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Unintended consequences of infection prevention and control measures during COVID-19 pandemic

  • Wee, Liang En Ian1, 2
  • Conceicao, Edwin Philip3
  • Tan, Jing Yuan4
  • Magesparan, Kamini Devi3
  • Amin, Ismawati Binte Mohamad3
  • Ismail, Bushra Binte Shaik3
  • Toh, Hui Xian3
  • Jin, Pinhong3
  • Zhang, Jing5
  • Wee, Elaine Geok Ling3
  • Ong, Sheena Jin Min3
  • Lee, Gillian Li Xin3
  • Wang, Amanda En-min5
  • How, Molly Kue Bien3
  • Tan, Kwee Yuen3
  • Lee, Lai Chee3
  • Phoon, Poh Choo5
  • Yang, Yong3
  • Aung, May Kyawt3
  • Sim, Xiang Ying Jean2, 3
  • And 2 more
  • 1 Singhealth Infectious Diseases Residency, Singapore
  • 2 Department of Infectious Diseases, Singapore General Hospital, Singapore
  • 3 Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
  • 4 Department of Internal Medicine, Singapore General Hospital, Singapore
  • 5 Department of Nursing Speciality Care Unit, National Heart Centre, Singapore
Published Article
American Journal of Infection Control
Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc.
Publication Date
Nov 04, 2020
DOI: 10.1016/j.ajic.2020.10.019
PMID: 33157180
PMCID: PMC7610096
PubMed Central


Background In the current COVID-19 pandemic, aggressive Infection Prevention and Control (IPC) measures have been adopted to prevent health care-associated transmission of COVID-19. We evaluated the impact of a multimodal IPC strategy originally designed for the containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs). Methodology From February-August 2020, a multimodal IPC strategy was implemented across a large health care campus in Singapore, comprising improved segregation of patients with respiratory symptoms, universal masking and heightened adherence to Standard Precautions. The following rates of HAI were compared pre- and postpandemic: health care-associated respiratory-viral-infection (HA-RVI), methicillin-resistant Staphylococcus aureus , and CP-CRE acquisition rates, health care-facility-associated C difficile infections and device-associated HAIs. Results Enhanced IPC measures introduced to contain COVID-19 had the unintended positive consequence of containing HA-RVI. The cumulative incidence of HA-RVI decreased from 9.69 cases per 10,000 patient-days to 0.83 cases per 10,000 patient-days (incidence-rate-ratio = 0.08; 95% confidence interval [CI] = 0.05-0.13, P < .05). Hospital-wide MRSA acquisition rates declined significantly during the pandemic (incidence-rate-ratio = 0.54, 95% CI = 0.46-0.64, P < .05), together with central-line-associated-bloodstream infection rates (incidence-rate-ratio = 0.24, 95% CI = 0.07-0.57, P < .05); likely due to increased compliance with Standard Precautions. Despite the disruption caused by the pandemic, there was no increase in CP-CRE acquisition, and rates of other HAIs remained stable. Conclusions Multimodal IPC strategies can be implemented at scale to successfully mitigate health care-associated transmission of RVIs. Good adherence to personal-protective-equipment and hand hygiene kept other HAI rates stable even during an ongoing pandemic where respiratory infections were prioritized for interventions.

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