Some HAI Incident Increases Continued Into Second Year of COVID-19

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Despite the increase of infection control and prevention protocols during the COVID-19 pandemic, during the first two years, several health care-acquired infections (HAIs) continued and most increased according to a study recently published, “Continued Increases in HAI Incidence During the Second Year of the COVID-19 Pandemic.”

“For most HAIs, our results are representative of most acute care hospitals in the U.S. and provide a national picture of the impact of COVID-19 on HAI incidence,” the investigators noted in the study. “Our findings describe the increases in HAIs that occurred during the 2021 COVID-19 pandemic year and underscore the continued challenges experienced in infection prevention. Resilient approaches are needed to reduce HAIs in 2022 and beyond.”

Central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections (SSIs), and laboratory-identified (LabID) methicillin resistant Staphylococcus aureus (MRSA) bacteremia increased during 2021, especially during the first and third quarters of the year. However, Clostridioides difficile incidences decreased.

The lead author on the study, Lindsey Lastinger, MPH, health scientist with the Centers for Disease Control and Prevention (CDC) and published by CambridgeCore, answered questions for Infection Control Today^® (ICT^®). She summarizes the study, what are the practical applications for infection preventionists, and what research is coming on this topic.

Infection Control Today^® (ICT^®): Please give a summary of the key findings and why they are important.

Lindsey Lastinger, MPH: U.S. hospitals continued to face challenges with infection prevention and control during the second year of the pandemic. We found that the incidence of certain types of health care-associated infections (HAIs) in U.S. hospitals remained significantly higher in 2021 compared to the pre-pandemic time period. Within 2021, HAIs appeared to be highest during the first and third quarters of the year, coinciding with COVID-19 surges in the U.S. and the resulting high volume of COVID-19 hospitalizations.

ICT^®: What is the practical application for the key findings for infection preventionists from this study?

LL: Infection preventionists should regularly review their HAI surveillance data to identify any gaps in infection prevention practices, paying particular attention to CLABSIs, VAEs, and MRSA bacteremia infections, which all appeared to have significant and substantial increases on the national-level during 2021. Health system leaders and infection prevention staff should explore building resiliency into their programs so that future efforts may better withstand public health emergencies.

ICT^®: What results surprised you, if any?

LL: The heightened HAI incidence during 2021 is consistent with the results that were observed during 2020, the initial year of the pandemic. Unfortunately, the COVID-19 pandemic has presented numerous and unprecedented operational challenges in hospitals, particularly for those facilities experiencing high system stress as a result of an increasing caseload, the effects of which we are continuing to see during COVID-19 surges.

ICT^®: What, if any, future research will there be related to this study?

LL: CDC will continue to monitor national HAI incidence throughout the pandemic and continue to identify new ways to improve HAI prevention efforts.

ICT^®: Is there anything else that you would like to add?

LL: Previous efforts in health care settings to prevent HAIs were working effectively to decrease HAIs in the years prior to the onset of the COVID-19 pandemic. However, despite the utility of these efforts, our findings demonstrate the difficulty of HAI mitigation in times of severe strain on the health care system. Our report highlights this reality in the context of the COVID-19 pandemic which continues to take a significant toll on health care systems in the United States. It may also have implications for future instances of severe strain upon the health care system.