The global COVID-19 pandemic has brought infection prevention teams into the spotlight, showcasing their expertise and decades of work on preparedness. As the pandemic continues to unfold with the omicron and delta variants driving hospitalizations up again, these teams are helping manage unprecedented surges of critically ill patients in the face of additional ongoing challenges created by inadequate supplies of personal protective equipment, staff shortages, fear and fatigue. The COVID-19 response has challenged established procedures in ways previously unimaginable.
This experience brings into focus the importance of maintaining robust infection prevention teams and fully engaging them in emergency preparedness planning. Hospital and health system leadership should make it a high priority to provide staffing and resources to support robust infection control teams that have the bandwidth to anticipate and respond to a pandemic or local outbreaks while also advancing antibiotic stewardship and infection-prevention practices. According to research based on the Medical Expenditure Panel Survey from the federal Agency for Healthcare Research and Quality, antibiotic resistance adds nearly $1,400 to the treatment of a single bacterial infection. A 2014 AHRQ study found healthcare-associated infections cost hospitals from $28 billion to $45 billion a year.
Despite heroic efforts, hard-won progress on healthcare-associated infection rates took a step backwards in the COVID-19 pandemic. A recent report published in Infection Control and Hospital Epidemiology from the Centers for Disease Control and Prevention National Health Safety Network found increases in four types of healthcare- associated infections from 2019 to 2020. Increased ventilator and other device use for critically ill COVID patients explained some, but not all, of the rise in central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events, and methicillin-resistant Staphylococcus aureus (MRSA) infections. These increases came after years of steady decline in healthcare-associated infections.
This report also had some good news that demonstrates infection prevention works when properly supported. Surgical-site infection and C. diff rates remained steady during the first pandemic waves—likely because long-established operating room processes remained in place, and because handwashing, patient isolation and environmental cleaning increased systemwide.
Beyond the surgical suite, many of the tried-and-true infection prevention efforts were disrupted as teams fought to save lives and treat waves of COVID patients under challenging circumstances. Infection prevention and control teams were spread thin responding to issues created by staffing stress, the reassignment of personnel who needed rapid training, and the need to establish and modify infection prevention protocols for COVID based on shifting knowledge of the virus. Antibiotic stewardship took a hit, especially early in the pandemic as health teams with few options tried multiple ways to treat patients, leading to overuse of antibiotics.
This real-life stress test on our system emphasized the need to configure infection prevention practices differently so that they are a sustainable part of care delivery. The evidence shows that strengthening infection prevention and control capacities works, but stronger, deeper and broader resources are required to improve our ability to protect patients in future pandemics while also improving patient care and protecting patients from infection every day.
As the pandemic evolves and ultimately winds down, it is essential that healthcare leaders get behind efforts to return to the basics to train and retrain staff, cross-train and build systems that will work even under stress. Infection prevention policies, antibiotic stewardship and training will require continuous monitoring of rebuilt capabilities weakened in the latest crisis. Leaders must ensure that infection prevention teams are robust enough to play a lead role in managing outbreaks while continuing their crucial role in overall patient safety. Without vigilance, healthcare-associated infection rates, antibiotic overuse and related complications, deaths and costs will continue to rise, and quality of care will decrease.
Health systems must hardwire care processes to ensure monitoring for healthcare-associated infections doesn’t suffer during times when cases surge. This requires healthcare leaders to commit dedicated resources, especially adequate staffing, to infection control. It is also essential that leaders include hospital epidemiologists and infection preventionists in all emergency preparedness planning, making sure they are core members of command centers.
There is no time to lose. It’s never a question of “if” but rather “when” the limits of the healthcare system will be tested again by another outbreak, epidemic or pandemic. Our readiness depends on healthcare leaders committing to never forget the hard-fought lessons of the COVID-19 pandemic and prioritizing resources for lasting and sustainable change.