COVID-19 Impact on HAIs

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 [PDF – 53 pages] (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:

U.S. Maps: The Impact of COVID-19 on HAI Incidence, by State [PDF - 4 pages]

• 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 [PDF – 1 page]
• 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 [XLS – 34 KB]
  • Quarterly SIR comparisons for each HAI type, by state, 2019 vs. 2020 [XLS – 228 KB]
• Additional HAI and COVID-19 data reports from NHSN can be found on the NHSN Reports page