The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections

Meghan A. Baker, Kenneth E. Sands, Susan S. Huang, Ken Kleinman, Edward J. Septimus, Neha Varma, Jackie Blanchard, Russell E. Poland, Micaela H. Coady, Deborah S. Yokoe, Sarah Fraker, Allison Froman, Julia Moody, Laurel Goldin, Amanda Isaacs, Kacie Kleja, Kimberly M. Korwek, John Stelling, Adam Clark, Richard PlattJonathan B. Perlin

Research output: Contribution to journalArticlepeer-review

134 Scopus citations


Background: The profound changes wrought by coronavirus disease 2019 (COVID-19) on routine hospital operations may have influenced performance on hospital measures, including healthcare-associated infections (HAIs). We aimed to evaluate the association between COVID-19 surges and HAI and cluster rates. Methods: In 148 HCA Healthcare-affiliated hospitals, from 1 March 2020 to 30 September 2020, and a subset of hospitals with microbiology and cluster data through 31 December 2020, we evaluated the association between COVID-19 surges and HAIs, hospital-onset pathogens, and cluster rates using negative binomial mixed models. To account for local variation in COVID-19 pandemic surge timing, we included the number of discharges with a laboratory-confirmed COVID-19 diagnosis per staffed bed per month. Results: Central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as COVID-19 burden increased. There were 60% (95% confidence interval [CI]: 23-108%) more CLABSI, 43% (95% CI: 8-90%) more CAUTI, and 44% (95% CI: 10-88%) more cases of MRSA bacteremia than expected over 7 months based on predicted HAIs had there not been COVID-19 cases. Clostridioides difficile infection was not significantly associated with COVID-19 burden. Microbiology data from 81 of the hospitals corroborated the findings. Notably, rates of hospital-onset bloodstream infections and multidrug resistant organisms, including MRSA, vancomycin-resistant enterococcus, and Gram-negative organisms, were each significantly associated with COVID-19 surges. Finally, clusters of hospital-onset pathogens increased as the COVID-19 burden increased. Conclusions: COVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.

Original languageEnglish (US)
Pages (from-to)1748-1754
Number of pages7
JournalClinical Infectious Diseases
Issue number10
StatePublished - May 15 2022


  • COVID-19
  • catheter-associated urinary tract infection (CAUTI)
  • central line-associated blood stream infection (CLABSI)
  • healthcare-associated infections (HAI)
  • Pandemics
  • Vancomycin-Resistant Enterococci
  • COVID-19 Testing
  • Humans
  • Cross Infection/microbiology
  • Methicillin-Resistant Staphylococcus aureus
  • COVID-19/epidemiology
  • Bacteremia/epidemiology
  • Delivery of Health Care
  • Urinary Tract Infections/epidemiology
  • Catheter-Related Infections/prevention & control
  • Pneumonia, Ventilator-Associated/microbiology

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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