key: cord-0964964-2h4cat6k
authors: Cole, Jennifer; Barnard, Emily
title: The Impact of the COVID-19 Pandemic on Healthcare Acquired Infections with Multidrug Resistant Organisms
date: 2020-10-02
journal: Am J Infect Control
DOI: 10.1016/j.ajic.2020.09.013
sha: 3592146f7f0eee39421e2287bd1fc97212f82eab
doc_id: 964964
cord_uid: 2h4cat6k

This retrospective, cross-sectional study was conducted in four community hospitals in Los Angeles County, California. The assumption of this study was, coronavirus disease-19 (COVID-19) contributed to the increase in healthcare workers (HCW) compliance with infection prevention measures. IP initiatives fostered among HCWs have increased awareness of effective hand washing, cleaning equipment after use and appropriate personal protective equipment (PPE) use which has subsequently decreased healthcare acquired infections (HAI) with multidrug-resistant organisms (MDRO).

Multidrug-resistant organisms (MDROs) are microorganisms that are resistant to one or more therapeutic classes of antimicrobial agents and MDRO HAIs are a major concern in hospitals across the country (Weinstein, 2008) . Previous methods that worked successfully to (Siegel et al., 2006) . The spread of MDROs was thought to be a complicated and complex issue that required numerous interventions to reduce the incidence rates (Webb et al, 2012) .

However, the COVID-19 pandemic has been a stark reminder of the importance of basic infection measures including hand washing, cleaning equipment and the use of PPE when providing patient care to prevent MDRO HAIs from occurring.

When COVID-19 become a significant concern in Los Angeles County, our health care workers received additional education regarding appropriate PPE usage, donning and doffing techniques, cleaning equipment after use and the importance of hand hygiene before and after patient contact. This education was provided during 5-minute huddles at the change of shift.

Additionally, educational flyers with this information were posted strategically near clock-in areas and break rooms.

This retrospective, cross-sectional study reviewed the prevalence of healthcare onset infections with multidrug resistant organisms including, methicillin-resistant staphylococcus aureus (MRSA), Extended Spectrum Beta-Lactamase (ESBL) and Vancomycin-resistant Enterococcus (VRE) pre and post COVID-19 pandemic. Specimen types included urine, wound, blood or sputum cultures. In each instance, the patient did not have a positive culture for the specific organism until on or after day 4 of hospital admission.

Overall, MDRO rates decreased from Q1-2020 to Q2-2020 and ranged from 21% to 80%. In 2020 from Q1 to Q2, HAI-MDRO proportion decreased 0.3% and 0.2% respectively with a proportion p-value of 0.0342.

HCWs are at the front-line of COVID-19 pandemic, frequent exposure to infected patients can put them at a greater risk for acquiring and transmitting the infection. COVID-19 has increase awareness of basic infection control measures and subsequently reduced the incidence of MRDO HAIs in our hospitals. One of the most frequently reported strategies implemented in hospitals was frequent hand hygiene with soap and water or hand sanitizer by HCWs (Virani, et al., 2020) . During Q2-2020, when COVID patients began arriving at our four Los Angeles

County hospitals, alcohol-based hand sanitizer and hand soap usage increased by 25% compared to Q1-2020 (pre-COVID).

Infection Prevention initiatives fostered in healthcare organizations among HCWs have contributed to a reduction in rate of HAI with MDROs. Further research is needed over a longer duration to determine if the reduction of these rates are sustainable. Limitations of this study and confounding variables include pooled data between different hospitals with varied practices and resources. Furthermore, conducting hospital specific research over a longer duration could assess the need for the enhanced cleaning technologies and an electronic hand hygiene system to further reduce the incidence of MDRO-HAIs.

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The Impact of the COVID-19 Pandemic on Healthcare Acquired Infections with Multidrug Resistant Organisms 6

Recommendations for Metrics for Multidrug-Resistant Organisms in Healthcare Settings: SHEA/HICPAC Position Paper