America's coronavirus epidemic has stretched the country's already thin workforce of infection preventionists and infectious disease physicians even further, leading some experts to worry that, as a result, hospital-acquired infections (HAIs) may be increasing, Maria Castellucci reports for Modern Healthcare.

A small field

The number of providers specializing in and focused on infectious diseases at hospitals is fairly small in America, according to Castellucci. In 2017, for instance, there were around 9,100 infectious disease physicians in the country—which was significantly lower than the numbers of physicians in some other specialties, such as the more than 42,000 emergency medicine physicians in the country that same year, Castellucci reports.

"We are a small field given how many hospitals there are in the United States and the fact that HAIs are in the top 10 leading causes of death," David Weber, medical director of infection prevention at UNC Health Care, told Castellucci.

According to Castellucci, the limited workforce is likely driven by two factors. First, there isn't as much interest in the specialty when compared with others, because infectious disease specialists tend to have lower salaries than other specialists, Castellucci reports. For example, Castellucci cites a recent MedScape survey that found the average annual salary for infectious disease specialists in 2020 is $246,000—among the lowest of all specialties.

Second, infectious disease physicians typically don't generate as much revenue for hospitals as physicians in other specialties, Castellucci reports. That's because much of an infectious disease physicians' time is spent analyzing data and teaching best practices for infection control rather than performing surgeries and other procedures, according to Castellucci.

Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau, told Castellucci, "We aren't revenue generators, but we are huge [cost] avoiders." He added, "The specialty doesn't get the recognition it should, nor does it get the financial recognition it should. That is a big difficulty for recruiting people to the field."

Experts fear HAIs may increase amid coronavirus epidemic

And infectious diseases specialists may be more vital than ever amid America's coronavirus epidemic. Since the start of the epidemic, infectious disease physicians have played a key role in acquiring personal protective equipment for hospitals, setting up Covid-19 care units and coronavirus testing sites, and redesigning other care units to allow for the proper physical distancing and isolating of patients, Castellucci reports.

In addition, Castellucci reports that some evidence suggests patients with Covid-19, the disease caused by the novel coronavirus, may be more vulnerable to HAIs, such as central line-associated bloodstream infections. That's because those patients often are cared for in ICUs for a long period of time, receive antibiotics, and are hooked up to machines.

"The more exposure you have to devices and antimicrobials, the more at risk you are for complications," Anurag Malani, medical director of infection prevention and antimicrobial stewardship programs at St. Joseph Mercy Health System, explained.

But as infectious disease specialists are spending more time focused on efforts to address the coronavirus, some experts worry that the already-small workforce may be stretched too thin, which could mean they and other providers consequently are paying less attention to typical infection-control initiatives.

"There has been a tremendous strain placed on infection preventionists during this [epidemic]," Connie Steed, president of the Association for Professionals in Infection Control and Epidemiology (APIC), told Castellucci. "Many infectious disease programs are already under-resourced and really don't have enough staff to be able to adequately monitor infection rates at all times."

And Steed said she's heard from APIC members that some hospitals have had to either lay off or furlough members of their infection-control staff amid the epidemic.

"Now is a time when [hospitals] really need an increase of infection prevention resources, not less," Steed said.

Michael Stevens, associate chair of infectious diseases at VCU Health in Richmond, told Castellucci, "The major concern is the impact this is going to have on HAIs." As fighting the novel coronavirus takes priority, "[t]he traditional things that people do to prevent infections—they go by the wayside," he said.

Data on HAIs for 2020 may be incomplete

According to Castellucci, the most recent data on HAIs from the federal Agency for Healthcare Research and Quality shows HAIs have been decreasing, though they're still one of the top complications for inpatients—and they cost hospitals an estimated $28 billion to $45 billion each year.

That data doesn't include information on HAI rates this year, Castellucci reports, and it's not clear whether federal data on HAIs for 2020 will be complete once it's available, as CMS made hospital reporting on HAIs optional for the first two quarters of this year to ease provider burdens amid the epidemic. According to Castellucci, experts say they expect hospitals took advantage of those waived requirements, especially if they saw increases in HAIs—which potentially could lead to them seeing lower Medicare payments.

"If you are given a choice to report or not, when reporting could hurt your finances more, then you are going to take the path of least resistance, which is not to risk more financial ruin," Bernard Camins, medical director of infection prevention at Mount Sinai Health System, told Castellucci. "You're talking about millions of dollars in reimbursement" (Castellucci, Modern Healthcare, 8/22).