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U.S. Hospital-borne Infections Spiked in 2020

photo of IV

Sept. 3, 2021 -- Several health care-associated infections in US hospitals spiked in 2020 compared to the previous year, according to CDC analysis . that found soaring hospitalization rates, sicker patients who required more frequent and intense care, and pandemic-enduced staffing and supply shortages contributed to this increase.

It is the first reported increase in health care-associated infections since 2015, according to the CDC study published Thursday in Infection Control and Hospital Epidemiology

The findings "are a reflection of the enormous stress that COVID has placed on our health care system," Arjun Srinivasan, MD,, associate director of the CDC's Healthcare-Associated Infection Prevention Programs in Atlanta, says.

He was not an author of the article, but the research occurred under his supervision.

"We don't want anyone to read this report and think that it represents a failure of the individual provider or a failure of health-care providers in this country in their care of COVID patients," he says.

Srinivasan says health care professionals have provided "tremendously good care to patients under extremely difficult circumstances.

"People don't fail ― systems fail ― and that's what happened here," he says. "Our systems that we need to have in place to prevent health care-associated infection simply were not as strong as they needed to be to survive this challenge."

In the study, researchers used data reported to the National Healthcare Safety Network, the CDC's tracking system for health care-associated infections. The team compared national standard infection rates between 2019 and 2020 for six typical infections:

  • Central line-associated bloodstream infections.
  • Catheter-associated urinary tract infections.
  • Ventilator-associated events .
  • Infections during colon surgery and abdominal hysterectomy
  • Clostridioides difficile infections.
  • Methicillin-resistant Staphylococcus aureus (MRSA) infections.

"The new report highlights the need for health care facilities to strengthen their infection prevention programs and support them with adequate resources so that they can handle emerging threats to public health, while at the same time ensuring that gains made in combating [infections] are not lost," the Association for Professionals in Infection Control and Epidemiology said in a statement.

The analysis revealed significant national increases in infections to the bloodstream around a central line, which is a long IV line inserted into a large vein. Infections from catheters, ventilators and MRSA infections also increased.

The influx of sicker patients in hospitals in 2020 led to more frequent and longer use of medical devices such as catheters and ventilators. The use of these devices increases risk for infection, David P. Calfee, MD, chief medical epidemiologist at the Presbyterian/Weill Cornell Medical Center, in New York City, says. He is an editor of Infection Control and Hospital Epidemiology and was not involved with the study.

Shortages in personal protective equipment and crowded intensive care units could also have affected how care was delivered, he said. These shortages could have led to "reductions in the ability to provide some of the types of care that are needed to optimally reduce the risk of infection."

There was either no change or drops in infections associated with colon surgery or abdominal hysterectomy, likely because there were fewer elective surgeries performed, said Srinivasan. Infections tied to C difficilecommonly known as C-diff -- also decreased in 2020.

Common practices to prevent the spread of COVID-19 in hospitals, such as environmental cleaning, use of personal protective equipment, and patient isolation, likely helped to curb the spread of C difficile. Although these procedures help protect against MRSA infection, many other factors, notably, the use of medical devices such as ventilators and catheters, can increase the risk, Srinivasan says.

Although more research is needed to identify the reasons for these spikes, the findings help quantify the scope of these increases across the United States, Calfee says.

The data allow hospitals and health-care professionals to "look back at what we did and then think forward in terms of what we can do different in the future," he says, "so that these stresses to the system have less of an impact on how we are able to provide care."

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