We're back at it again. For the third consecutive year, the Infection Control Consulting Services (ICCS) team — with a little help from followers of our LinkedIn page — has come up with its list of 10 of the scariest healthcare infections and threats in conjunction with Halloween. Little did we know that when we assembled our last list, we'd still be dealing with the top threat a year later (we think you can guess what it was).
Without further ado, here's this year's list!
1. Misinformation
We had this at #5 on the 2020 list. While the order of these Halloween-themed lists is not meant to represent any significance, we are intentionally placing misinformation at the top of this year's list. The spread of misinformation and disinformation — with the latter indicating deliberate, malicious intent — concerning COVID-19 is indirectly and directly causing harm and the loss of lives. If we hope to end this pandemic sooner than later, we must greatly reduce the spread and impact of misinformation.
2. Delta variant
In January, it looked like the country was heading in a good direction with COVID-19. By the end of June, the 7-day moving average of reported cases was around 12,000. About one month later, that figure surpassed 60,000 — despite the availability of vaccines. The primary contributing factor: the Delta variant, the predominant and more virulent variant of the SARS-CoV-2 virus.
There's a mix of good and possible bad news regarding the Delta variant today: The good news is that after the 7-day average surpassed more than 175,000 cases in mid-September, we've been on a steady decline since, down to about 72,000 on October 27. This has been helped by increases in vaccinations. The possible bad news: Delta is not going to be the final variant we confront. Hopefully future variants are not worse than Delta and we continue to get more people vaccinated and now receiving their booster shots.
3. Healthcare-acquired infections
A CDC analysis published in September that compared infection rates before and during pandemic revealed a significant increase in healthcare-associated infections (HAI) in 2020. The news, while not surprising, was still a gut punch considering how much work has gone into bringing down HAIs in recent years.
ICCS Founder Phenelle Segal, RN, CIC, FAPIC, responded to the report, stating, "Concerns about COVID-19 negatively impacting HAI prevention strategies and decades of progress is now a reality. We must be reminded that it is incumbent on us as infection preventionists to stress the critical need for infection prevention practices to return to pre-pandemic times, despite the ongoing serious challenges COVID-19 has created. Ongoing education, monitoring, and feedback is critical to patient safety."
4. Drug-resistant infections
Every chance we get, we try to bring attention to news and developments concerning antibiotic-resistant infections. They remain a significant challenge and threat. Leading up to the pandemic, we were seeing more resources dedicated to reducing the burden of antimicrobial resistance. Unfortunately, the pandemic shifted much of these away. The sooner we can get back to giving drug-resistant infections the attention they deserve, the better. After all, a recent study of 2017 data provided some eye-opening statistics. Infections caused by bacteria resistant to multiple antibiotics led to:
$1.9 billion in healthcare costs
Nearly 450,000 days in the hospital
Nearly 12,000 deaths among older adults across the United States
5. MRSA
We thought it would be worthwhile to call out methicillin-resistant Staphylococcus aureus (MRSA) as a multidrug-resistant organism that has seen a significant spike over the past few years. Preliminary data for the last quarter of 2020 revealed a jump of 34% in MRSA compared with the same quarter in 2019, according to a recent study. In some states like Arizona and New Jersey, rate increases approached 100%. This is obviously not the data we want to see but knowing that this has become an area where rates are rising should encourage us to refocus our efforts on getting the figures back down.
6. Fungal infections and emerging anti-fungal resistance
Much of the attention around infections and antibiotic-resistance is paid to microbes like bacteria, such as Acinetobacter, C. difficile, and S. aureus (MRSA). But the rise of fungus infections and antifungal resistance is a problem requiring much more attention.
In the CDC's Antibiotic Resistance Threats in the United States, 2019, the agency included Candida auris as an urgent threat and dozens of Candida species as a serious threat. The CDC also put Aspergillus on its watch list. Outbreaks of C. auris have been reported in COVID-19 units of acute care hospitals.
7. Poorly managed space
This is one of the suggestions that came from a LinkedIn follower, and we couldn't agree more with it. While COVID-19 has made healthcare providers more cognizant of the spaces they work in, and we've seen some changes and improvements that have helped reduce patient and staff infection risk (such as those concerning ventilation and the usage of separate entrances for potentially contagious patients), there's still considerable work to be done to further decrease threats from the built environment.
Just a few of the areas we believe deserve more attention and consideration: placement of handwashing stations, patient and staff flow, sink-to-bed ratios, HVAC, appropriate equipment for the space, and allocation of space for the delivery of virtual services. As one final example, in our first "10 of the Scariest Healthcare Infections and Threats," we called attention to the infection risks associated with the placement of hospital sinks next to toilets.
8. Supply chain challenges
Coverage of supply chain issues are all over the news these days, with many reports focusing on how these issues may disrupt holiday shopping. That's the least of our worries. Supply chain issues are expected to persist well into 2022, affecting everything from personal protective equipment to drug shortages to semiconductor chips that power equipment and devices. When supply chain issues force healthcare organizations to deviate from their policies, procedures, and preferred care processes, we know the risk of infection increases.
9. Healthcare worker burnout
"Half of health workers report burnout amid COVID-19" (American Medical Association)
"Health workers know what good care is. Pandemic burnout is getting in the way" (NPR)
"Medical burnout: Breaking bad" (AAMC)
"Frontline Healthcare Workers Aren't Feeling the 'Summer of Joy'" (New York Times)
"Burned out by the pandemic, 3 in 10 healthcare workers consider leaving the profession" (The Washington Post)
The list of reports about healthcare worker burnout can go on and on. Burnout is a major problem facing our industry. We know that burnout causes impaired quality of care and even medical errors, both of which can contribute to increases in infections and infection risk. If you're feeling burned out, don't ignore it. Take action! Mayo Clinic offers some good guidance around this serious matter here.
10. Complacency
When we were discussing this list, we knew we wanted to end with something impactful. We kept coming back to the advice we gave in last year's list about COVID-19. "Be vigilant," we said. We hope that describes you over the past year.
And now we hope that will continue to describe you in the year ahead of us. There's no time for complacency, even with the positives we're seeing around declining new cases and test positivity rates, and now the authorizations of vaccinations for children. If we become complacent, we can very easily undo the progress we've made. But by successfully fighting any desire to become complacent, we can continue building on our accomplishments. Hopefully when we put together this list next year, we'll be able to speak about COVID-19 in the past tense.
What did we omit? What are your scariest healthcare infections and threats?
Thank you for reading our list! By no means is it comprehensive, but, as we've tried to do with this list every year, we've worked to identify a variety of threats that we feel are deserving of a little more attention and that we hope will help you think about the top threats facing the healthcare industry, your organization, and your role as a healthcare professional. If we omitted a scary infection or threat that would be on your list, let us know on LinkedIn!