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Healthcare-associated infections in Veterans Affairs acute-care and long-term healthcare facilities during the coronavirus disease 2019 (COVID-19) pandemic

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  05 April 2022

Martin E. Evans Open the ORCID record for Martin E. Evans [Opens in a new window] ,
Loretta A. Simbartl ,
Stephen M. Kralovic ,
Marla Clifton ,
Kathleen DeRoos ,
Brian P. McCauley Open the ORCID record for Brian P. McCauley [Opens in a new window] ,
Natalie Gauldin ,
Linda K. Flarida ,
Shantini D. Gamage Open the ORCID record for Shantini D. Gamage [Opens in a new window]  and
Makoto M. Jones
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Martin E. Evans*
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC Lexington Veterans Affairs Healthcare System, Lexington, Kentucky Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky School of Medicine, Lexington, Kentucky
Loretta A. Simbartl
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
Stephen M. Kralovic
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC Cincinnati Veterans Affairs Healthcare System, Cincinnati, Ohio Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio
Marla Clifton
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
Kathleen DeRoos
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
Brian P. McCauley
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
Natalie Gauldin
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
Linda K. Flarida
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
Shantini D. Gamage
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio
Makoto M. Jones
Affiliation:
VA Salt Lake City Health Care System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Gary A. Roselle
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC Cincinnati Veterans Affairs Healthcare System, Cincinnati, Ohio Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio
*
Author for correspondence: Martin E. Evans, E-mail: martin.evans@va.gov
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Abstract

Objective:

To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infections (HAIs) reported from 128 acute-care and 132 long-term care Veterans Affairs (VA) facilities.

Methods:

We compared central-line–associated bloodstream infections (CLABSIs), ventilator-associated events (VAEs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile infections and rates reported from each facility monthly to a centralized database before the pandemic (February 2019 through January 2020) and during the pandemic (July 2020 through June 2021).

Results:

Nationwide VA COVID-19 admissions peaked in January 2021. Significant increases in the rates of CLABSIs, VAEs, and MRSA all-site HAIs (but not MRSA CLABSIs) were observed during the pandemic in acute-care facilities. There was no significant change in CAUTI rates, and C. difficile rates significantly decreased. There were no significant increases in HAIs in long-term care facilities.

Conclusions:

The COVID-19 pandemic had a differential impact on HAIs of various types in VA acute care, with many rates increasing. The decrease in CDI HAIs may be due, in part, to evolving diagnostic testing. The minimal impact of COVID-19 in VA long-term facilities may reflect differences in patient numbers and acuity and early recognition of the impact of the pandemic on nursing home residents leading to increased vigilance and optimization of infection prevention and control practices in that setting. These data support the need for building and sustaining conventional infection prevention and control strategies before and during a pandemic.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 3 , March 2023 , pp. 420 - 426
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Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States.
Copyright
© US Department of Veterans Affairs, 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Weiner-Lastinger, LM, Pattabiraman, V, Konnor, RY, et al. The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: a summary of data reported to the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2022;43:12–25.CrossRefGoogle Scholar
Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:14–19.10.1056/NEJMoa1007474CrossRefGoogle ScholarPubMed
National Healthcare Safety Network. Ventilator-associated events. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf. Published 2021. Assessed November 30, 2021.Google Scholar
McCauley, BP, Evans, ME, Simbartl, LA, Gamage, SD, Kralovic, SM, Roselle, GA. Effect of testing methods on incidence of Clostridioides difficile infection rates in Veterans Affairs medical centers. Infect Control Hosp Epidemiol 2021;42:461–463.10.1017/ice.2020.452CrossRefGoogle ScholarPubMed
National Healthcare Safety Network. CDC/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. Published 2021. Assessed November 30, 20 21.Google Scholar
Clifton, M, Kralovic, SM, Simbartl, LA, et al. Achieving balance between implementing effective infection prevention and control practices and maintaining a home-like setting in US Department of Veterans Affairs nursing homes. Am J Infect Control 2018;46:1307–1310.10.1016/j.ajic.2018.04.221CrossRefGoogle ScholarPubMed
Singh, M, Evans, M, Kralovic, S, Simbartl, L, Roselle, G. Evaluating the effect of a Clostridium difficile infection prevention initiative in Veterans Health Administration long-term care facilities. Infect Control Hosp Epidemiol 2018;39:343–345.CrossRefGoogle ScholarPubMed
Evans, M, Kralovic, S, Simbartl, L, Jain, R, Roselle, G. Effect of a Clostridium difficile infection prevention initiative in Veterans Affairs acute-care facilities. Infect Control Hosp Epidemiol 2016;37:720–722.CrossRefGoogle ScholarPubMed
National Surveillance Tool to assess readiness across the VA’s health system—VAntage Point. US Department of Veterans Affairs website. https://blogs.va.gov/VAntage/74896/national-surveillance-tool-assesses-readiness-across-vas-health-system/Published 2020. Accessed November 30, 2021.Google Scholar
Lu, R, Zhao, X, Li, J, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565–574.CrossRefGoogle ScholarPubMed
Lansbury, L, Lim, B, Baskaran, V, Lim, WS. Coinfections in people with COVID- 19: a systematic review and meta-analysis. J Infect 2020;81:266–275.CrossRefGoogle ScholarPubMed
Rawson, TM, Moore, LSP, Zhu, N, et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020;71:2459–2468.Google ScholarPubMed
Clancy, CJ, Schwartz, IS, Kula, B, Nguyen, MH. Bacterial superinfections among persons with coronavirus disease 2019: a comprehensive review of data from postmortem studies. Open Forum Infect Dis 2021;8:ofab065. CrossRefGoogle ScholarPubMed
Russell, CD, Fairfield, CJ, Drake, TM, et al. Coinfections, secondary infections, and antimicrobial use in patients hospitalized with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. Lancet Microbe 2021;2:e354–e365.10.1016/S2666-5247(21)00090-2CrossRefGoogle Scholar
Kubin, CJ, McConville, TH, Dietz, D, et al. Characterization of bacterial and fungal infections in hospitalized patients with coronavirus disease 2019 and factors associated with healthcare-associated infections. Open Forum Infect Dis https://doi.org/10.1093/ofid/ofab201. Published 2021. Accessed November 30, 2021.CrossRefGoogle Scholar
Ponce-Alonso, M, de la Fuente, JS, Rincón-Carlavilla, A, et al. Impact of the coronavirus disease 2019 (COVID-19) pandemic on nosocomial Clostridioides difficile infection. Infect Control Hosp Epidemiol 2021;42:406–410.CrossRefGoogle ScholarPubMed
Luo, Y, Grinspan, LT, Fu, Y, et al. Hospital-onset Clostridioides difficile infections during the COVID-19 pandemic. Infect Control Hosp Epidemiol 2021;42:1165–1166.10.1017/ice.2020.1223CrossRefGoogle ScholarPubMed
Goetz, MB, Willson, TM, Stevens, VM, Graber, CJ, Rubin, M. Antimicrobial use before and during COVID-19—data from 108 VA facilities. Open Forum Infect Dis 2021;8:S194–S195.CrossRefGoogle Scholar
Evans, ME, Kralovic, SM, Simbartl, LA, Jain, R, Roselle, GA. Eight years of decreased methicillin-resistant Staphylococcus aureus healthcare-associated infections associated with a Veterans Affairs Prevention Initiative. Am J Infect Control 2017;45:13–16.CrossRefGoogle ScholarPubMed
Evans, ME, Kralovic, SM, Simbartl, LA, et al. Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units. Amer J Infect Control 2013;41:422–426.CrossRefGoogle ScholarPubMed
Goto, M, O’Shea, A, Livorsi, DJ, et al. The effect of a nationwide infection control program expansion on hospital-onset gram-negative rod bacteremia in 130 Veterans Health Administration medical centers: an interrupted time series analysis. Clin Infect Dis 2016;63:642–502.10.1093/cid/ciw423CrossRefGoogle ScholarPubMed
Render, ML, Hasselbeck, R, Freyberg, RW, et al. Reduction of central-line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Qual Saf 2011;20:725–732.CrossRefGoogle ScholarPubMed
Veterans Health Administration Office of Emergency Management. COVID-19 response plan. Veterans Health Administration website. https://www.va.gov/opa/docs/VHA_COVID_19_03232020_vF_1.pdf. Published March 23, 2020. Accessed March 4, 2022.Google Scholar
Prestel, C, Anderson, E, Forsberg, K, et al. Candida auris outbreak in a COVID-19 specialty care unit—Florida, July–August 2020. Morbid Mortal Wkly Rep 2021;70:1–2.Google Scholar
Veterans Health Administration (VHA) coronavirus 2019 (COVID-19) response report—annex A, May 10, 2021. Veterans Health Administration website. https://www.va.gov/health/docs/VHA-COVID-19-Response-2021.pdf. Published May 10, 2021. Accessed March 4, 2022.Google Scholar
Spotswood, S. VA touts lower CLC COVID-19 rates vs community nursing homes. US Medicine website. https://www.usmedicine.com/late-breaking-news/va-touts-lower-clc-covid-19-rates-vs-community-nursing-homes/. Published 2020. Accessed November 30, 2021.Google Scholar
Rudolph, JL, Hartronft, S, McConeghy, K, et al. Proportion of SARS-CoV-2 positive tests and vaccination in Veterans Affairs community living centers. J Am Geriatr Soc 2021;69:2090–2095.CrossRefGoogle ScholarPubMed