COVID-19 Impact on Healthcare-associated Infections

COVID-19 Impact on HAIs in 2021

• A CDC analysis published in the Infection Control and Hospital Epidemiology journal reveals continued increases in healthcare-associated infections in U.S. hospitals during 2021, the second year of the COVID-19 pandemic.
  • Data from the National Healthcare Safety Network (NHSN) show significantly higher incidence in central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in 2021 compared to 2019.
  • These increases coincided with periods of high COVID-19 hospitalizations and were especially elevated during the first and third quarters of 2021.
  • Data also revealed strong declines in Clostridioides difficile (C. diff), likely due to pandemic-related improvements in hand hygiene, personal protective equipment (PPE) practices, and environmental cleaning in the healthcare settings.
  • Ventilator-associated events (VAEs) had the largest increases across all infection types. First quarter standardized infection ratios (SIRs) were 51% higher than the same period in 2019, and 60% higher in the third quarter when the Delta variant drove COVID-19-related hospitalizations to all-time highs.
• Continued changes to hospital practices, longer patient length of stay, additional co-morbidities and higher patient acuity levels, and a longer, more frequent use of devices in 2021 likely contributed to an overall increased potential for device-associated (DA) infections during the pandemic.
• The 2021 analysis of the impact of COVID-19 on healthcare-associated infections followed the same methodology as the published 2020 data summarized at the bottom of this page.

Interpretation: The HAI types shown on this graph are those that have been found to be most impacted by the COVID-19 pandemic, as demonstrated by CDC data. SIRs for other types of infections are available in Tables 1-3 of the manuscript, and in the 2020 report below. This graph displays the quarterly SIR point estimates from 2019-Q1 – 2021-Q3 and does not constitute a statistical trend analysis.

COVID-19 Impact on HAIs in 2020

• The data below are from Impact of COVID-19 on HAIs in 2020: A summary of data reported to NHSN; Infect Control Hosp Epidemiol 2021.
• This report used HAI data reported to the National Healthcare Safety Network (NHSN) from acute care hospitals to assess changes in the quarterly Standardized Infection Ratio (SIRs) for CLABSIs, CAUTIs, VAEs, SSIs, MRSA bacteremia, and C. difficile laboratory-identified events (2019 vs 2020)

Nationally, significant increases in 2020 were observed for CLABSI, CAUTI, VAE, and MRSA bacteremia compared to 2019. The largest increases occurred during quarter 4 (October, November, December) of 2020:

• CLABSI: 47% increase in Q4 across all location types
  • 65% increase in intensive care units (ICUs)
  • 16% increase in select inpatient wards
• CAUTI: 19% increase in Q4 across all location types
  • 30% increase in ICUs
• VAE: 45% increase in Q4 across all location types
  • 44% increase in ICUs
  • 35% increase in adult inpatient wards
• Significant decreases were observed in C. difficile throughout 2020, compared to 2019
• A summary of changes in national HAI SIRs, for all quarters in 2020, can be found here: Figure 1
• Increases in device utilization (central line, urinary catheter, and ventilators) were also observed
  • Ventilator utilization increased by 25 – 31% in 2020 Q2 – 2020 Q4
• Supplemental data tables are available:
  • Changes in the national device-associated HAI SIRs, by location type, 2020 vs. 2019
  • Quarterly SIR comparisons for each HAI type, by state, 2019 vs. 2020
• Additional HAI and COVID-19 data reports from NHSN can be found on the NHSN Reports page