Looking into the Crystal Ball – How COVID-19 may impact healthcare associated infections

Reviewed by Lauren M. DiBiase, MS; University of North Carolina Hospitals

Using the experiences of hospitals in NYC and St. Louis, McMullen et al. discuss the observed impact of COVID-19 on healthcare associated infection (HAI) rates and potential future impacts. In the beginning of the pandemic, many hospitals experienced decreases in their overall census, leaving the sickest patients most at risk of developing an infection in-house and driving down device utilization, leading to increased rates. In the two hospitals included in the study, CLABSI rates had increased 420% and 327%.  The same factors that have led to increased CLABSI rates may increase CAUTI rates a well. The authors suggest that due to several hospitals limiting the number of surgical procedures done that initially surgical site infection (SSI) rates will decrease, but note that after an initial decrease in SSI, there may be an increase since patients selected for the first waves of non-emergent surgeries will likely be at higher infection risk. The authors hypothesize that C. difficile and MDRO rates may decrease since facilities have increased their focus on hand hygiene and environmental cleaning compliance.

As hospitals have returned to normal census numbers, patients are presenting after delaying crucial primary and preventative care visits, such that higher acuity in non-COVID-19 patients should be expected. Increased acuity may lead to increased CLABSI and CAUTI rates. Additionally, as the pandemic rages on, several nursing-related practices related to infection prevention strategies, such as disinfecting needleless access devices, conducting peer audits, etc. may experience decreases in compliance due to staffing shortages and burn-out/low morale.

There is no question that COVID19 activity will continue to affect HAI.


McMullen KM, Smith BA, Rebmann T. Impact of SARS-CoV-2 on hospital acquired infection rates in the United States: Predictions and early results. Am J Infect Control. 2020 Nov;48(11):1409-1411. doi: 10.1016/j.ajic.2020.06.209

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