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. 2023 Mar;44(3):420-426.
doi: 10.1017/ice.2022.93. Epub 2022 Apr 5.

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

Martin E Evans  1   2   3 , Loretta A Simbartl  1 , Stephen M Kralovic  1   4   5 , Marla Clifton  1 , Kathleen DeRoos  1 , Brian P McCauley  1 , Natalie Gauldin  1 , Linda K Flarida  1 , Shantini D Gamage  1   5 , Makoto M Jones  6   7 , Gary A Roselle  1   4   5
Affiliations

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

Martin E Evans et al. Infect Control Hosp Epidemiol. 2023 Mar.

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.

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Figures

Fig. 1.
Fig. 1.
Nationwide central-line–associated bloodstream infections (CLABSIs) and rates in acute-care facilities 1 year before (baseline) and 1 year during the COVID-19 pandemic. (Data were not required to be reported from February through June 2020.)
Fig. 2.
Fig. 2.
Nationwide ventilator-associated events (VAEs) and rates in acute-care facilities 1 year before (baseline) and 1 year during the COVID-19 pandemic. (Data were not required to be reported from February through June 2020.)
Fig. 3.
Fig. 3.
Nationwide methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections and rates per 1,000 patient days in acute-care facilities 1 year before (baseline) and 1 year during the COVID-19 pandemic. (Data were not required to be reported from February through June 2020.)
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References

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    1. 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. - PubMed
    1. 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.
    1. 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. - PubMed
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