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What’s New in the Patient Safety World

October 2021

HAI’s Increase During COVID-19 Pandemic



The COVID-19 pandemic appears to have reversed the previous trend toward decreases in HAI’s (hospital-associated infections). Researchers used data from the National Healthcare Safety Network (NHSN), the nation’s largest HAI surveillance system, to analyzed recent trends in HAI’s (Weiner-Lastinger 2021). Early in 2020 there was a slight decrease in HAI’s compared to the same period in 2019. Then the pandemic hit. The remainder of 2020 saw significant national increases in CLABSI’s (central line–associated bloodstream infections), CAUTI’s (catheter-associated urinary tract infections), VAE’s (ventilator-associated events), and MRSA infections compared to 2019.


CLABSI’s, which had actually decreased 12% in the first quarter of 2020, increased 46% to 47% in the third quarter and fourth quarters of 2020 compared to 2019.


CAUTI’s increased significantly with the fourth quarter increasing by 19% compared to 2019.


VAE’s had significant increases nationally in all 4 quarters of 2020 compared to 2019, with the largest increase of 45% occurring in Q4.


MRSA bacteremia saw increases of 23% and 34% during 2020-Q3 and 2020-Q4 compared to 2019.


Decreases in SSI’s (surgical site infections) in 2020 likely reflected a substantial decrease in the number of adult inpatient colon or abdominal hysterectomy procedures (the 2 types of surgery included in the data) done during the pandemic.


Interestingly, C difficile–associated infections (CDI) decreased throughout 2020 compared to 2019. The authors attributed the decrease in CDI to increased focus on hand hygiene, environmental cleaning, patient isolation, and use of PPE during 2020, combined with continued inpatient antimicrobial stewardship programs and a marked decline in outpatient antibiotic prescribing,


It really should come as no surprise that HAI’s would increase during the pandemic. The increase in COVID-19 hospitalizations have put an incredible strain on hospital resources. Many more patients required intensive care, with increased use of ventilators. The authors also note that a longer patient length-of-stay, additional comorbidities and higher patient acuity levels, and a longer duration of device use in 2020 could have contributed to an overall increased risk of a device-associated infection during the pandemic. They also note that some studies identified an increased risk of ventilator associated conditions in critically ill COVID-19 patients


One would also suspect that PPE shortages, staffing shortages, burnout, and increased patient burden were likely factors contributing to the increase in most of these HAI’s.


The resurgence of COVID-19 infections and hospitalizations in 2021, driven by emergence of the delta variant, forbodes continued high levels of HAI’s.



Some of our prior columns on HAI’s (hospital-acquired infections):


December 28, 2010     HAI’s: Looking In All The Wrong Places

October 2013              HAI’s: Costs, WHO Hand Hygiene, etc.

February 2015             17% Fewer HAC’s: Progress or Propaganda?

April 2016                   HAI’s: Gaming the System?

September 2016          More on Preventing HAI’s

November 2018          Privacy Curtains Shared Rooms and HAI’s

December 2018           HAI Rates Drop

January 2019               Oral Decontamination Strategy Fails

February 2019             Infection Prevention for Anesthesiologists

March 2019                 Does Surgical Gowning Technique Matter?

May 2019                    Focus on Prophylactic Antibiotic Duration

July 2019                    HAI’s and Nurse Staffing

February 2020             NICU: Decolonize the Parents

June 16, 2020              Tracking Technologies

August 2020               Surgical Site Infections and Laparoscopy

December 2020           Do You Have These Infection Control Vulnerabilities?

May 2021                    CLABSI’s Up in the COVID-19 Era

August 2021               Updated Guidelines on C. diff






Weiner-Lastinger L, Pattabiraman V, Konnor R, et al. 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 2021; 1-14 Published online 03 September 2021






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