The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections
The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections
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冠状病毒疾病 2019（COVID-19）对医疗保健相关感染的影响
DOI：
10.1093/cid/ciab688
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发表时间：
2021-09-20
影响因子：
11.8
通讯作者：
Perlin, Jonathan B.
中科院分区：
文献类型：
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作者：
Baker, Meghan A.;Sands, Kenneth E.;Perlin, Jonathan B.
2019冠状病毒病（COVID-19）对医院常规操作造成的深刻变化可能影响了医院措施的绩效，包括医疗保健相关感染（HAIs）。我们的目的是评估COVID-19激增与HAI和聚集率之间的关系。方法在2020年3月1日至2020年9月30日的148家HCA医疗保健附属医院，以及截至2020年12月31日有微生物学和聚集性数据的医院子集中，采用负二项混合模型评估COVID-19激增与HAIs、医院发病病原体和聚集性发病率之间的关系。为了解释COVID-19大流行高峰时间的地方差异，我们纳入了每月每个工作人员床位的实验室确诊COVID-19出院人数。结果随着COVID-19负担的增加，中央线相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）和耐甲氧西林金黄色葡萄球菌（MRSA）菌血症增加。在没有COVID-19病例的情况下，7个月内CLABSI比预期多60%(95%置信区间[CI]: 23-108%)， CAUTI比预期多43% (95% CI: 8-90%)， MRSA菌血症比预期多44% （95% CI: 10-88%）。艰难梭菌感染与COVID-19负担无显著相关性。来自81家医院的微生物学数据证实了这一发现。值得注意的是，医院发病的血液感染率和耐多药微生物（包括耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌和革兰氏阴性微生物）的发生率均与COVID-19激增显著相关。最后，随着COVID-19负担的增加，医院发病病原体聚集性增加。结论COVID-19激增对医院内HAI率和聚集性感染产生不利影响，强调需要平衡与COVID-19相关的需求与常规医院感染预防。2019冠状病毒病（COVID-19）的激增对医疗保健相关的感染率和医院内的聚集性感染产生了不利影响，强调需要平衡与COVID-19相关的需求与常规医院感染预防。
Background The profound changes wrought by coronavirus disease 2019 (COVID-19) on routine hospital operations may have influenced performance on hospital measures, including healthcare-associated infections (HAIs). We aimed to evaluate the association between COVID-19 surges and HAI and cluster rates. Methods In 148 HCA Healthcare-affiliated hospitals, from 1 March 2020 to 30 September 2020, and a subset of hospitals with microbiology and cluster data through 31 December 2020, we evaluated the association between COVID-19 surges and HAIs, hospital-onset pathogens, and cluster rates using negative binomial mixed models. To account for local variation in COVID-19 pandemic surge timing, we included the number of discharges with a laboratory-confirmed COVID-19 diagnosis per staffed bed per month. Results Central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as COVID-19 burden increased. There were 60% (95% confidence interval [CI]: 23-108%) more CLABSI, 43% (95% CI: 8-90%) more CAUTI, and 44% (95% CI: 10-88%) more cases of MRSA bacteremia than expected over 7 months based on predicted HAIs had there not been COVID-19 cases. Clostridioides difficile infection was not significantly associated with COVID-19 burden. Microbiology data from 81 of the hospitals corroborated the findings. Notably, rates of hospital-onset bloodstream infections and multidrug resistant organisms, including MRSA, vancomycin-resistant enterococcus, and Gram-negative organisms, were each significantly associated with COVID-19 surges. Finally, clusters of hospital-onset pathogens increased as the COVID-19 burden increased. Conclusions COVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.Coronavirus disease 2019 (COVID-19) surges adversely impact healthcare-associated infection rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.