An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemic
Background. The coronavirus disease 2019 (COVID-19) pandemic placed an unprecedented strain on intensive care units (ICUs) in South Africa. Infection prevention and control (IPC) strategies were highlighted to minimise the risk to healthcare workers and for the protection of patients from contr...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
South African Medical Association
2023-12-01
|
| Series: | South African Medical Journal |
| Subjects: | |
| Online Access: | https://samajournals.co.za/index.php/samj/article/view/971 |
| _version_ | 1797194725601574912 |
|---|---|
| author | B Mashigo A Parker U Lalla B W Allwood M S Moolla T Lovelock C F N Koegelenberg |
| author_facet | B Mashigo A Parker U Lalla B W Allwood M S Moolla T Lovelock C F N Koegelenberg |
| author_sort | B Mashigo |
| collection | DOAJ |
| description |
Background. The coronavirus disease 2019 (COVID-19) pandemic placed an unprecedented strain on intensive care units (ICUs) in South Africa. Infection prevention and control (IPC) strategies were highlighted to minimise the risk to healthcare workers and for the protection of patients from contracting hospital-acquired infections (HAIs). During the third wave, our institution adopted a shift system to address severe burnout among ICU personnel. We noted an upstroke in the occurrence of HAIs, specifically carbapenem-resistant Enterobacterales (CRE) and multidrug-resistant (MDR) Acinetobacter baumannii.
Objectives. To report these outbreaks, compare the rate of CRE and A. baumannii infections with the first COVID-19 wave and to analyse its impact on patient outcomes.
Method. We retrospectively analysed data from a prospectively collected registry involving all adult patients with severe COVID-19 admitted to the dedicated COVID-19 ICU from May 2021 to September 2021. Information from the admission database, including the patients’ demographics, comorbidities, laboratory results and length of ICU stay were extracted.
Results. Ninety patients were admitted with severe COVID-19 during the third wave. There was an outbreak of both CRE (the majority Klebsiella pneumoniae) and A. baumannii. Furthermore, 18 patients cultured the same CRE organism, and 25 patients cultured the environmental organism A. baumannii. The HAI rate was significantly higher compared with the first wave published data: 59/90 (65.6%) v. 73/363 (20.1%, p<0.01). Patients with any HAI had a longer mean stay in ICU (10.1 days v. 6.7 days (p<0.01) and a higher mortality of 48/59 (81%) v. 19/31 (61%) (p=0.05).
Conclusion. We observed a very significant rise in HAIs in the COVID-19 ICU during the third wave compared with the first, with almost three times as many patients developing HAIs. Unsurprisingly, it was associated with a longer mean stay in ICU and a higher mortality. The outbreak of both CRE and A. baumannii, and the fact that many patients cultured the same CRE organism and A. baumannii, strongly suggests that a critical breakdown in IPC measures had occurred.
|
| first_indexed | 2024-04-24T06:00:51Z |
| format | Article |
| id | doaj.art-575510fd0fd9485c9c2766ab3bdff8ad |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-04-24T06:00:51Z |
| publishDate | 2023-12-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-575510fd0fd9485c9c2766ab3bdff8ad2024-04-23T07:48:00ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352023-12-011131210.7196/SAMJ.2023.v113i12.971An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemicB Mashigo0A Parker1https://orcid.org/0000-0002-2005-698XU Lalla2https://orcid.org/0000-0002-4395-5152B W Allwood3https://orcid.org/0000-0003-0421-2978M S Moolla4https://orcid.org/0000-0003-0274-6909T Lovelock5https://orcid.org/0000-0002-3730-1646C F N Koegelenberg6https://orcid.org/0000-0002-5563-8429Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South AfricaUnit for Infection Prevention and Control, Tygerberg Hospital, Cape Town, South Africa; Division of Infectious Diseases, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South AfricaDivision of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South AfricaDivision of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South AfricaDivision of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South AfricaDivision of Infectious Diseases, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South AfricaDivision of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa Background. The coronavirus disease 2019 (COVID-19) pandemic placed an unprecedented strain on intensive care units (ICUs) in South Africa. Infection prevention and control (IPC) strategies were highlighted to minimise the risk to healthcare workers and for the protection of patients from contracting hospital-acquired infections (HAIs). During the third wave, our institution adopted a shift system to address severe burnout among ICU personnel. We noted an upstroke in the occurrence of HAIs, specifically carbapenem-resistant Enterobacterales (CRE) and multidrug-resistant (MDR) Acinetobacter baumannii. Objectives. To report these outbreaks, compare the rate of CRE and A. baumannii infections with the first COVID-19 wave and to analyse its impact on patient outcomes. Method. We retrospectively analysed data from a prospectively collected registry involving all adult patients with severe COVID-19 admitted to the dedicated COVID-19 ICU from May 2021 to September 2021. Information from the admission database, including the patients’ demographics, comorbidities, laboratory results and length of ICU stay were extracted. Results. Ninety patients were admitted with severe COVID-19 during the third wave. There was an outbreak of both CRE (the majority Klebsiella pneumoniae) and A. baumannii. Furthermore, 18 patients cultured the same CRE organism, and 25 patients cultured the environmental organism A. baumannii. The HAI rate was significantly higher compared with the first wave published data: 59/90 (65.6%) v. 73/363 (20.1%, p<0.01). Patients with any HAI had a longer mean stay in ICU (10.1 days v. 6.7 days (p<0.01) and a higher mortality of 48/59 (81%) v. 19/31 (61%) (p=0.05). Conclusion. We observed a very significant rise in HAIs in the COVID-19 ICU during the third wave compared with the first, with almost three times as many patients developing HAIs. Unsurprisingly, it was associated with a longer mean stay in ICU and a higher mortality. The outbreak of both CRE and A. baumannii, and the fact that many patients cultured the same CRE organism and A. baumannii, strongly suggests that a critical breakdown in IPC measures had occurred. https://samajournals.co.za/index.php/samj/article/view/971COVID-19Infection Prevention and ControlMDRCREHAIAcinetobacter baumannii |
| spellingShingle | B Mashigo A Parker U Lalla B W Allwood M S Moolla T Lovelock C F N Koegelenberg An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemic South African Medical Journal COVID-19 Infection Prevention and Control MDR CRE HAI Acinetobacter baumannii |
| title | An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemic |
| title_full | An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemic |
| title_fullStr | An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemic |
| title_full_unstemmed | An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemic |
| title_short | An outbreak within an outbreak: The impact of Infection Prevention and Control strategies on hospital-acquired infections and the occurrence of multi-drug resistant organisms during the COVID-19 pandemic |
| title_sort | outbreak within an outbreak the impact of infection prevention and control strategies on hospital acquired infections and the occurrence of multi drug resistant organisms during the covid 19 pandemic |
| topic | COVID-19 Infection Prevention and Control MDR CRE HAI Acinetobacter baumannii |
| url | https://samajournals.co.za/index.php/samj/article/view/971 |
| work_keys_str_mv | AT bmashigo anoutbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT aparker anoutbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT ulalla anoutbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT bwallwood anoutbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT msmoolla anoutbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT tlovelock anoutbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT cfnkoegelenberg anoutbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT bmashigo outbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT aparker outbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT ulalla outbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT bwallwood outbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT msmoolla outbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT tlovelock outbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic AT cfnkoegelenberg outbreakwithinanoutbreaktheimpactofinfectionpreventionandcontrolstrategiesonhospitalacquiredinfectionsandtheoccurrenceofmultidrugresistantorganismsduringthecovid19pandemic |