Infection preventionists are reporting increasing outbreaks of healthcare associated infections (HAIs) as the COVID-19 pandemic demands outsized efforts by overworked caregivers.

A survey by the Association for Professionals in Infection Control and Epidemiology (APIC) found that respondents reported a 27.8% increase in central line-associated bloodstream infections (CLABSIs); a 21.4% jump in catheter-associated urinary tract infections (CAUTIs); and a 17.6% climb in ventilator-associated pneumonia (VAPs) or ventilator-associated events (VAEs).1

For example, in July 2020, the Florida Department of Health was alerted to three Candida auris bloodstream infections and one urinary tract infection in four patients with coronavirus disease 2019 (COVID-19) who received care in the same dedicated COVID-19 unit of an acute care hospital (hospital A), the Centers for Disease Control and Prevention (CDC) reports.2

A multidrug-resistant yeast that can cause invasive infections, C. auris has been described as spreading more like bacteria and is notoriously difficult to remove from the environment. Accordingly, before the pandemic, the hospital screened on admission for C. auris, admitting colonized patients to a dedicated ward.

“Hospital A’s COVID-19 unit spanned five wings on four floors, with 12 to 20 private, intensive care-capable rooms per wing,” the CDC stated. “Only patients with positive test results for SARS-CoV-2 ... at the time of admission were admitted to this unit. After patient discharge, room turnover procedures included thorough cleaning of all surfaces and floor, and ultraviolet disinfection.”

Among 67 patients admitted to the COVID-19 unit and screened during point prevalence surveys, 35 (52%) were positive for C. auris. Of those, six had clinical cultures that grew the fungus.

Healthcare workers in the COVID-19 unit had a practice of wearing multiple layers of gowns and gloves during care of pandemic patients.

“A second, disposable isolation gown and pair of gloves were donned before entering individual patient rooms, then doffed and discarded upon exit,” the CDC noted. “Alcohol-based hand sanitizer was used on gloved hands after doffing outer gloves. HCP (healthcare professionals) removed all PPE (personal protective equipment) and performed hand hygiene before exiting the unit.”

Computers and medical equipment were not always disinfected between uses, and medical supplies (e.g., oxygen tubing and gauze) were stored in open bins in hallways. “A combination of factors that included HCP using multiple gown and glove layers in the COVID-19 unit, extended use of the underlayer of PPE, lapses in cleaning and disinfection of shared medical equipment, and lapses in adherence to hand hygiene likely contributed to widespread C. auris transmission,” the CDC concluded. “After hospital A removed supplies from hallways, enhanced cleaning and disinfection practices, and ceased base PPE layer practices, no further C. auris transmission was detected.”

REFERENCES

  1. Association for Professionals in Infection Control and Epidemiology. National survey shows healthcare facilities implementing PPE crisis standards of care. Dec. 3, 2020. https://apic.org/news/national-survey-shows-healthcare-facilities-implementing-ppe-crisis-standards-of-care/
  2. Prestel C, Anderson E, Forsberg K, et al. Candida auris outbreak in a COVID-19 specialty care unit — Florida, July-August 2020. MMWR Morb Mortal Wkly Rep 2021;70:56-57.