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Health Care-Associated Infections Among Neonates During the COVID-19 Pandemic.

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Enhanced infection prevention measures in neonatal intensive care units (NICUs) significantly reduced viral health care-associated infections (HAIs) during the COVID-19 pandemic. However, these measures did not decrease bacterial or fungal HAIs in infants.

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Area of Science:

  • Neonatal Medicine
  • Infectious Disease Epidemiology
  • Public Health

Background:

  • Neonatal intensive care units (NICUs) implemented stringent infection prevention protocols during the COVID-19 pandemic to curb viral transmission.
  • It was hypothesized that these enhanced measures would also reduce nonviral health care-associated infections (HAIs) in neonates.

Purpose of the Study:

  • To compare the incidence of viral and bacterial or fungal HAIs in infants admitted to NICUs before and during the COVID-19 pandemic.
  • To evaluate the effectiveness of pandemic-related infection control measures on different types of HAIs in a neonatal population.

Main Methods:

  • A cohort study involving 12 level 3 or 4 NICUs in the US and Canada, analyzing data from March 1, 2018, to July 31, 2022.
  • Comparison of HAI incidence (episodes per 1000 patient-days) before (March 2018-March 2020) and during (April 2020-July 2022) the pandemic using Poisson regression.
  • HAI confirmation through molecular diagnostics for viruses and cultures for bacterial or fungal pathogens.

Main Results:

  • Viral HAI rates significantly decreased from 0.35 to 0.16 per 1000 patient-days during the pandemic (adjusted rate ratio [aRR], 0.45; 95% CI, 0.34-0.59).
  • Bacterial or fungal HAI rates did not show a significant change, remaining stable from before (1.70) to during (1.78) the pandemic (aRR, 1.04; 95% CI, 0.95-1.14).
  • Reductions in viral HAIs persisted even as community viral infections increased, and site-level changes in bacterial/fungal HAIs did not correlate with viral HAI rates.

Conclusions:

  • Enhanced infection prevention measures during the COVID-19 pandemic were effective in reducing viral HAIs in NICU infants.
  • These measures provided limited additional benefit in preventing bacterial or fungal HAIs, suggesting pathogen-specific efficacy.
  • Findings highlight the potential utility of pandemic-era infection control strategies during periods of high viral circulation but underscore the need for continued vigilance against nonviral pathogens.