Impact of COVID-19 pandemic on the implementation of transmission-based precautions

Multidrug-resistant organisms and hospital-acquired infections threaten patient safety. Transmission-based precautions (TBPs) are critical infection prevention and control (IPC) measures but resource intensive. The COVID-19 pandemic disrupted routine IPC practices due to resource diversion for pandemic response, straining systems and compromising TBPs for pathogens of interest (POIs).

To investigate the impact of the COVID-19 pandemic on the implementation of pathogen-specific TBPs in five Singapore acute hospitals before and during the COVID-19 pandemic from August 2020 to August 2021.

The primary outcome measure was the proportion of patients on appropriate pathogen-specific TBPs. The variables between the two cycles were compared to assess the impact of COVID-19 on the implementation of pathogen-specific IPC measures.

A total of 8601 patient records were reviewed (4132 in Cycle 1 and 4469 in Cycle 2). Appropriate TBP implementation decreased by 39% during Cycle 2 compared to Cycle 1 (odds ratio (OR): 0.61; 95% confidence interval (CI): 0.50-0.73; P < 0.01). Staff unawareness of POIs emerged as the most common factor contributing to inappropriate TBP placement across both cycles. Notably, patients with meticillin-resistant Staphylococcus aureus only experienced a significant decrease in appropriate TBP during Cycle 2 (OR: 0.56; 95% CI: 0.44-0.71; P < 0.01). Interestingly, hospitals with higher pre-pandemic TBP adherence rates maintained better compliance during the pandemic.

The COVID-19 pandemic adversely affected the implementation of appropriate TBPs in Singapore acute care hospitals. This study highlights the need for proactive appropriate TBP maintainance during public health emergencies.