 24% and 34% respectively during the pandemic period. VAEs increased in all phases of the pandemic, while CLABSIs increased in later phases of the pandemic. CDI trend increased by 4.2% per month in the pandemic period. On stratifying the analysis by hospital characteristics, the impact of the pandemic on healthcare-associated infections was more significant in smaller sized and community hospitals. CAUTIs did not change significantly during the pandemic across all hospital types.

CONCLUSIONS:

CLABSIs, VAEs, and CDIs increased significantly during the pandemic, especially in smaller community hospitals, most of which lack ID physician expertise. Future efforts should focus on better understanding challenges faced by community hospitals, strengthening infection prevention infrastructure, and expanding the ID workforce, particularly to community hospitals.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid