Coronavirus prevention measures reduce germs in hospital

Measures implemented to protect against the coronavirus in hospitals also reduce other nosocomial agents. One study shows that MRSA rates can even be halved.

Surveillance data from the largest hospital in Singapore, with 1,800 beds, show that infection protection measures implemented to prevent COVID-19 can also prevent other nosocomial infections.

The most important findings at a glance:

High compliance rates in hand hygiene, upping surface hygiene and handling personal protective equipment correctly significantly reduce MRSA and catheter-associated bloodstream infections in particular.
This study shows that compulsory social distancing and mask-wearing reduces nosocomial viral respiratory infections, which are responsible for severe courses of illness and intensive care.
Other multidrug-resistant agents such as carbapenemase-forming/carbapenem-resistant Enterobacteriaceae and Clostridioides difficile can be kept stable despite high levels caused by the pandemic.

Success formula: Surveillance and reinforced infection control

We are not yet certain if upping our infection protection measures in the context of the coronavirus pandemic also reduces other hospital infections. This is due to a particular lack of comparative data before and during the pandemic. Now we have new evidence to suggest the coronavirus measures have a positive influence in reducing other hospital germs, provided by data from the largest hospital in Singapore. The 1,800-bed clinic established stringent infection protection measures from February to August 2020. The hospital maintained surveillance of important hospital agents and infections during this period.

The following nosocomial agents were monitored, among others:

Respiratory viral infections caused by agents such as human metapneumovirus (HMPV), respiratory syncytial virus (RSV), rhinovirus A/B/C, influenza virus A/B, human parainfluenza virus (HPIV), human coronavirus (hCoV)
Methicillin-resistant Staphylococcus aureus (MRSA)
Carbapenemase-forming, carbapenem-resistant Enterobacteriaceae (CP/CRE)
Clostridioides difficile
Device-associated infections (urinary tract infections, bloodstream infections, ventilator-associated pneumonia)

Multi-stage infection control program

With the occurrence of the first SARS-CoV-2 case in January 2020, the Singapore hospital established a multi-level prevention strategy:

Isolation of patients with symptoms of respiratory disease and a minimum social distance of 1.5 m between beds
Universal compulsory mask-wearing for personnel, initially ordinary face masks, later FFP2 masks
Upping the surface disinfection in the environment surrounding the patient to 3 x daily
Surveillance of surface disinfection with fluorescent markers
Intensifying hand hygiene
Personal protective equipment (gowns, gloves) for health workers; and cleaning staff including training on how to properly wear it

Positive effects for patient safety

Viral respiratory diseases

The greatest positive effect was seen in the decrease in nosocomial viral respiratory infections. The incidence decreased from 9.69 cases per 10,000 patient stay-overs before the infection control program was introduced to 0.83 cases per 10,000 patient stay-overs. Viral respiratory diseases are often an underestimated cause of severe hospital-acquired pneumonia that eventually requires intensive care.

MRSA

The MRSA rate also developed in a positive way. Before the pandemic, it was 11.7 cases per 10,000 patient stay-overs, compared to 6.4 cases per 10,000 patient stay-overs during the pandemic. Nosocomial bacteraemia caused by MRSA decreased from 0.36 cases per 10,000 patient stay-overs to 0.11 cases per 10,000 patient stay-overs.

Catheter-associated bloodstream infections

For catheter-associated bloodstream infections, the authors of the study recorded a decrease from 0.83 cases per 1,000 days a catheter was used (95 incidents, 113,466 days a catheter was used) to 0.20 incidents per 1,000 days a catheter was used.

CP-CRE and other nosocomial agents

Despite the interruptions to the daily running of the clinic caused by the pandemic, CP-CRE and C. difficile rates remained stable. The authors assume that upping alcohol-based hand disinfection was not successful to the same extent with C. difficile as it was with MRSA, since hands must be washed as well as sanitized. For CP-CRE, it’s mainly hospital sinks and drains that serve as reservoirs. Surface hygiene during the COVID-19 pandemic focused in particular on frequent disinfection of the environment surrounding the patient as well as frequently touched surfaces. A less frequent usage of sanitary areas could have led to CP-CRE persisting in sinks and drains.

Despite these limitations, the positive effects of the coronavirus prevention measures should not be underestimated and should not be taken for granted: for example, during the first SARS outbreak in 2003, there was an increase of MRSA in a Hong Kong hospital intensive care unit that cared for SARS patients. Resistant agents increased from 3.53% in the pre-SARS period to 25.30% during the SARS period and then decreased again to 2.21% in the post-SARS period. The rate of ventilator-associated pneumonia was also high at 36.5 episodes per 1,000 days on a ventilator.

Sources:

1. Liang En Ian Wee et al. Unintended consequences of infection prevention and control measures during COVID-19 pandemic. American Journal of Infection Control 2021; 49:469−477.
https://www.ajicjournal.org/article/S0196-6553(20)30963-9/pdf
(Letzter Zugriff 13.06.2021).

2. Yap FHY et al. Increase in Methicillin-Resistant Staphylococcus aureus Acquisition Rate and Change in Pathogen Pattern Associated with an Outbreak of Severe Acute Respiratory Syndrome. Clinical Infectious Diseases 2004; 39:511–6.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204093/
(Letzter Zugriff 13.06.2021).

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