key: cord-0841187-v3xv90ov authors: Sturm, Lisa K.; Saake, Karl; Roberts, Phil; Masoudi, Frederick; Fakih, Mohamad G. title: Impact of COVID-19 Pandemic on Hospital Onset Bloodstream Infections (HOBSI) at a Large Health System date: 2021-12-29 journal: Am J Infect Control DOI: 10.1016/j.ajic.2021.12.018 sha: 20eb911c0ac2563f8938fb344a07616a7cbc0167 doc_id: 841187 cord_uid: v3xv90ov BACKGROUND: The COVID-19 pandemic has had a considerable impact leading to increases in healthcare-associated infections, particularly bloodstream infections (BSI). METHODS: We evaluated the impact of COVID-19 in 69 US hospitals on BSIs before and during the pandemic. Events associated with 5 pathogens (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida sp.) were stratified by community onset (CO) if ≤ 3 days from admission or hospital onset (HO) if >3 days after admission. We compared pre-pandemic CO and HO rates with pandemic periods and the rates of BSI for those with and without COVID-19. RESULTS: COVID-19 patients were less likely to be admitted with COBSI compared to others (10.85 vs. 22.35 per 10,000 patient days; p<0.0001). There was a significant increase between pre-pandemic and pandemic HOBSI rates (2.78 vs. 3.56 per 10,000 patient days; p<0.0001). Also, COVID-19 infected patients were 3.5 times more likely to develop HOBSI compared to those without COVID-19 infection (9.64 vs. 2.74 per 10,000 patient-days; p<0.0001). CONCLUSIONS: The COVID-19 pandemic period was associated with substantial increases in HOBSI and largely attributed to COVID-19 infected patients. Future research should evaluate whether such measures would be beneficial to incorporate in evaluating infection prevention trends. Lisa K. Sturm based, was vulnerable and became compromised for several reasons. Some early pandemic behaviors included placing intravenous pumps in the hallways, or extending the dwell time of the device, to reduce healthcare worker exposure risk. As the pandemic ensued, hospitals across the world started to note increases in hospital bloodstream infections. 1- 5 We evaluated the impact of the pandemic on hospital onset bloodstream infections (HOBSI) in a multi-state healthcare system in the United States. Setting: Using one infection prevention surveillance system, we identified all positive blood cultures for 5 organisms commonly associated with healthcare infections [6] [7] [8] Events associated with the 5 organisms were classified as community and hospital onset. Community-onset BSI (COBSI) was defined for patients with BSI the 1 st 3 days of admission. Each HOBSI event was classified based on a modified National Healthcare Surveillance Network (NHSN) definition of lab-ID event, and identified >3 days after admission, if the patient had no prior event in the previous 14 days. 9 We evaluated the overall COBSI and HOBSI rates per 10,000 patient-days (based on patient length of stay) pre-pandemic and during the pandemic period (stratified out further by COVID-19 infected vs. others), as well as the contributing pathogen. We also evaluated the relative proportions of COBSI vs. HOBSI during the entire time period. Patients with COVID-19 infection were identified by a confirmed SARS-CoV-2 positive result by polymerase chain reaction testing, or a COVID-19 encounter diagnosis of International Classification of Diseases 10 code U07.1. Data analysis: Descriptive analyses of the pre-pandemic and pandemic periods for BSI for the 5 organisms combined and at the individual level were done. COBSI and HOBSI were also evaluated between COVID-19 infected and non-COVID-19 infected patients during the pandemic. p<0.0001). There were significant changes in the proportion of S. aureus (increase, p=0.003) and E. coli (decrease, p=0.0002) contributing to pre-pandemic and pandemic COBSI events ( Figure 1 ). The HOBSI rate for all patients in the pre-pandemic period was 2.78 compared to 3.56 per 10,000 patient days (p=<0.0001) during the pandemic period ( Although COVID-19 patients represented less than 12% of total patient-days during the pandemic, they accounted for more than 30% of HOBSI events during the same period ( Figure 2 ). We evaluated changes in COBSI to HOBSI event ratios pre-pandemic and pandemic periods. For all organisms combined, COBSI events were almost 8 times higher than HOBSI (7.61) in the pre-pandemic period but dropped down to approximately 6 times higher (5.9) during the pandemic period (p<0.0001; Table 3 ). The ratio of COBSI:HOBSI for COVID-19 infected patients during the pandemic period was 1.12, compared to 8.17 for pandemic non-COVID-19 infected patients (p=<0.0001). These differences were significant for each organism under evaluation. On the other hand, there were no significant differences in COBSI:HOBSI ratios for non-COVID-19 infected patients for pre-pandemic and pandemic periods. Trending such measures will be independent of shortages in infection preventionists or their increased workload. The electronically captured outcomes for infection prevention will be less susceptible to attrition in reporting and will provide a better picture of the national performance. The pandemic has resulted in significant changes in patient care practices and has had a considerable impact on outcomes. Our proposed metric may allow for more rapid identification of changes in outcomes with minimal surveillance workload on the infection prevention professional. Our study has some limitations. We present the changes in events for five pathogens commonly associated with HOBSIs. It is not inclusive of all organisms that have been reported to increase during the pandemic. 2, 15 However, our measure avoids including organisms considered commensals (e.g. coagulase negative staphylococci) and others that may be associated with contamination from skin flora (e.g. streptococci, enterococcus species). Furthermore, the HOBSI measure is not risk-adjusted to the patient's severity of illness and comorbidities. Finally, we address the experience of one health system with a history of focus on reducing healthcare associated infections. Notwithstanding these limitations, our study represents a large evaluation of HOBSI during COVID-19 pandemic in the US, from a large number of hospitals of diverse geographic locations, making our findings generalizable. In conclusion, the COVID-19 pandemic period was associated with substantial increases in HOBSI and largely attributed COVID-19 infected patients. The HOBSI measure provides support to the evaluation of infection prevention performance over time and helps identify significant changes in hospital onset invasive disease associated with COVID-19 pandemic. Future research should evaluate whether such measures would be beneficial to incorporate in evaluating infection prevention trends. 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National Institutes of Health COVID-19 hospital prevalence as a risk factor for mortality: an observational study of a multistate cohort of 62 hospitals Coronavirus disease 2019 (COVID-19) pandemic, centralline-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Hospital-Onset Staphylococcus aureus Bacteremia Is A Better Measure Than MRSA Bacteremia for Assessing Infection Prevention: Evaluation of 50 US Hospitals Acknowledgments: The authors report no external sources of financial support. No potential conflicts of interest for any of the authors.