The Pandemic’s Impact on HAIs, Antimicrobial Stewardship and Implementation Science

By Kelly M. Pyrek

This year’s IDWeek meeting presented numerous opportunities to review how the pandemic has impacted hospital pathogens, healthcare-associated infections (HAIs), and antimicrobial stewardship efforts. We present highlights of some of the more pertinent presentations.

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Updated recommendations on how to prevent central line-associated bloodstream infections (CLABSIs), as well as ventilator-associated pneumonia, ventilator-associated events (VAEs), and non-ventilator healthcare-associated pneumonia (NV-HAP) were recently published as part of the updates to the infection prevention resource known as the SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. The Compendium provides practical recommendations for preventing healthcare associated infections (HAIs) that have major impacts on the quality and safety of patient care.

During her IDWeek presentation, “What’s Hot (and Not) in MRSA Prevention,” Kyle Popovich, MD, MS, an infectious diseases physician at Rush University Medical Center in Chicago, reviewed updates in the 2022 Compendium, including a move from calling “basic” practices to “essential” practices throughout, as well as a change in nomenclature from “special approaches” to “additional approaches” throughout the guidance. For example, antimicrobial stewardship has been reclassified from an unresolved issue to an essential practice. Also, while contact precautions remain an essential practice, considerations have been provided for hospitals that are considering discontinuing the use of contact precautions for some or all patients with MRSA colonization or infection.

Additionally, active surveillance testing (AST) remains an additional practice but specific recommendations, supporting data and quality of evidence ratings for the use of AST in several specific patient populations have been added. Also, Popovich pointed out that decolonization therapy for patients with MRSA colonization remains an additional practice but specific recommendations for use of universal or targeted decolonization in several specific patient populations have been added to the Compendium.
Popovich reported that using contact precautions for MRSA-colonized and MRSA-infected patients remains unchanged from the 2014 Compendium but noted that some hospitals have already discontinued this practice for MRSA prior to the pandemic, and some have stopped this practice to conserve personal protective equipment (PPE) during early stages of the pandemic. She noted that more hospitals are weighing their decision post-pandemic.

For those facilities choosing to discontinue contact precautions for MRSA, Popovich outlined the Compendium’s recommendations, including conducting a MRSA risk assessment. The Compendium notes that the opportunity for transmission is affected by the proportion of patients who are MRSA carriers and serve as a reservoir for transmission. These patients can be identified through review of clinical cultures and/or AST.

If there is an ongoing MRSA outbreak or high or increasing MRSA infection rates, the guidance says hospitals should consider not discontinuing contact precautions for MRSA-colonized or -infected patients. Facilities should ensure excellent infection prevention and control practices and promote adherence with standard precautions. Popovich noted that many studies demonstrating success with stopping contact precautions had several horizontal strategies in place. Further, hospitals should monitor key metrics and consider reinstituting contact precautions if rates increase.

Read further from the December 2022 issue HERE