Pandemic’s paradox: heightened infection control reduces resistant pathogens


Additional infection control measures implemented during the early COVID-19 pandemic have resulted in fewer inpatients isolating with multidrug resistant organisms (MRO).

A Queensland study, published in Infection, Disease & Health, compared patient isolation days with one or more MROs of concern before, during and after the first lockdown associated with COVID-19.

The MROs included vancomycin-resistant Enterococcus (VRE) VanA resistance, VRE VanB resistance, carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenemase-producing / carbapenem-resistant Enterobacterales (CPE/CRE), extended spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-KP), methicillin-resistant Staphylococcus aureus United Kingdom strain 15/hospital strain (MRSA UK15/HS) and carbapenem resistant Pseudomonas aeruginosa (CRP).

The study found patient isolation days dropped significantly during lockdown (26 March – 1 June) compared to before lockdown (28 Jan – 20 March) and increased again after the lockdown (7 June – 2 4 July) but not to pre-lockdown levels.

The incidence rate ratio was 0.65 when comparing lockdown to pre-lockdown periods and 0.87 when comparing post-lockdown to pre-lockdown periods.

The study found the change in patient isolation days was seen across wards including infectious diseases, renal/general medicine, respiratory and colorectal.

The decrease in patient isolation was also evident across all but one MRO type.

“Patient isolation days attributed to VRE VAN-B were uniquely not impacted during COVID-19 restrictions and increased after restrictions were lifted,” the study said.

“Patient isolation days decreased in both during and post-COVID-19 restriction periods across five wards, while increases in VRE VAN-B led to increased isolation days in Haematology and Vascular wards.”

The study estimated that if maintained post pandemic, improved isolation efficiency could save AU $54,692 per month in hospital costs by reducing closure of multi-bed rooms used as back up when single-bed isolation rooms were full.

“We have shown a hospital committed to reduced microorganism transmission, as occurred during COVID-19 pandemic, can immediately reduce the MRO burden, with potential ongoing improvements in MRO prevention and patient isolation efficiency,” the study concluded.

The researchers said their findings were consistent with an Italian study which also found COVID-19 preventive measures in a Rome hospital led to a significant reduction in the incidence of all multidrug resistant bacterial infections.

Lead author on the local study Thomas Elliott, a health economist at the QIMR Berghofer Medical Research Institute, told the limbic the study provided a glimpse of what the best possible infection control procedures could achieve.

“With COVID-19, people started taking infection control much more seriously…they spent much more time making sure there were no pathogens spreading across the hospital.”

“The interesting thing we found is that this behaviour continued on after the Brisbane lockdown.”

He said a more in-depth and long term study utilising patient level data such as reasons for admission and patient movement through different wards would be worthwhile.

Mr Elliott predicted the best infection control measures would lead to savings in the costs of treating pathogens, use of hospital beds, quality of life years and possibly lives saved compared to increased PPE and testing costs and person-hours associated with isolation.

 

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