Coronavirus disease 2019 (COVID-19) pandemic, central-line–associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on US hospitalizations, affecting processes and patient population. Methods: We evaluated the impact of COVID-19 pandemic in 78 US hospitals on central line associated bloodstream infections (CLABSI) and catheter associated urinary tract infections (CAUTI) events 12 months pre-COVID-19 and 6 months during COVID-19 pandemic. Results: There were 795,022 central line-days and 817,267 urinary catheter-days over the two study periods. Compared to pre-COVID-19 period, CLABSI rates increased during the pandemic period from 0.56 to 0.85 (51.0%) per 1,000 line-days (p<0.001) and from 1.00 to 1.64 (62.9%) per 10,000 patient-days (p<0.001). Hospitals with monthly COVID-19 patients representing >10% of admissions had a NHSN device standardized infection ratio for CLABSI that was 2.38 times higher compared to those with <5% prevalence during the pandemic period (p=0.004). Coagulase-negative staphylococcus CLABSI increased by 130% from 0.07 to 0.17 events per 1,000 line-days (p<0.001), and Candida sp. by 56.9% from 0.14 to 0.21 per 1,000 line-days (p=0.01). In contrast, no significant changes were identified for CAUTI (0.86 vs. 0.77 per 1,000 catheter-days; p=0.19). Conclusions: The COVID-19 pandemic was associated with substantial increases in CLABSI but not CAUTI events. Our findings underscore the importance of hardwiring processes for optimal line care, and regular feedback on performance to maintain a safe environment.

Bloodstream Infections in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Fourteen studies [6,10,18,20,27,28,32,34,35,38,42,46,50,55] reported data on mortality in patients with COVID-19 and BSI. The pooled estimated occurrence of mortality (at the longest available follow-up) was 41% (95% CI 30%-52.8%; 189/482 patients; I 2 = 78%; Figure 3).…”

“…Among the 11 studies with a comparison group, all except two had historical comparison groups [27,35]. Furthermore, 8 out of 11 studies reported only unadjusted statistical analysis [10,12,18,20,22,27,28,44]. These were the most frequently downgraded domains.…”

Characterization of Secondary Bacterial Infections and Antibiotic Use in Mechanically Ventilated Patients With COVID-19 Induced Acute Respiratory Distress Syndrome

“… 24 Other studies looking at central line associated infections have demonstrated higher rates during the pandemic compared to the preceding year. 25 , 26 …”

COVID-19 hospital prevalence as a risk factor for mortality: an observational study of a multistate cohort of 62 hospitals

“…We have previously reported that hospitals with increased COVID-19 prevalence had significantly higher central line-associated bloodstream infection (CLABSI) events. 30 In addition, patients infected with COVID-19 were greater than five times likely to develop CLABSIs compared with other patients during the pandemic. 30 Our clinical and quality teams are re-evaluating our processes to ensure the standards of care are hardwired, patient decompensation is recognised early and prompt management is instituted for patients who are clinically deteriorating.…”