Potential Benefit of Masking and Other COVID-19 Infection Prevention Measures on Late-onset Infections in the NICU

Background: The incidence of nosocomial blood stream infections (BSI) among NICU admissions remains high, with significant mortality and morbidity. Due to COVID-19, there are increased infection prevention (IP) measures in NICUs including universal masking for all healthcare workers and families, social distancing, visitation restrictions, and increased attention to hand hygiene. These measures may also affect late-onset infection rates and offer understanding of novel interventions for prevention.

Methods: We examined infection rates from three neonatal centers during the 24 months prior to implementation of COVID-19 IP measures (PRE-period) compared to the months after implementation from April 2020 (POST-period). Late-onset infections were defined as culture-confirmed infection of the blood, urine, and other sterile fluids or identification of respiratory viral pathogens. An interrupted time series analysis of infection per 1000 patient days was performed based on a change-point Poisson regression with a lagged dependent variable and the number of patient days used as offsets. Each month was treated as independent with additional analysis using an observation-driven model to account for serial dependence.

Results: Multicenter analysis to date included all infants cared for at three centers (Level 3 and 4) from 2018-2020. Monthly BSI rates decreased in the POST-period at the three centers (Figure 1). At all centers actual BSI rate was lower than the expected rate in the POST-period (Figure 2). The combined BSI rate per 1000 patient days was 41% lower compared to the rate prior to implementation (95% CI, 0.42 to 0.84, P=0.004). In subgroup analysis of BSI by birthweight, during the POST-period there was a 39% reduction in infants < 1000g (P=0.023), a 44% decrease for 1000-1500g patients (P=0.292) and a 53% decrease in those > 1500g (0.083). Examining single center data from the University of Virginia through March 2021, there was a 36% decrease in all late-onset infections (BSI, UTI, Viral, and peritonitis) (95% CI, 0.46 to 0.90, P=0.011).

Conclusion: In this preliminary analysis, we found a reduction of BSI after the implementation of COVID-19 infection prevention measures. Additionally, there were fewer viral infections, though there were a limited number of episodes. Further analyses of multicenter data and a larger number of patients from all 12 centers of our study network will elucidate the significance of these findings and the role some of these IP measures, such as universal masking, may have in infection prevention in the NICU (Supported in part by Grant Funding from the Gerber Foundation).

Presenting Author(s)

Jaclyn B. Wiggins, MD
Neonatal Perinatal Medicine Fellow
University of Virginia
Charlottesville, Virginia
Disclosure: No Financial Relationships Disclosed

Co-Author(s)

Charlene Bultmann, DO
Fellow
University of Virginia
Charlottesville, Virginia
Disclosure: No Financial Relationships Disclosed
Sagori Mukhopadhyay, MD, MMSc
Assistant Professor of Pediatrics
Pennsylvania Hospital/Children's Hospital of Pennsylvania
University of Pennsylvania, Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
DF
Dustin D. Flannery, DO, MSCE
Assistant Professor of Pediatrics
University of Pennsylvania/Children's Hospital of Philadelphia
Philadephia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
MC
Mark Conaway, PhD
Professor, Public Health Sciences
University of Virginia
Charlottesville, Virginia
Disclosure: No Financial Relationships Disclosed
Miren B. Dhudasia, MBBS, MPH
Research Assistant
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
Kristin Weimer, MD, PhD, MHS
Assistant Professor of Pediatrics
Duke
Duke University Health System
Durham, North Carolina
Disclosure: No Financial Relationships Disclosed
DV
Dipen Vyas, MD
Neonatal Perinatal Fellow
Tower Health
Newyork, New York
Disclosure: No Financial Relationships Disclosed
Margaret Gilfillan, MD
Assistant Professor
Drexel
Drexel University College of Medicine
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
AC
Alison Carey, MD
Section Chief
Tower Health
West Reading, Pennsylvania
Disclosure: No Financial Relationships Disclosed
JW
Julie Wohrley, MD
Assistant Professor
Rush University
Chicago, Illinois
Disclosure: No Financial Relationships Disclosed
SK
Sarah Khan, MD
Assistant Professor of Pediatrics
McMaster University
West Hamilton, Ontario, Canada
Disclosure: No Financial Relationships Disclosed
Michael T. Favara, DO
Physician
ChristianaCare
Sidney Kimmel Medical College at Thomas Jefferson University
MEDIA, Pennsylvania
Disclosure: No Financial Relationships Disclosed
DT
Deborah Tuttle, MD
Assistant Professor of Pediatrics
Christiana Care
Newark, Delaware
Disclosure: No Financial Relationships Disclosed
KZ
Kathryn A. Ziegler, DO
Medical director
Abington Hospital Jefferson Health
Abington, Pennsylvania
Disclosure: No Financial Relationships Disclosed
EC
Eddie Chang, MD, MBA
Chief of Neonatology
Abington Hospital-Jefferson Health
Abington, Pennsylvania
Disclosure: No Financial Relationships Disclosed
JG
Jessica Gaulton, MD
Assistant Professor
Jefferson Abington Hospital
Abington, Pennsylvania
Disclosure: No Financial Relationships Disclosed
HW
Hendrik Wietkamp, MD
Associate Professor of Pediatrics
Vanderbilt University
Nashville, Tennessee
Disclosure: No Financial Relationships Disclosed
PS
Pablo Sanchez, MD
Professor of Pediatrics
Nationwide Children's Hospital
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed

Senior Author(s)

DK
David Kaufman, MD
Neonatologist
University of Virginia
Charlottesville, Virginia
Disclosure: No Financial Relationships Disclosed