Background: In the current COVID-19 pandemic, aggressive Infection Prevention and Control (IPC) measures have been adopted to prevent healthcare-associated transmission of COVID-19. We evaluated the impact of a multi-modal IPC strategy originally designed for the containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs).
Methodology: From February-August 2020, a multi-modal IPC strategy was implemented across a large healthcare campus in Singapore, comprising improved segregation of patients with respiratory symptoms, universal masking and heightened adherence to Standard Precautions. The following rates of HAI were compared pre- and post-pandemic: healthcare-associated respiratory-viral-infection (HA-RVI), MRSA and CP-CRE acquisition rates, healthcare-facility-associated C.difficile infections (HCFA-CDI) and device-associated HAIs.
Results: Enhanced IPC measures introduced to contain COVID-19 had the unintended positive consequence of containing HA-RVI. The cumulative incidence of HA-RVI decreased from 9.69 cases per 10,000 patient-days to 0.83 cases per 10,000 patient-days (incidence-rate-ratio=0.08; 95%CI=0.05-0.13, p<0.05). Hospital-wide MRSA acquisition rates declined significantly during the pandemic (incidence-rate-ratio=0.54, 95%CI=0.46-0.64, p<0.05), together with central-line-associated-bloodstream infection (CLABSI) rates (incidence-rate-ratio=0.24, 95%CI=0.07-0.57, p<0.05); likely due to increased compliance with Standard Precautions. Despite the disruption caused by the pandemic, there was no increase in CP-CRE acquisition, and rates of other HAIs remained stable.
Conclusion: Multimodal IPC strategies can be implemented at scale to successfully mitigate healthcare-associated transmission of RVIs. Good adherence to personal-protective-equipment and hand hygiene kept other HAI rates stable even during an ongoing pandemic where respiratory infections were prioritized for interventions.
Wee LE, Conceicao EP, Tan JY, Magesparan KD, Amin IBM, Ismail BBS, Xian TH, Pinhong J, Jing Z, Elaine WGL, Ong SJM, Lee GLX, Wang AE, Bien MHK, Yuen TK, Chee LL, Choo PP, Yong Y, Aung MK, Sim XYJ, Venkatachalam I, Ling ML. Unintended consequences of infection prevention and control measures during COVID-19 pandemic. Am J Infect Control. 2020 Nov 3:S0196-6553(20)30963-9. doi: 10.1016/j.ajic.2020.10.019. Epub ahead of print. PMID: 33157180; PMCID: PMC7610096.