450 - Impact of COVID-19 infection prevention measures on healthcare-associated infections in the Neonatal Intensive Care Unit

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 450
Publication Number: 450.431

Sagori Mukhopadhyay, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Miren B. Dhudasia, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Mark Conaway, University of Virginia School of Medicine, Charlottesville, VA, United States; Dustin D. Flannery, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Joern-Hendrik Weitkamp, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Sarah Khan, Mcmaster Children’s Hospital, Hamilton, ON, Canada; Kristin E. D.. Weimer, Duke University School of Medicine, Durham, NC, United States; Margaret Gilfillan, Drexel University College of Medicine, Philadelphia, PA, United States; Andrew Berenz, Rush University Medical Center, Chicago, IL, United States; Redjana Carciumaru, McMaster University Michael G. DeGroote School of Medicine, Hamilton, ON, Canada; Milica Ivanovic, Oregon Health & Science University School of Medicine, Vancouver, WA, United States; Robert L. Schelonka, OHSU, Lake Oswego, OR, United States; Ryley J. Guay, Vanderbilt University School of Medicine, Nashville, TN, United States; Michael T. Favara, Sidney Kimmel Medical College at Thomas Jefferson University, MEDIA, PA, United States; Deborah Tuttle, Christiana Care Health System, Newark, DE, United States; Pablo J. Sanchez, Nationwide Children's Hospital -OSU, Columbus, OH, United States; Katia Camille. Halabi, Nationwide Children's Hospital, Columbus, OH, United States; Joseph B. Cantey, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, SAN ANTONIO, TX, United States; Lakshmi Srinivasan, CHOP - 3401 Civic Center BlvdPhiladelphia, PA 19104-4319UNITED STATES - Philadelphia, PA, Philadelphia, PA, United States; Julie Wohrley, Rush University Medical Center; Rush University children’s Hispital, Oak Park, IL, United States; Kathryn Ziegler, Sidney Kimmel Medical College at Thomas Jefferson University, JENKINTOWN, PA, United States; Jaclyn B.. Wiggins, University of Virginia School of Medicine, Charlottesville, VA, United States; Jose Rodriguez, Doernbecher Children's Hospital at Oregon Health & Science University, portland, OR, United States; Rachelle Crisan, Nationwide Children's Hospital, Canal Winchester, OH, United States; David Kaufman, University of Virginia School of Medicine, Charlottesville, VA, United States

Presenting Author(s)

Sagori Mukhopadhyay, MD, MMSc (she/her/hers)

Assistant Professor
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania, United States

Background: Enhanced infection prevention measures were implemented in Neonatal Intensive Care Units (NICU) during the COVID-19 pandemic. Although targeting airborne viral transmission, these measures may also impact overall infection rates by reducing hand-to-face contact, limiting visitors, and increasing adherence with prevention measures.

Objective:

To determine the change in rates of healthcare-associated bacterial, fungal, and viral infections in NICUs before and during the pandemic.

Design/Methods:

This multicenter cohort study included infants admitted to 12 NICUs from 2018-2022. Healthcare-associated infection was defined as culture-confirmed bacterial/fungal infection of blood, urine, or cerebrospinal fluid, or identification of respiratory viral pathogens, at >72 hours after NICU admission. Universal masking and other infection prevention measures were implemented in all sites from March-April 2020. Rates of infection per 1000 patient days (PD) in 4/1/2018 – 3/31/2020 (pre-pandemic) and 4/1/2020 – 3/31/2022 (pandemic) were compared using Poisson regression adjusting for site as random effect. Data during the pandemic period were incomplete for 2 sites with infection event reporting ending in 10/2020 and 3/2021, respectively.

Results:

Characteristics of the 12 study sites are shown in Table 1. The 5-year study period included a total of 811,346 patient days with 1,196 infants having ≥1 infection event: 1,440 bacterial/fungal infections in 1,111 infants and 159 viral respiratory infections in 131 infants (Table 2). Individual sites varied in baseline rates of infection (Figure). Overall, the rate of bacterial/fungal infections changed from 1.65/1000 PD pre-pandemic to 1.95/1000 PD during the pandemic. Site-adjusted pandemic/pre-pandemic ratio of bacterial/fungal infection rate was 0.94 (95% CI: 0.85, 1.04, P=0.26). The rates of respiratory viral infection changed from 0.25/1000 PD pre-pandemic to 0.12/1000 PD during the pandemic with a pandemic/pre-pandemic ratio of 0.36 (95% CI: 0.25, 0.52, P< 0.001). Results of analysis excluding the 2 sites with incomplete data were not different.

Conclusion(s): We found a significant reduction in respiratory viral infection associated with infection prevention measure enacted during the COVID-19 pandemic. Rates of bacterial/fungal infections were unchanged. Further reduction in bacterial/fungal healthcare-acquired infection among the NICU population may require novel interventions beyond optimized implementation of known infection prevention measures as done during the pandemic.