The pandemic-era spike in healthcare-associated infections was significantly more severe among smaller community hospitals than their larger academic medical center counterparts, according to a new study of hospitals across six southeastern states.
Published last week in Clinical Infectious Diseases, the investigation suggests that community hospitals strained to balance COVID-19 patients and their standard infection control practices, researchers from Duke University and the University of North Carolina wrote.
Many of these community hospitals were in rural regions and faced resource limitations exacerbated by the pandemic, they wrote.
They also serve older patient populations that more often have comorbidities and are underinsured—all of which could have played a role in the disparity of reported healthcare-associated infections (HAIs).
“To our knowledge, our study is the first to address disparities among larger academic hospitals and smaller community hospitals with respect to HAI trends during the pandemic,” researchers wrote in the journal. “The differences in impact of the COVID-19 pandemic across hospital types could be secondary to differences in resource allocation, availability of [infectious disease] expertise and catchment area served by smaller community hospitals.”
Researchers collected surveillance data for various HAIs from 51 community hospitals participating in the Duke Infection Control Outreach Network, as well as from Duke University Hospital and the University of North Carolina Medical Center.
The team compared changes in HAI incidence rates from prior to the pandemic (March 2020 to March 2021) to those of various time cutoffs during the pandemic’s first year (March 2020 to March 2021), as well as the differences between hospitals of different type and bed numbers.
Researchers found a steady 34% increase in ventilator-associated events (VAEs) throughout the pandemic’s first 12 months while central-line-associated bloodstream infections (CLABSIs) rose 24% but largely near the end of the study period. The incidence of Clostridioides difficile infections (CDIs) increased by 4.2% each month from baseline, while catheter-associated urinary tract infections (CAUTIs) did not significantly change during the study period.
Breaking out rates between hospital types showed no significant change in VAEs and CLABSI rates among the academic medical centers but a respective 48% and 41.1% increase among the community hospitals, according to the study. CDI incidence rose 4.5% per month during the pandemic among community hospitals while declining 43% at the academic medical centers.
The researchers also saw HAI rates either remain stable or decrease among the study’s larger hospitals (425 or more beds) but increase among those that were smaller
The team suggested that smaller community hospitals’ fewer resources and lack of an on-staff infectious disease specialist could have driven the disparities. They floated telehealth service expansions, reimbursement model adjustments and a broader national plan to strengthen the infectious disease workforce among community hospitals as potential policy solutions.
Additionally, “hospital leaders should further evaluate capacity and infrastructure needed to address COVID-19 burden, invest in [infectious disease] workforce and collaborate with policymakers to support enhanced hospital preparedness,” they wrote.
The Duke and UNC study comes in the wake of Centers for Disease Control and Prevention numbers warning of an “alarming increase” in drug-resistant infectious spread in hospitals. These recent trends wiped out “historic gains” in antibiotic stewardship hospitals had clawed out during the years leading up to the pandemic.