This news is shocking, but not surprising for officials who have watched waves of patients flood hospitals in 2020 because there were no vaccines or effective treatments. In 2021, vaccines are being rejected. We really had a perfect storm when it comes to health-care-associated infections and Covid, says Arjun Srinivasan, a physician and associate director of the CDCs program for preventing those infections.
He points out that patients with severe Covid most likely to be admitted to hospitals were older and more likely to have chronic diseases. Because there were so many patients, health workers were more likely to neglect preventive tasks and with such a limited supply of PPE, they were more susceptible to unknowingly passing pathogens between patients. Srinivasan explains that while you have more patients than ever before, you also have less staff to care for them. Because there is too much demand and not enough providers, normal care delivery systems will fail.
Last year, there was a skeptic that this would happen. In November, researchers from New York City and St. Louis predicted that Covid would lead to fewer people needing hospitalizations. They predicted that this would result in an increase of patients with severe illnesses who would require the type of hospital infections-related interventions. They based that prediction on early signals from their own institutions: In the first three months of the US pandemic, central-line-associated bloodstream infections rose by 420 percent in one hospital and 327 percent in another, compared to the previous 15 months.
My institution was infected by Covid in mid-March 2020. April was also the worst month for hospital infections in our hospital's history, according to Kathleen McMullen (senior manager of infection prevention at Northwest Healthcare in St. Louis) and the first author of the study. It was also a problem in other countries, so we decided to share our findings with colleagues.
They also predicted that certain types of infections such as those that can be caught in surgical incisions would decrease as elective surgery was postponed. They were right. According to the CDC, only two types of hospital infection declined last year: surgical-site infections after colon surgery or hysterectomy. This is the type that requires an open incision and not laparoscopy. Also, C. difficile, a pernicious intestinal infection, surges when broad-spectrum antibiotics are used.
McMullen said that all of this made sense given the conditions hospitals were experiencing in that first wave. There was so much patient, not so many health care workers and so much fear of not being comfortable. Patients wanted to be admitted quickly.
McMullen, her colleagues and McMullen had predicted that the CDC data they found was consistent with what McMullen observed. She believes it could underrepresent hospital infection rates across the country because of the intense labor required to care for the patients during the first wave. The federal Center for Medicare & Medicaid Services allowed hospitals not to report between April and June.
The CDC's data contain a particularly alarming sign. One of the infections that spiked, rising by a third between the end of 2019 and the end of last year, was bacteremiadissemination of infectious bacteria throughout the bloodstream, which can lead to sepsis and septic shockcaused by MRSA. Because it is one of the CMS-required infections, it was the only drug resistant infection. MRSA and other staph bacteria can live on the skin so it is possible to inject the bacterium into the body by piercing the skin with a catheter.
