October 2021
2020 National and State Healthcare-Associated Infections (HAI) Progress Report
Healthcare-Associated Infections
The year 2020 was a tragic and historic year in our nation's history, marked by the emergence of the COVID-19 global pandemic. With a total of 20 million cases and 372,000 deaths, and daily admissions reaching over 15,000, COVID-19 had a major impact on U.S. healthcare delivery in 20201. Unfortunately, the 2020 National and State Healthcare-Associated Infections (HAI) Progress Report suggests that ground has been lost in the progress made in the prevention of several important HAIs in Acute Care Hospitals (ACHs), including a 35% increase in the standardized infection ratio (SIR) for ventilator-associated events (VAE); 24% increase in central line-associated bloodstream infections (CLABSI), and a 15% increase in hospital-onset methicillin-resistant Staphylococcus aureus (MRSA)2. The report also found significant increase in LTACH-onset MRSA bacteremia (20%).
This impact of the COVID-19 pandemic on U.S. HAI incidence was also summarized in a recent report in which 2020 national and state quarterly SIRs were compared to 2019 for continuously reporting ACHs3. The analysis of the 2020 quarterly SIRs found significant increases in CLABSI, VAE, MRSA bacteremia, and catheter-associated urinary tract infections (CAUTI).
In contrast to this lost ground in the prevention of several HAIs for ACHs, the 2020 HAI Progress Report shows significant national reductions in surgical site infections (SSIs) related to abdominal hysterectomy (9%), colon surgery (5%), SSIs related to the 10 Surgical Care Improvement Project (SCIP) procedures, and hospital-onset C. difficile infection (CDI, 11%). The 2020 HAI Progress Report also shows progress in reducing some HAIs in other healthcare settings (figure 1). In long-term acute care hospitals (LTACHs), significant reductions were seen in CLABSI (8%), CAUTI (7%), and LTACH-onset CDI (24%), while no significant changes were observed in VAE. In inpatient rehabilitation facilities (IRFs), significant reductions were seen in hospital-onset CDI (10%), CLABSI (24%), CAUTI (14%), while no significant changes were observed in IRF-onset MRSA bacteremia.
For most HAIs in ACHs, the increases seen in 2020 present a strong contrast to the success in reducing these infections prior to the pandemic. The COVID-19 pandemic created a perfect storm for HAIs in healthcare settings. Many hospitals faced extraordinary circumstances that may have reduced the implementation of standard infection prevention and control (IPC) practices. The 2020 HAI Progress Report highlights the need for hospitals to continue to reinforce IPC practices in their facilities and regularly review HAI surveillance data to identify areas that need to be improved, plus address any gaps in prevention practices.
At the onset of the year 2020, most healthcare facilities in the US were required to report select HAI data to NHSN in 2020 for participation in various CMS Quality Reporting Programs (QRPs), which results in census reporting. However, on March 27, 2020, an Extraordinary Circumstance Exception (ECE) Policy to the CMS Quality Reporting Programs was announced and applied to 2019Q4 through 2020Q2 data due to COVID-19 pandemic response activities4. Many facilities across the nation were inundated with COVID-19 cases during the 2020Q1 and 2020Q2 CMS QRP reporting deadline. To alleviate some of the burden from facilities, CMS implemented an exception policy where facilities who were unable to report 2020Q1 and 2020Q2 HAI data to NHSN due to COVID-19 response activities were not penalized. Though the ECE policy was implemented for the first half of 2020, between 86-88% of acute care hospitals that conducted surveillance for CLABSI, CAUTI, MRSA bacteremia, or CDI during 2019Q1 or 2019Q2 also reported surveillance data for 2020Q1 or 2020Q2. Larger declines in the number of reporting hospitals were seen for VAE (22-25% drop) and SSI (25-36% drop) surveillance. Although there were drops in the number of hospitals reporting VAEs, ventilator utilization for those hospitals reporting VAE data continuously increased significantly compared to the pre-pandemic quarters. The drop in reporting hospitals for SSI surveillance resulted in a significant drop in surgical procedures compared to the previous year. The drop in surgical procedures could also be a result of the facilities performing only elective surgeries during the first half of 2020.
Reporting levels during the second half of 2020 were close to pre-pandemic time periods for most HAIs.
Explore the Antimicrobial Resistance & Patient Safety Portal (AR&PSP) for data from this HAI Progress Report. You may also read the full 2020 HAI Progress Report for additional national and state-specific HAI data.
Standardized Infection Ratio (SIR) and Hospitalized Infections Changes Over Time
| year | Standardized Infection Ratio |
|---|---|
| 2019 | 0.69 |
| 2020 | 0.86 |
Figure 1. Changes in the 2020 national healthcare-associated infection (HAI) Standardized Infection Ratios (SIRs), compared to 2019 SIRs, by facility setting, National Healthcare Safety Network.
| HAI Type | Acute Care Hospitals | Inpatient Rehabilitation Facilities | Long-term Acute Care Hospitals |
|---|---|---|---|
| CLABSI | Up 24% | Down 24% | Down 8% |
| CAUTI | No Change | Down 14% | Down 7% |
| VAE | Up 35% | No Change | |
| SSI: Colon Surgery | Down 5% | ||
| SSI: Abdominal Hysterectomy | Down 9% | ||
| LabID MRSA Bacteremia | Up 15% | No Change | Up 20% |
| LabID CDI | Down 11% | Down 10% | Down 24% |
Figure 2. Changes in the 2020 national healthcare-associated infection (HAI) Standardized Infection Ratios (SIRs), compared to 2015 baseline SIR of 1, by facility setting, National Healthcare Safety Network.
| HAI Type | Acute Care Hospitals | Inpatient Rehabilitation Facilities | Long-term Acute Care Hospitals |
|---|---|---|---|
| CLABSI | Down 14% | Down 45% | Down 29% |
| CAUTI | Down 25% | No Change | Down 26% |
| VAE | Up 30% | Down 45% | |
| SSI: Colon Surgery | Down 19% | ||
| SSI: Abdominal Hysterectomy | Down 11% | ||
| LabID MRSA Bacteremia | Down 6% | No Change | Down 16% |
| LabID CDI | Down 48% | Down 48% | Down 60% |
Figure 3. National surgical site infection (SSI) Standardized Infection Ratios (SIRs), by procedure category, National Healthcare Safety Network, 2020.
| Procedure Category | # Hospitals Reporting | SIR vs. Nat'l Baseline | 2020 SIR vs. 2019 SIR | Nat'l SIR |
|---|---|---|---|---|
| Abdominal Aortic Aneurysm | 164 | Down 100% | Down 100% | 0.00 |
| Abdominal hysterectomy | 2,845 | Down 11% | Down 9% | 0.89 |
| Appendix surgery | 460 | Down 38% | No Change | 0.62 |
| Bile duct, liver or pancreatic surgery | 349 | Down 15% | No Change | 0.85 |
| Breast abscess or mastitis | 314 | Down 26% | No Change | 0.74 |
| Cardiac surgery | 403 | No Change | No Change | 0.86 |
| Carotid endarterectomy | 238 | No Change | No Change | 1.22 |
| Cesarean section | 562 | No Change | No Change | 0.96 |
| Colon surgery | 3,062 | Down 19% | Down 5% | 0.81 |
| Coronary artery bypass graft surgery | 694 | Down 24% | No Change | 0.76 |
| Craniotomy | 228 | Up 24% | No Change | 1.24 |
| Exploratory Laparotomy | 457 | No Change | No Change | 0.97 |
| Gallbladder surgery | 479 | No Change | No Change | 0.89 |
| Gastric surgery | 431 | Down 35% | No Change | 0.65 |
| Heart transplant | 30 | No Change | No Change | 1.08 |
| Herniorrhaphy | 300 | Down 18% | No Change | 0.82 |
| Hip prosthesis | 2,119 | No Change | No Change | 0.98 |
| Kidney surgery | 299 | No Change | No Change | 1.28 |
| Kidney transplant | 45 | Up 56% | No Change | 1.56 |
| Knee prosthesis | 2,059 | Up 5% | No Change | 1.05 |
| Laminectomy | 635 | Down 26% | Down 28% | 0.74 |
| Limb amputation | 212 | Up 110% | Up 48% | 2.10 |
| Liver transplant | 33 | Down 30% | No Change | 0.70 |
| Neck surgery | 104 | Down 25% | No Change | 0.75 |
| Open reduction of fracture | 465 | No Change | No Change | 0.98 |
| Ovarian surgery | 408 | No Change | No Change | 0.92 |
| Pacemaker surgery | 314 | No Change | No Change | 1.28 |
| Peripheral vascular bypass surgery | 270 | No Change | No Change | 0.93 |
| Prostate surgery | 135 | Up 148% | No Change | 2.48 |
| Rectal surgery | 373 | Down 71% | Down 32% | 0.29 |
| Shunt for dialysis | 123 | No Change | No Change | 1.13 |
| Small bowel surgery | 461 | Down 25% | Down 13% | 0.75 |
| Spinal fusion | 836 | No Change | No Change | 0.99 |
| Spleen surgery | 249 | No Change | No Change | 1.40 |
| These 10 procedures combined | 12,524 | Down 14% | Down 5% | 0.86 |
| Thoracic surgery | 368 | Down 24% | No Change | 0.76 |
| Thyroid and/or parathyroid surgery | 154 | No Change | No Change | 1.84 |
| Vaginal hysterectomy | 535 | No Change | No Change | 0.85 |
| Ventricular shunt | 143 | Up 29% | No Change | 1.29 |
HAI Progress Legend
Red upward arrow signifies statistically significant increase.
Green downward arrow signifies statistically significant decrease.
“No Change” signifies that the change in SIR was not statistically significant.
Grayed out fields indicate the HAI-specific surveillance is not performed in the facility type indicated.
References
- Centers for Disease Control and Prevention. COVID Data Tracker. Available at covid.cdc.gov/covid-data-tracker. Accessed September 21, 2021.
- Centers for Disease Control and Prevention. 2020 National and State Healthcare-Associated Infections Progress Report. Available at the full report. Accessed September 21, 2021.
- Weiner-Lastinger, L., Pattabiraman, V., Konnor, R., Patel, P., Wong, E., Xu, S., … Dudeck, M. (2021). The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network. Infection Control & Hospital Epidemiology, 1-14. doi:10.1017/ice.2021.362. Available at doi.org/10.1017/ice.2021.362. Accessed September 21, 2021.
- Centers for Medicare and Medicaid Services. Exceptions and Extensions for Quality Reporting Requirements for Acute Care Hospitals, PPS-Exempt Cancer Hospitals, Inpatient Psychiatric Facilities, Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, Ambulatory Surgical Centers, Renal Dialysis Facilities, and MIPS Eligible Clinicians Affected by COVID-19. Available at COVID-19 Quality Reporting Programs Guidance Memo (cms.gov).
Additional Resources
- Magill SS et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med. 2018 Nov 1;379(18):1732-1744. doi: 10.1056/NEJMoa1801550.
- Magill SS et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014 Mar 27;370(13):1198-208. doi: 10.1056/NEJMoa1306801.
- Data Summary of HAIs in the US: Assessing Progress 2006-2016
Footnotes
- The number of hospitals that reported to NHSN and are included in the SIR calculation. This number may vary across HAI types; for example, some hospitals do not use central lines or urinary catheters, or do not perform colon or abdominal hysterectomy surgeries.