Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections in Arizona Acute Care Hospitals: 2016-2020 HAI Progress Report

BACKGROUND: Since March 2020, coronavirus disease 2019 (COVID-19) has impacted clinical practices among Arizona acute care hospitals (ACHs), potentially affecting healthcare-associated infection (HAI) rates among these facilities. The Arizona Department of Health Services (ADHS) analyzed the impact of the COVID-19 pandemic on HAI occurrence among Arizona ACHs by utilizing data from the National Healthcare Safety Network (NHSN). METHODS: Standardized infection ratios (SIRs) from NHSN's National and State HAI Progress Reports (2016-2020) along with 2015 national baselines and 2020 Health and Human Services (HHS) HAI target goals were compiled to evaluate trends for central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream events, and Clostridioides difficile infections (CDI). CLABSI and CAUTI SIRs among intensive care units (ICUs), ward locations, and neonatal critical care units (CLABSI only) were also analyzed. To calculate statistical significance, 95% confidence intervals were used. RESULTS: Among reporting Arizona ACHs (n= 66-71, depending on year and HAI type) from 2016-2020, all four HAI SIRs decreased significantly from 2016 through 2019—CLABSI, 32% decrease; CAUTI, 25% decrease; MRSA, 41% decrease; and CDI, 36% decrease. However, CLABSI and MRSA SIRs increased significantly (60% and 45%, respectively) during 2020. Arizona CAUTI SIRs have been statistically significantly lower than the national SIRs from 2016-2020, remaining below the HHS target goal (SIR- 0.75) even during the onset of the pandemic (Arizona 2020 CAUTI SIR- 0.64). Among reporting ICUs during 2020, the CLABSI SIR increased 176% to 1.20 (significantly higher than the 2015 national baseline) and the ICU CAUTI SIR increased 49% to 0.69. CONCLUSIONS: Arizona ACH HAI incidence significantly increased during the COVID-19 pandemic, especially for CLABSIs. Future recommendations for Arizona ACHs should focus on prevention activities and interventions specific to CLABSI and CAUTI occurrence among ICUs.