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Health care–associated infections persisted in 2021
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Health care–associated infections persisted in 2021

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Olivia C. Welter, PharmD

Released in late 2022, CDC’s most recent National and State Healthcare-Associated Infections (HAI) Progress Report examined the prevalence of 6 common infections across 3 health care settings: acute care hospitals (ACHs), inpatient rehabilitation facilities, and long-term acute care hospitals. However, the main takeaways from the report are focused on ACHs.

The 6 common infections include central-line associated bloodstream infections (CLABIs), ventilator-associated events (VAEs), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections, and surgical site infections (SSIs). CDC’s HAI Progress Report, released annually, compiles institutional data reported to the National Healthcare Safety Network (NHSN). This report intends to inform health care professionals of trends in HAIs and examines potential contributing factors to changes in the data trends.

The numbers outlined in the NHSN report are for 2021 and are compared to findings from 2020. Due to delays in reporting, data shown in this iteration of the report were collected through June 2022.

Image of a man in hospital bed

Impact of COVID-19

The COVID-19 pandemic affected all aspects of health care, including factors associated with HAIs. At the beginning of the pandemic, most facilities opted to delay elective surgical procedures and non-urgent operations were put on hold indefinitely for many patients. Patients may also have refrained from going to hospitals or other types of facilities during the COVID-19 pandemic if they didn’t feel the visit was necessary. Because of this, there may have been fewer surgical procedures to report on as compared to before patients and institutions adhered to these precautions.

However, patients with severe COVID-19 infection overwhelmed health systems and kept beds full. In addition, the health care system suffered extreme staffing and supply shortages, some of which are not fully resolved.

NHSN had also implemented a reporting exemption in 2020, meaning not all institutions were submitting data for analysis. The exemption ended mid-2020.

Increased prevalence of infection

Data collected by NHSN and reported out by CDC showed that 4 of the 6 common infections were more prevalent among ACHs nationwide in 2021 as compared to 2020.

CLABSIs increased 7%, and the difference from 2020 was greater among intensive care units (ICUs), which experienced an overall increase of 10% in CLABSIs.

VAEs increased by 12% across ICUs, but by 16% in non-ICU areas of ACHs.

CDC reported that CAUTIs increased by 5% at ACHs, but ICUs were affected more overall with a 9% increase in infection prevalence.

MRSA bacteremia increased by 14% overall with no distinctions made between which areas of care saw the greatest rate of increase.

Health care providers should note that, although there were increases from 2020 in prevalence of these various infections, they are far lower increases than what was reported from 2019 to 2020. For example, CLABIs had increased 47% in 2020, but only 7% in 2021.

Decreased prevalence of infection

C. diff. infections saw a significant decrease in prevalence in ACHs, with 3% less infections being reported. ACHs had only 1 of the 6 infection categories reported as being lower in 2021 than in 2020. This is a continued trend—C. diff. was also a category which saw a decrease in 2020 compared to 2019 data.

No significant change in prevalence of infection

NHSN tracks 10 select procedures performed in ACHs—part of the Surgical Care Improvement Project—for SSI data. Data analysis for SSI revealed that there was not a significant increase or decrease in infections associated with surgery. However, the report specifies that there was an 11% increase in infection from abdominal hysterectomies between 2020 and 2021, and there was not a significant change in infection prevalence associated with colon surgery from the same timeframe. ■