Our infection prevention teams reflects on rising HAIs and what’s ahead for infection prevention and control. 2021 was another trying year for healthcare and infection prevention. While hospitals have tried to allocate more resources to IPC efforts to contain the spread of COVID-19, it has primarily come at the expense of controlling other far too common HAIs. As a result, 2020 HAI data compared to that of 2019, indicates significant increases in CLABSI, CAUTI, VAE, and MRSA bacteremia. Combine that with increasingly complex patient populations and the current shortage the U.S. is facing in healthcare workers, especially in infection prevention, it’s been an uphill battle.
We want to thank our fellow infection prevention teams in hospitals across the country for persevering in this challenging time and dedicating themselves to preventing infection and improving patient outcomes. We took some time to reflect on this year and look ahead to 2022 to identify key focus areas or predictions for the coming year.
Increase investment in IPC teams to increase resiliency
2021 presented an opportunity to take the first comprehensive look at the impact of COVID-19 on HAI incidence. The observed increases in HAI trends following years of pre-pandemic decreases highlighted the unavoidable importance of building strong resiliency within Infection Prevention & Control (IPC) programs. It’s true that a larger volume of sicker patients at higher risk of infection and sepsis have been admitted to the hospital over the last year, but the CDC concluded that 2020 increases in HAIs were also a result of lacking surge capacity and other operational challenges.
Looking ahead to 2022, hospitals will benefit by investing more into IPC teams with aims to increase resiliency, specifically. The most pressing areas for additional support within this area should certainly include:
- Increasing IPC surge capacity that can quickly adapt not only to increased supply and patient care needs but also to increased IPC staffing needs, increased IPC educational needs, as well as increased employee needs surrounding their mental/physical wellbeing.
- Increasing access to various IPC informatic tools to leverage technology improves surveillance, data management, data analysis, and data dissemination efforts and thus, results in more efficient, lean processes. Now more than ever, IPC teams need to remain ahead of the curve and equipped with quick risk identification abilities leading to greater opportunities for early intervention.
HAIs increasing, CDI rates to follow
The COVID-19 pandemic has had a considerable impact on healthcare-associated infections. In 2020, significant increases were observed nationally for CLABSI, CAUTI, VAE, and MRSA bacteremia. I suspect that we’ll see these increases begin to plateau when evaluating 2021 and looking ahead to 2022 as the pandemic continues.
Interestingly, we’ve observed significant decreases in Clostridioides difficile infection (CDI) and overall antimicrobial consumption during the pandemic. It’s theorized that these sharp declines are due to a dramatic reduction in primary care consultations during the pandemic wherein 80-90% of all antibiotics are typically prescribed. I predict that antimicrobial use and CDI infections will begin to creep back toward pre-pandemic levels as individuals begin to seek primary care in a more typical fashion in 2022.
Infection Prevention & Control (IPC) teams continue to struggle with the resources, staffing, and capacity required to perform optimally during surge events throughout the pandemic. In September 2021, the Biden-Harris Administration announced a $2.1 billion investment to improve infection prevention and control activities across the U.S. public health and healthcare sectors, including 6,000 hospitals, 15,400 nursing homes and other long-term care facilities, 7,900 dialysis clinics, and 4,700 ambulatory surgery centers. In 2022, it will be interesting to see how this funding is mobilized. I predict that many lingering IPC resiliency concerns will still require localized investment and internal organizational focus.
IP shortage to increase, likely to see more remote surveillance
As we look ahead to the provision of health care in 2022 and beyond, two trends continue to contribute to a perfect storm of increased challenges in HAI prevention. The ongoing COVID-19 pandemic only adds to these burdens. These trends are 1.) the rapid increase in population growth and aging, and 2.) the precipitous exodus of experienced infection preventionists from the workforce, in part, due to retirement.
In the next 25 years, the U.S. population is projected to grow by 10.6%, from about 328 million to 363 million, with a projected 42.4% increase in those aged 65 and above. As more individuals live into and beyond their 80s, more patients will present to hospitals with ever-increasing co-morbidities. These patients will require much more complex care, further taxing hospitals’ resources. And with the increase of more complex inherent and modifiable risk factors, the risk of HAIs will become more prevalent.
The field of infection prevention is approaching a demographic cliff. A significant number of infection preventionists are rapidly moving toward retirement. The 2017 APIC Megasurvey found that 37.4% if survey respondents were aged 56-65; and 172 (4.2%) were age 66 or older. The 2020 APIC Megasurvey found similar results. 38% of infection preventionists in the U.S. are over age 55 (32% are between ages 55 and 65; an additional 6% are over the age of 65).1
As more experienced infection preventionists continue to leave the workforce, new, clinicians, sometimes with very little infection prevention expertise, are being hired by hospitals. Leaders in acute, sub-acute, and long-term care facilities are finding it difficult to fill the role of infection preventionist. With this current staffing outlook, leveraging remote, electronic infection prevention surveillance applications such as Sentri7 has proven very effective. Sentri7 provides proactive identification of patients at risk for developing an HAI during the course of their hospitalization, as well as early detection of possible HAIs. It provides automated reports through robust data aggregation and analyses, and facilitates easy, one-click submission to NHSN.
In 2022 and beyond, web-based, remote electronic surveillance will continue to grow as a solution to the challenges of and aging population, and shrinking pool of infection preventionists on a national, regional and local scale.
Read all Wolters Kluwer expert predictions in healthcare technology for 2022.