Impact of a zero-visitation policy on healthcare-associated infections in a non-COVID intensive care unit

Abstract

The impact of visitor restrictions in intensive care units (ICUs) during the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infections (HAIs) remains unclear. This study aimed to compare HAI rates between the pre-pandemic restricted-visitation period and the pandemic zero-visitation period in a non-COVID tertiary ICU. This single-center retrospective cohort study included patients admitted to the Anesthesiology and Reanimation ICU of the Duzce University Health Practice and Research Center between March 14, 2019, and March 13, 2021. Patients admitted during the pre-pandemic restricted-visitation period were assigned to Group 19 –20, whereas those admitted during the pandemic zero-visitation period were assigned to Group 20–21. Patients with an ICU stay of < 48 hours, infection at admission, or infection developing within the first 48 hours were excluded. The primary outcome was HAI incidence. Secondary outcomes included the standardized infection ratio, cumulative attributable difference, inflammatory markers, and microbiological findings. A total of 933 patients were screened, and 206 patients met the inclusion criteria (Group 20–21, n = 115; Group 19–20, n = 91). In the patient-based analysis, the HAI rate was significantly lower in Group 20–21 than in Group 19–20 (6.1% vs 22.0%, P < .001). Similar findings were observed in the episode-based analysis (10.4% vs 33.0%, P < .001). The time to infection onset was significantly longer in Group 20–21 ( P = .003). Procalcitonin, C-reactive protein, white blood cell count, and lactate levels were significantly lower during the zero-visitation period. The standardized infection ratio for ventilator-associated pneumonia was significantly lower in Group 20–21 ( P = .02). A marked reduction in the number of Acinetobacter spp. isolates was also observed during the pandemic. A zero-visitation policy in a non-COVID tertiary ICU was associated with lower HAI rates. The consistency of the surveillance indicators, inflammatory markers, and microbiological findings supports the observed association. However, these findings should not be attributed solely to visitor restrictions and should be interpreted in the context of multiple infection control measures implemented during the pandemic.