Hello Burnout: National data on Healthcare-Associated Infections during the COVID19 Pandemic

Reviewed by Rebekah Moehring, MD, MPH, FSHEA, FIDSA; Duke University

Who’s feeling burnt? The CDC reported that US hospitals experienced increased rates of healthcare-associated infections (HAIs) as the pandemic droned on in 2020. Hospital-epidemiologists and infection preventionists who have been battling COVID19 for more than 18 months, must turn a bit of their focus back to our old, known HAI foes. This report, though, offers some evidence of the toll the pandemic has taken on infection prevention programs as a whole.

Weiner-Lastinger and colleagues evaluated surveillance data reported to the National Healthcare Safety Network (NHSN) for 6 HAIs: central-line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated events (VAE), surgical site infections (colon, abdominal hysterectomy, SSI), C. difficile LabID events, and MRSA bacteremia LabID events. Quarterly rates from 2020 were compared with 2019 rates in a compilation of standardized infection ratio (SIR) estimate comparisons outlined in 9 (that’s a lot!) tables in the manuscript. Short story: the pandemic is bad for most HAIs, and with each subsequent quarter the percent increases seemed to get worse when compared with 2019. The only exception seemed to be in SSI rates, with showed no change or actually some downtrend by quarter 4 of 2020. C. difficile LabID events, which had been on a nice downtrend for several years, also continued to go down, but the SIRs appeared to be leveling off. However, one limitation to the data presented is the lack of trend analysis or “big picture” trajectories in these HAIs, so interpretations were based on quarterly, percent change comparisons and prior reports of declining HAI SIRs.  Investigators also looked at SIRs for selected states, revealing that hardest-hit states (e.g., Florida, Texas) seemed to bear more of an HAI burden during 2020, particularly in CLABSI and VAE. Another finding points to a key area where IP programs are struggling – just doing routine surveillance and reporting. The number of hospitals with complete data for 2020 compared to 2019 was lower for both Q1 and Q2, especially for hysterectomy SSI (-27%) and for VAE (-36%). Even for our usual CLABSI and CAUTI, reporting dropped 14%.

If anything, this national report helps us understand that pandemic effects are all over the US – you are NOT alone with your hospital’s high CLABSI rates. Now, grab some resiliency pizza and get back out there, team! 

Weiner-Lastinger, L., Pattabiraman, V., Konnor, R., Patel, P., Wong, E., Xu, S., . . . Dudeck, M. (2021). The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network. Infection Control & Hospital Epidemiology, 1-14. doi:10.1017/ice.2021.362

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