Unintended consequences of infection prevention and control measures during COVID-19 pandemic

Wee, Liang En; Conceicao, Edwin Philip; Tan, Jing Yuan; Magesparan, Kamini Devi; Amin, Ismawati Binte Mohamad; Ismail, Bushra Binte Shaik; Xian, Toh Hui; Pinhong, Jin; Jing, Zhang; Elaine, Wee Geok Ling; Ong, Sheena Jin Min; Lee, Gillian Li Xin; Wang, Amanda En-min; Bien, Molly How Kue; Yuen, Tan Kwee; Chee, Lee Lai; Choo, Phoon Poh; Yong, Yang; Aung, May Kyawt; Sim, Xiang Ying Jean; Venkatachalam, Indumathi; Ling, Moi Lin

BACKGROUND: In the current COVID-19 pandemic, aggressive Infection Prevention and Control (IPC) measures have been adopted to prevent healthcare-associated transmission of COVID-19. We evaluated the impact of a multi-modal IPC strategy originally designed for the containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs). METHODOLOGY: From February-August 2020, a multi-modal IPC strategy was implemented across a large healthcare campus in Singapore, comprising improved segregation of patients with respiratory symptoms, universal masking and heightened adherence to Standard Precautions. The following rates of HAI were compared pre- and post-pandemic: healthcare-associated respiratory-viral-infection (HA-RVI), MRSA and CP-CRE acquisition rates, healthcare-facility-associated C.difficile infections (HCFA-CDI) and device-associated HAIs. RESULTS: Enhanced IPC measures introduced to contain COVID-19 had the unintended positive consequence of containing HA-RVI. The cumulative incidence of HA-RVI decreased from 9.69 cases per 10,000 patient-days to 0.83 cases per 10,000 patient-days (incidence-rate-ratio=0.08; 95%CI=0.05-0.13, p<0.05). Hospital-wide MRSA acquisition rates declined significantly during the pandemic (incidence-rate-ratio=0.54, 95%CI=0.46-0.64, p<0.05), together with central-line-associated-bloodstream infection (CLABSI) rates (incidence-rate-ratio=0.24, 95%CI=0.07-0.57, p<0.05); likely due to increased compliance with Standard Precautions. Despite the disruption caused by the pandemic, there was no increase in CP-CRE acquisition, and rates of other HAIs remained stable. CONCLUSION: Multimodal IPC strategies can be implemented at scale to successfully mitigate healthcare-associated transmission of RVIs. Good adherence to personal-protective-equipment and hand hygiene kept other HAI rates stable even during an ongoing pandemic where respiratory infections were prioritized for interventions.