Nosocomial infections are one of the most common complications affecting hospital patients and greatly increase morbidity and mortality, often resulting in a prolonged hospital stay. Preventing nosocomial infections, therefore, presents an important challenge to clinicians and health service managers [1-3]. In this point-prevalence survey conducted in our center, we found that nosocomial infections affected 1.39% of hospitalized patients in 2020—a significantly lower percentage than we observed in a survey conducted in 2019, which was 2.56%. The prevalence was lower than that stated in previous reports from other Chinese cities and other countries [4，12-13]. The overall mortality rate of the point survey in 2019 was 0.13%, while the mortality in 2020 was 0.07%, which may have been due to the reduction of nosocomial infection prevalence. Nosocomial infection was a main factor causing mortality of patients in hospitals. The median length of stay of inpatients was 5.9 days, which is shorter than that of patients with 6.3 days before COVID-19. Our data first indicated that the significant reductions in the prevalence of nosocomial infections that were achieved in our hospital were due to preventative initiatives based on COVID-19 controlling.
With the emergence of the COVID-19 pandemic, several resources with recommendations for the prevention of COVID-19 transmission have been developed. A series of recommendations based on strategies outlined in the 2019 guidelines and the current background and epidemic situation for the management of COVID-19 were released in 2020 . In addition, the guidelines provide regional prevention strategies for local health department implementation. Our hospital has also developed region-specific resources and tools to guide facilities in their COVID-19 prevention efforts.
Our results provide evidence of success in preventing nosocomial infections. The data showed that the prevalence of nosocomial infection declined in most departments, including the hematological, gastrointestinal (GI), neonatal, neurological, respiratory, kidney, cardiological, infectious disease (ID), surgery, and endocrine departments, excluding the ICU. The neonatal department and the ICU were the unaccompanied wards with strict isolation and aseptic operation in our hospital, which are also relevant prevention measures during the COVID-19 pandemic. The prevalence of nosocomial infection did not differ significantly between 2019 and 2020 in the ICU, but for the neonatal department, the percentages of patients with a nosocomial infection were lower in 2020 than they were in 2019, with a total patient decline due to COVID-19. Thus, inadequate resources are still a problem that we need to confront in our center.
The decline of prevalence was most pronounced in respiratory and digestive tract infections. Respiratory infections were the most common nosocomial infections with a prevalence of 38.9%, while the rate was decreased to 30.1% with changes after COVID-19 emerged. COVID-19 spreads by droplets shed of the respiratory system by someone infected with the virus, which means it would spread faster with higher proximity of people, larger contact networks, and lower levels of hygiene. During the COVID-19 epidemic, masks, gloves, and hand sanitizer were used to prevent the transmission owing to the fact that respiratory droplets and contact transmission are the main routes of transmission of this disease . This is why the prevalence of respiratory nosocomial infection was reduced significantly. Pathogen analysis of patients with respiratory tract infection showed that gram-negative bacteria, such as Acinetobacter, Enterobacter pylori, pseudomonas aeruginosa, staphylococcus aureus, and fungi, were the main pathogens causing nosocomial infections. Acinetobacter baumannii is an opportunistic human pathogen that predominantly infects critically ill patients. In contrast to a previous report , our data indicate that Acinetobacter infection rates are higher compared to other gram-negative pathogens. In light of this, continual public health monitoring and prevention activities are needed aside from the measures taken during the COVID-19 pandemic.
In pediatrics, rotavirus is the main pathogen of gastrointestinal infection, and under the coronavirus prevention measures, the rotavirus is also one of the pathogens with the most obvious decline in nosocomial infection. Rotavirus is considered to be a major cause of infant and childhood morbidity and mortality, particularly in developing countries . Thus, it is vital to monitor its prevalence. These results indicate that the preventive measures implemented during the COVID-19 pandemic can significantly reduce the incidence of rotavirus infection. Therefore, we believe that relevant measures should be maintained in future work.
Although the percentages of patients with CLABSIs did not differ significantly between 2019 and 2020, the percentages of Enterobacteriaceae in patients with central line-associated bloodstream infections were lower in 2020 than in 2019. As we all know, the recommended approach to prevent Enterobacteriaceae transmission, which was enhanced during the COVID-19 pandemic, is improved hand hygiene [16-17]. Besides, CAUTIs mostly occurred in the critical care unit, and there was no significant reduction in catheter-related infection. In addition to the standard and transmission-based precautions for critically ill patients, several strategies focused on the prevention of specific nosocomial infections, such as ventilator-associated pneumonia (VAP), CLABSIs, and CAUTIs, are needed [18-20]. To reduce the incidence rate of catheter-related infection for critically ill patients, more evidence-based interventions should be boosted, in addition to the preventative measures based on the COVID-19 pandemic.
We acknowledge that there are some limitations to this study. First, since the study was based on surveillance data, we did not have information on the patients’ specific underlying diseases and the severity of their medical conditions, which has certainly influenced the patients’ outcomes. Second, we did not have data on whether the antimicrobial therapy was appropriate or not, nor data on delays in the commencement of the treatment.