Clusters of emerging multidrug-resistant organisms in US health care facilities during the initial months of the SARS-CoV-2 pandemic - 08/08/24

Doi : 10.1016/j.ajic.2024.07.013

D. Cal Ham, MD, MPH ^a,^⁎ , Ruoran Li, PhD ^a, Tisha Mitsunaga, DrPH, ScM ^b, Christopher Czaja, MD, DrPH ^c, Christopher Prestel, MD ^a, Sandeep Bhaurla, MPH ^d, Melissa Cumming, MS ^e, Brenda Brennan, MSPH ^f, Gabriel Innes, VMD, PhD ^g, Savannah Carrico, MPH ^h, Allison Chan, MPH ⁱ, Enyinnaya Merengwa, MD, DrPH ^j, Anna Stahl, MPH ^a, Belinda Ostrowsky, MD ^a,^k, Marie A. de Perio, MD ^l, Maroya Spalding Walters, PhD ^a
^a Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
^b Healthcare-Associated Infections Program, California Department of Public Health, Sacramento, CA
^c Healthcare-Associated Infections and Antimicrobial Resistance Program, Communicable Disease Branch, Colorado Department of Public Health and Environment, Denver, CO
^d Healthcare Outreach Unit, Acute Communicable Disease Control, Los Angeles County Department of Public Health, Los Angeles, CA
^e Healthcare-Associated Infections and Antimicrobial Resistance Program, Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
^f Surveillance for Healthcare-Associated & Resistant Pathogens (SHARP) Unit, Michigan Department of Health and Human Services, Lansing, MI
^g Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
^h Communicable Disease Branch, North Carolina Division of Public Health, Raleigh, NC
ⁱ Healthcare Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, TN
^j Healthcare Safety Unit, Texas Department of State Health Services, Austin, TX
^k Health Care Epidemiology & Infection Control (HEIC), Program Metropolitan Regional Area Office (MARO), New York State Department of Health, Albany, NY
^l Office of the Director, National Institute for Occupational Safety and Health, Washington, DC

^⁎Address correspondence to D. Cal Ham, MD, MPH, 1600 Clifton Rd NE, Atlanta, GA 30329.1600 Clifton Rd NEAtlantaGA30329

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Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 08 August 2024

Résumé

Background

Outbreaks of emerging multidrug-resistant organisms (eMDROs), including carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, and Candida auris, have been reported among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients. We describe eMDRO clusters in SARS-CoV-2 units and associated infection control (IC) practices early in the SARS-CoV-2 pandemic.

Methods

We conducted a retrospective survey of a convenience sample of health departments in 11 states to describe clusters of eMDROs that began before November 1, 2020 and involved SARS-CoV-2 units. Cluster characteristics and IC practices during the cluster period were assessed using a standardized outbreak report form, and descriptive analyses were performed.

Results

Overall, 18 eMDRO clusters (10 carbapenem-resistant Enterobacterales, 6 C auris, 1 carbapenem-resistant Pseudomonas aeruginosa, and 1 carbapenem-resistant A baumannii) in 18 health care facilities involving 397 patients were reported from 10 states. During the cluster period, 60% of facilities reported a shortage of isolation gowns, 69% extended use of gowns, and 67% reported difficulty obtaining preferred disinfectants. Reduced frequency of hand hygiene audits was reported in 85% of acute care hospitals during the cluster period compared with before the pandemic.

Conclusions

Changes in IC practices and supply shortages were identified in facilities with eMDRO outbreaks during the SARS-CoV-2 pandemic and might have contributed to eMDRO transmission.

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Highlights

•	Outbreaks of emerging MDROs have been reported among SARS-CoV-2 patients.
•	Health departments completed a survey describing MDRO clusters in this population.
•	Eighteen clusters were reported in 11 hospitals and 7 post–acute care facilities.
•	Changes in infection control practices might have contributed to transmission.

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Key Words : Outbreaks, COVID-19, Infection control

Plan

Background

Methods

Cluster definition

Project design and settings

Data collection and analytic methods

	The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
	Conflicts of interest: Several authors receive funding from the CDC as part of their work in public health departments; however, none were directly funded for this work. The authors have no conflicts of interest to report.