The news is appalling, but not surprising to officials who have been watching waves of patients flood hospitals — in 2020, because there were no vaccines and few effective treatments; in 2021, because vaccines are being rejected. “We really had a perfect storm in terms of health-associated infections and Covid,” says Arjun Srinivasan, doctor and associate director of the CDC program to prevent these infections.
During the first waves, he points out, patients most likely to enter hospitals with severe covid were older, with chronic diseases, possibly immunocompromised, and as a result were more likely to end up in the ICU and needed ventilation tubes to take it relieves breathing and carries it into your bloodstream to administer medications. With so many patients, health workers were lying down, with more risk of skipping preventative tasks, and with such low PPE, with more risk of carrying pathogens unknowingly among patients. “So at the same time, you have more patients than you’ve had before, you have fewer staff than you normally should take care of,” Srinivasan says. “Normal care delivery systems are breaking down, because you just have too much demand for care and you don’t have enough health care providers to provide it.”
Last year there was an expectation concern that this could happen. In November, a team of researchers from New York and St. Louis predicted the American Journal of Infection Control that according to Covid, people with less acute illnesses or delayed surgeries would be less likely to be admitted to hospitals. They predict that this would lead to an increase in patients with serious illnesses who would need the type of interventions that lead to hospital infections. They based this prediction on the first signs of their own institutions: in the first three months of the American pandemic, bloodstream infections associated with the central line increased by 420 percent in a hospital and 327 percent in another, compared to the previous 15 months.
“At my institution, Covid came to us in mid-March 2020 and April was the worst month of hospital infections in the history of our hospital,” says Kathleen M. McMullen, Senior Infection Prevention Manager and Occupational Health at Christian Hospital and Northwest Healthcare in St. Louis. Louis and first author of this study. “Talking to colleagues nationwide, we knew they were dealing with it too and we thought, ‘We need to get that out.’
The team also predicted that some categories of infections, such as those taken advantage of in surgical incisions, would decrease as elective surgeries were postponed. His instincts were solid. New CDC data show that the only types of hospital infections that declined last year were surgical site infections after colon surgery or hysterectomy (those that require an open incision, not those that are done). by laparoscopy), and also It is difficult, the pernicious intestinal infection that occurs when broad-spectrum antibiotics disrupt the balance of intestinal bacteria.
All of this made sense, given the conditions the hospitals suffered in that first wave, McMullen says, “There were so many patients, not many more health workers, and so much fear of not being comfortable, of wanting to get in and out of the hospital. ‘a patient’s room quickly’.
The data the CDC discovered coincides with what McMullen and his colleagues observed and then predicted. But she says it actually can be unrepresentative hospital infections across the country, because the work of caring for patients in that first wave was so intense that the Federal Center for Medicare and Medicaid Services allowed hospitals to suspend mandatory reporting between April and June.
There is a signal especially foreshadowed in the CDC data. One of the infections that increased, which increased by a third between late 2019 and late last year, was bacteremia — the spread of infectious bacteria through the bloodstream, which can cause sepsis and septic shock — caused by MRSA. . It was the only drug-resistant infection that appeared in his data, as it is one of the infections to be reported from CMS. (MRSA and all staphylococcal bacteria live on the skin, so piercing it with a catheter or incision can drive the bacterium inside the body).