As infection prevention professionals, we must confront the escalating concern over the recent surge in respiratory-transmitted diseases (RTDs), a phenomenon initially attributed to ‘immune debt.’ However, scientific evidence is increasingly leaning towards post-COVID immune dysfunction as a plausible reason. Such epidemic trends pose a persistent and potentially worsening problem if not supported by proactive healthcare measures.
In a response addressing these, the Centers for Medicare & Medicaid Services (CMS) Center for Clinical Standards Quality/Quality, Safety & Oversight Group unfolded new hospital requirements on November 1, 2024. These outlined that hospitals must report patients with confirmed infections of COVID-19, influenza, and respiratory syncytial virus (RSV). However, the notable precedence of COVID-19, its potential long-term disability, and its recurrent, seasonally indifferent nature call for a more comprehensive reporting system.
This article advocates for the CMS to augment its COVID-19 reporting expectations by developing the following metrics: 1. Specific tracking of hospital-onset COVID-19 infections; 2. Cumulative count of COVID-19 infections among healthcare workers; and 3. A comprehensive statistic of total emergency room visitations and associated COVID-19, influenza, and RSV infections.
Existing regulations fall short in providing a clear picture of the situation. For instance, hospital-onset COVID-19 infections are not contemporarily tracked in the United States, whereas a different story emerges across the pond. The UK’s National Health Service (NHS) mandates this reporting. Consequently, Scotland reported 18,137 probable and definite hospital-onset COVID-19 cases between March 1, 2020, and December 18, 2022. Similarly, in 2023, New South Wales (NSW), Australia reported that at least 6,007 patients contracted COVID-19 within hospitals, significant to 297 deaths.
Reporting standards should be revised based on these findings while considering the tremendous impact of COVID-19 on healthcare workers. For instance, the National Health Service in the UK mandates the reporting of worker absences due to acute COVID-19. As of October 31, 2024, 50,155 worker absences were recorded, with 990 attributed to acute COVID-19. Such statistics underscore the vital importance of reporting worker infections to mitigate future disease outbreaks.
Lastly, the total emergency room (ER) visitations for respiratory infections should be introduced as a critical electronic medical records metric. EPIC research’s methodology in this regard serves as a potential model for similar metrics. The voluntary participation of healthcare facilities in the implementation of this metric has shown this to be a non-burdensome approach. To contain the spread of these diseases, strategies such as increased ventilation, clean air, masking, and admission testing need wider adoption.
Furthermore, financial incentives from CMS directed towards compliance with these COVID-19 metrics could potentially drive these strategies. Among the various methods available, professionals can also explore the NHSN 2022 Rebaseline initiative and understand how it aligns with contemporary healthcare trends to promote better infection prevention strategies. Additionally, it would be beneficial to learn more about how effective air pressure regulation in health care facilities aids in controlling airborne pathogens.
Notably, the practice of hand hygiene remains integral to minimizing Clostridioides difficile infections that impose a considerable strain on US healthcare. Electronic Hand Hygiene Monitoring (EHHMS) systems remind healthcare workers about applying soap and water and have been associated with reduced cases of C difficile, as per a recent study comparing incidents in 10 hospitals with CMS data. Incorporating these essential elements into our infection prevention armory could significantly aid in tackling this escalating situation in healthcare facilities.