Post-COVID, hospital infections fall while other safety risks rise

Hospital acquired infections are down post-COVID, but other risks remain for patients.

Hospital-acquired infections, which became substantially more common during the pandemic, have returned to pre-pandemic levels, according to a new report from a patient safety watchdog group. It’s key to note, researchers say, that infection rates before March 2020 were nothing to celebrate.

On top of that moderately good news, the Leapfrog Group found other metrics that measure patient safety and satisfaction have fallen significantly, likely because of hospital staffing shortages and other pandemic-era challenges.

“We’re encouraged and relieved to see that infections are rapidly decreasing in hospitals following the spike during the pandemic, but we remain very concerned about a number of major problems in hospitals,” said Leah Binder, president and CEO of Leapfrog, an independent, national nonprofit founded by large employers and other purchasers.

Patient surveys following hospital visits found declines in experiences for the second year in a row in all states. Particularly significant drops were reported in “communication about medicines” and “responsiveness of hospital staff.” Preventable errors have been linked to these problems.

“Hospitals need to take a hard look at what they are unnecessarily continuing post-pandemic that are not helping patients,” Binder said.

Close up of provider writing medical data of hospitalized patient while visiting him at intensive care unit.

Infection rates fell but could still be better

“Hospital-acquired” infections are those considered avoidable if staff wash their hands appropriately and follow other infection-control procedures.

Common hospital-acquired infections include Methicillin-resistant Staphylococcus aureus, or MRSA, central line-associated bloodstream infections and catheter-associated urinary tract infections.

Leapfrog, which analyzes hospital safety data twice a year, showed that rates of all three reached a five-year high during the pandemic and remained elevated through last year’s ranking before getting better.

The report released Monday, which included data from 3,000 hospitals nationwide, showed:

◾ 19% of hospitals reduced levels of all three infections,

◾ 66% of hospitals reduced instances of at least one infection and

◾ 16% of hospitals had infection rates that continued to rise or made no improvement.

A cluster of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. MRSA can cause skin infections, blood stream infections and pneumonia. For Kim Painter's story on the World Health Organization sounding the alarm on rising levels of antibiotic resistance.

Leapfrog assigns letter grades to hospitals based on their safety records and ranks states according to their percentage of A-rated hospitals. (Ratings for individual hospitals are available on the organization’s website.)

Utah topped the list for the first time, with 52% of its hospitals earning an A grade.

The District of Columbia and four states ‒ Vermont, Wyoming, Delaware and North Dakota ‒ brought up the rear with no A-grade hospitals.

Nationwide, nearly 30% of hospitals earned an A grade, 24% earned a B, 39% earned a C, 7% a D, and less than 1% an F.

Typically, for a state to rank well, a few local hospital systems must focus on safety. “It’s not about money or resources or partisanship,” Binder said. “It’s about do people actually care so much about safety that they put effort into it. It’s elbow grease.”

That commitment from top executives has been clear in Utah, she said, but not in Vermont. “I hope Vermonters will talk to their hospital leaders and ask for that commitment.”

Binder said she’s also concerned about New York, which consistently ranks near the bottom nationally. A large percentage of medical and nursing students pass through New York during their training, so it’s a particularly key place for patient safety to be a priority, Binder said.

AdventHealth, a nonprofit, faith-based health system that runs 52 hospitals across six states in the Southeast, as well as Texas, Colorado and Wisconsin, has more A-grade hospitals this year than ever before, said Dr. William Scharf, Advent’s executive clinical director of quality and safety.

Out of 42 hospitals examined by Leapfrog, Advent earned an A on 31 and infection levels across the chain have now dropped below what they were before the pandemic, he said.

“This does not happen by accident,” Scharf said. Just as construction sites often report days since their last accident, Advent hospitals typically report the number of days since their last hospital-acquired infection.

During the pandemic, Advent’s hospitals started to see an increase in infections, but decided “not to accept the new normal of COVID,” he said, instead focusing on “back to basics and back to baseline.”

AdventHealth Wesley Chapel in Florida was one of 31 AdventHealth hospitals to receive an "A" grade from Leapfrog for patient safety.

Patient satisfaction slipping fast

Like most hospitals during the pandemic, Advent relied on visiting nurses and saw a lot of turnover due to burnout. They’ve made an effort since to hire more staff, move away from agency nurses, improve the benefits package and emphasize the company’s supportive culture.

“We recognized that we had to do something different and we had to do something better,” Scharf said.

Research has shown that hospitals that had higher quality ratings and more staff before the pandemic slipped less during that stressful time.

In many hospitals, though, turnover, particularly the departure of experienced nurses, remains very high and compassion fatigue has set in, said Dr. Pablo Moreno Franco, chair of the Department of Critical Care Medicine at Mayo Clinic Florida and a member of Leapfrog’s advisory board.

“Some of the staff that has remained may not have the same level of resilience and tolerance they once had,” Franco said.

Experienced nurses are often the ones to raise patient safety issues, challenge the system and suggest improvements, he said. Newer nurses, particularly those trained during the pandemic, may not have as much hands-on, front-line experience or know how to communicate as effectively with patients face-to-face, he said, because of the distance and technology that was necessary during the pandemic.

Patients themselves have also changed, he and Binder said. “A lot of industries have said that people are crabbier, more short-tempered,” Binder said.

Data shows an increase in patient violence toward staff, “which does not create the conditions for a therapeutic relationship,” Franco noted. “We need to be compassionate to them so we can get compassion back.”

The expansion of telemedicine and artificial intelligence offers tremendous opportunities for creativity, including options like virtual nurses to provide standardized information to patients, Franco said. However, government and patient safety advocates need to help ensure these advances are implemented carefully so as not to add stress to already maxed-out hospital workers.

“If we try to bring too much technology too quickly that upsets the staff as well as the patient,” he said.

Still, Franco said, he remains optimistic that the post-pandemic rebound is just beginning.

“We do hope that the combination of creativity with precise execution and better use of technology can help us not only get to pre-pandemic levels but get even better by learning from these lessons.”