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Tactics to De-escalate Transmission of COVID-19 in Healthcare Facilities

Considered a dangerous, yet preventable healthcare phenomenon, healthcare-acquired infections (HAIs) put patients at risk for serious complications that can lead to sepsis or death. HAIs, also called nosocomial infections, are infections that develop in a healthcare facility while a patient is receiving medical attention. HAIs can be transmitted through person-to-person contact and can spread rapidly once they have surfaced.

As demonstrated during the rapid onset of the COVID-19 pandemic, viruses are not confined by geopolitical borders and are capable of rapid transmission. The virus has proven its ability to spread not only as a community-acquired illness, but also as an infection that can be acquired within a healthcare facility. "A review of 40 studies suggested 44% of COVID-19 cases worldwide are nosocomial."1 Hospital-acquired COVID-19 is a serious problem, and patients' heightened concerns about exposure may cause a reluctance to receive medical attention when needed.2

To safeguard patient health, tactics such as increased hygiene measures, universal masking, and syndromic infectious disease testing should continue to be used to slow the rate of facility transmission and deescalate COVID-19 as a transmissible HAI.

The Impact of COVID-19 on Other HAIs

HAI infections commonly include central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and Clostridium difficile infections (CDI).3 While some HAIs may be more common, any infection acquired within a healthcare facility is classified as a healthcare-acquired infection (HAI). "COVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.4

From the early stages of the COVID-19 pandemic, infection preventionists had predicted that changes in the frequency of HAIs were to come. Experts suspected these rates would grow, given the increase in very ill patients requiring a longer length of hospital stay.1

The Centers for Disease Control & Prevention (CDC) reported the impact the COVID-19 pandemic has had on HAI rates in U.S. hospitals in 2020. The data show a significant increase in HAIs such as CLABSIs, CAUTIs, and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.5

Strategies to Lessen Facility Transmission of COVID-19

The SARS-CoV-2 virus is transmitted "when an infected person breathes out droplets and very small particles that contain the virus."6 Given its transmissibility through air droplets, evidence suggests that universal masking, when coupled with extreme hand hygiene and other intensified measures, are effective in prevention. Hospitals around the world have seen substantial drops in many HAIs when abiding by these prevention guidelines over time.1

Data indicate that outbreaks within healthcare facilities such as hospitals have been linked to unmasked exposure to other healthcare workers, such as in break rooms and cafeterias.1 As the U.S. Food & Drug Administration (FDA) advises, it is important to recognize the most optimal way to prevent transmission of viruses such as COVID-19 is by using a combination of interventions, not just personal protective equipment (PPE) alone.7 "Immunization with government approved vaccines directed against SARS-CoV-2 has impacted on both community and healthcare rates of COVID-19."8

Other practices aimed at minimizing nosocomial COVID-19 transmission include infection protection and control teams, staff and patient screening, ongoing surveillance, a managerial COVID-19 risk-based strategy, isolation of infected patients, and surface and equipment cleaning and decontamination.8 Research also suggests that methods of infection prevention such as improved delivery of fresh air including door and window opening, extractor fan placement, HEPA filtration units and UV light technologies can also help lessen the burden of indoor transmission.8

Syndromic Testing Contributes Significantly to COVID-19 Mitigation Strategies

Hand inserts pouch into BIOFIRE

Advanced diagnostic tools such as the comprehensive BIOFIRE® FILMARRAY® System and BIOFIRE® FILMARRAY® Panels should also be leveraged as part of COVID-19 and HAI mitigation strategies. Reliable syndromic testing has played a role in minimizing nosocomial and community-acquired COVID-19.

BIOFIRE respiratory solutions leverage a syndromic approach to provide fast test results. An integrated approach to sample preparation, amplification, detection, and analysis using multiplex PCR technology takes the guesswork out of pathogen identification. Faster time to detection and accurate results can aid surveillance and lessen the burden of nosocomial transmission of infections such as COVID-19. The comprehensive system’s minimal time to result provides healthcare workers with the relevant information needed to quickly isolate COVID-19 positive individuals within their facility aiding in infection control.
Like other commonly identified HAIs, the nosocomial transmission of the COVID-19 virus poses an immediate threat to patient health and safety. To deescalate and slow the rate of transmission, a combination of interventions is required to safeguard patients and minimize risk.

Learn More about Testing for COVID-19 and the Syndromic Approach

References

  1. Keep COVID-19 From Becoming a Health Care-Acquired Infection. Infection control. https://www.infectioncontroltoday.com/view/keep-covid-19-from-becoming-a-health-care-acquired-infection. Published April 2, 2021.
  2. Barranco R, Vallega Bernucci Du Tremoul L, Ventura F. Hospital-Acquired SARS-Cov-2 Infections in Patients: Inevitable Conditions or Medical Malpractice? International Journal of Environmental Research and Public Health. 2021;18(2):489. doi:10.3390/ijerph18020489
  3. Monegro AF, Hariharan Regunath. Hospital Acquired Infections. Nih.gov. Published December 16, 2019. https://www.ncbi.nlm.nih.gov/books/NBK441857/
  4. Baker MA, Sands KE, Huang SS, et al. The Impact of COVID-19 on Healthcare-Associated Infections. Clinical Infectious Diseases. Published online August 9, 2021. doi:10.1093/cid/ciab688
  5. 2020 National and State Healthcare-Associated Infections Progress Report. https://www.cdc.gov/hai/data/portal/progress-report.html
  6. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) - Transmission. Centers for Disease Control and Prevention. Published March 17, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html
  7. Health C for D and R. N95 Respirators, Surgical Masks, Face Masks, and Barrier Face Coverings. FDA. Published online September 15, 2021. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings
  8. Dancer SJ. Reducing the risk of COVID-19 transmission in hospitals: focus on additional infection control strategies. Surgery (Oxford). 2021;39(11):752-758. doi:10.1016/j.mpsur.2021.10.003

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