The potential impact of enhanced hygienic measures during the COVID-19 outbreak on hospital-acquired infections: A pragmatic study in neurological units

Abstract

Objective: Hospital-acquired infections (HAIs) are frequent complications among acute patients hospitalized in neurological units, especially among those hospitalized for stroke. This study aimed to investigate if enhanced hygienic measures, including the systematic use of personal protective equipment (PPE), determined a decrease in HAI during the recent COVID-19 outbreak in "COVID-free" neurological units.

Methods: Patients hospitalized in neurology and stroke units of Policlinico Umberto I Hospital in Rome from March 8, 2020 and discharged prior to May 31, 2020 were included in the study and compared with patients hospitalized during the same period in 2019.

Results: A total of 319 patients were included in the study (n = 103 in 2020, n = 216 in 2019). Among patients hospitalized in 2019, the incidence of HAIs was 31.5% (95% confidence interval (CI): 0.25-0.38), compared with 23.3% (95% CI: 0.15-0.32) in 2020 (p = 0.12). Multivariable logistic regression showed that hospitalization during 2020 was independently associated with a lower risk of HAIs (odds ratio: 0.34, 95% CI:0.16-0.71, p = 0.004). Poisson regression models showed that hospitalization during 2020 was also independently associated with both a lower number of HAIs (relative risk [RR]: 0.56, 95% CI:0.38-0.81, p = 0.01) and a lower number of prescribed antibiotics per patient (RR: 0.66, 95% CI: 0.49-0.87, p = 0.02).

Conclusion: Our study design provides evidence regarding the impact of stricter hygienic measures, such as increased PPE use, on HAIs. Larger studies are needed to support the extension of preventive measures even after the COVID-19 outbreak in order to limit the occurrence of HAIs.

Keywords: COVID-19; Hospital infections; Neurology unit; Sars-CoV-2; Stroke unit.

Fig. 1

Discharge diagnoses stratified by year of hospitalization. Discharge diagnoses expressed as percentages. Patients hospitalized during 2019 are in blue while those hospitalized during 2020 are in red. Abbreviations: FND = functional neurological disorders; TIA = transient ischemic attack.

Fig. 2

Forest plot of regression analyses. Forest plot of multivariable regression analyses. All independent variables in the models are represented. The upper panel shows the multivariable logistic regression model (M0) and relative factors associated with the absence/presence of hospital-acquired infections (HAIs). The X-axis represents the relative odds ratio (OR) and 95% confidence interval (CI) of each covariate. P values are reported on the right. The middle panel shows the multivariable Poisson regression model with the number of infections per patient as the outcome (M1). For each variable, the relative risk (RR) and 95% CI are reported and P values are shown on the right. The lower panel shows the multivariable Poisson regression model with the number of antibiotics administered per patient as the outcome (M2). For each variable, the RR and 95% CI are reported and P values are shown on the right.