COVID-19 Cited in Significant Increase in HAIs in 2020

After years of steady reductions in healthcare-associated infections, significantly higher rates of four out of six routinely tracked infections were observed in U.S. hospitals, according to a Centers for Disease Control and Prevention (CDC) analysis of data from the National Healthcare Safety Network (NHSN) published in Infection Control & Hospital Epidemiology. Increases were attributed to factors related to the COVID-19 pandemic, including more and sicker patients requiring more frequent and longer use of catheters and ventilators as well as staffing and supply challenges.

“COVID-19 created a perfect storm for antibiotic resistance and healthcare-associated infections in healthcare settings. Prior to the pandemic, public health — in partnership with hospitals — successfully drove down these infections for several years across U.S. hospitals,” said Arjun Srinivasan, MD, CDC’s associate director of Healthcare Associated Infection Prevention Programs. “Strengthening infection prevention and control capacities works. This information emphasizes the importance of building stronger, deeper and broader infection control resources throughout healthcare that will not only improve our ability to protect patients in future pandemics but will also improve patient care every day.”

For this analysis, researchers used data collected through NHSN, the nation’s largest healthcare-associated infection surveillance system, which is used by nearly all U.S. hospitals to fulfill local, state, or federal infection reporting requirements.

Major increases were found in 2020 compared to 2019 in four serious infection types: central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events, and antibiotic resistant staph infections. The largest increases were bloodstream infections associated with central line catheters that are inserted into large blood vessels to provide medication and other fluids over long periods. Rates of central line infections were 46% to 47% higher in the third and fourth quarters of 2020 compared to 2019.

With dramatic increases in the frequency and duration of ventilator use, rates of ventilator-associated infections increase by 45% in the fourth quarter of 2020 compared to 2019. The CDC analysis found sharp increases in standardized infection rates, indicating that the increases were not simply a reflection of more devices being used.

“Infection control practices in COVID-19 wards often adapted to shortages of personal protective equipment, responded to fear of healthcare personnel, and did not always lend themselves to better infection prevention,” said Tara N. Palmore, MD, and David K. Henderson, MD, of the National Institutes of Health, in an editorial that accompanied the study. “The success of the previous several years, with steady declines in rates of these (healthcare-associated) and device-related infections, further accentuated the upswings that occurred in 2020.”

The study found that two other types of infection remained steady or declined during COVID-19. Surgical-site infections rates did not increase as fewer elective surgeries were performed, largely in operating rooms with uninterrupted infection control processes that were separate from COVID wards. In addition, no increase was found in Clostridioides Difficile, or C. diff. The study said lower rates of C. diff may be a result of increased focus on hand hygiene, environmental cleaning, patient isolation, and use of personal protective equipment.

“Basic infection control practices must be hardwired into practice so that they are less vulnerable when the health care system is stressed,” the editorial concluded, “One approach might be to designate clinical staff to be added to the hospital epidemiology team to allow for rapid expansion of effort to support a pandemic response.”

In a statement, APIC president, Ann Marie Pettis, BSN, RN, CIC, FAPIC, calls this new CDC data “quite troubling and must serve as a call to action.” She adds, “As a nation we must take significant efforts to bolster our infection prevention and control programs throughout the healthcare continuum. The new report highlights the need for healthcare 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 combatting HAIs are not lost.”

Pettis continues, “The unfortunate reality is that in one year we lost nearly a decade of progress against HAIs like central line-associated bloodstream infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA), and ventilator-associated events. We now have an opportunity to use this data and take action to invest in our public health infrastructure, expand our nation’s infection prevention and control workforce, and put infection preventionists – specialists who are trained and certified to prevent infections — at the center of these efforts. APIC is calling on healthcare facilities to assess their infection prevention programs by looking at the care and services they provide and determining the appropriate level of personnel and resources necessary to protect patients and healthcare workers. Facility-wide infection prevention programs are critical and require adequately staffed, trained, and resourced infection prevention and control departments. APIC also calls on federal and state governments to provide funding to help support healthcare facilities across the continuum of care to ensure that there is adequate surge capacity so that infection prevention and control measures will endure when stressed by future pandemics and disease outbreaks.”


Weiner-Lastinger LM, et al. The impact of COVID-19 on healthcare-associated infections in 2020; A summary of data reported to the National Healthcare Safety Network. Infection Control & Hospital Epidemiology. Web (August 25, 2021).

Palmore TN and Henderson DK. Healthcare-Associated Infections in the Time of Pandemic COVID-19. Infection Control & Hospital Epidemiology. Web (August 25, 2021).

Source: Society for Healthcare Epidemiology of America