2021 National and State Healthcare-Associated Infections (HAI) Progress Report

The Recent Released 2021 National and State Healthcare-Associated Infections Progress Report Finds Continued Need to Strengthen Resiliency in Infection Prevention Programs.

The Centers for Disease Control and Prevention (CDC) released the 2021 National and State Healthcare-Associated Infections (HAI) Progress Report, showing significant increases between 2020 and 2021 in some HAIs for some healthcare settings. The report aligns with CDC's COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022, which demonstrated an increase of at least 15% in antimicrobial-resistant hospital-onset infections and deaths during the first year of the pandemic. Both findings represent a reversal of progress in preventing resistant infections, particularly in hospitals, as pandemic-related challenges weakened infection prevention and control (IPC) practices—such as hand hygiene, cleaning equipment, separating patients, and using personal protective equipment (PPE)—in U.S. healthcare facilities.

The 2021 National and State HAI Progress Report provides additional information on HAI data in the United States, including infections resistant to antibiotics and antifungals, during the first and second years of the pandemic. Statistically significant increases were observed for hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) (14%), ventilator-associated events (VAE) (12%), surgical site infections (SSI) following abdominal hysterectomy (HYST) (11%), central line-associated bloodstream infections (CLABSI) (7%), and catheter-associated urinary tract infections (CAUTI) (5%) between 2020 and 2021. Among acute care hospitals (ACHs), there was a 3% statistically significant decrease in Clostridioides difficile LabID events (C. difficile) between 2020 and 2021 and significant increases in all other HAI types but SSI following colon surgeries.

The 2015 national baseline standardized infection ratio (SIR) of 1 is used as a reference point for measuring prevention progress. In 2021, all national SIRs except VAEs and MRSA showed improvements compared to the 2015 baseline SIR of 1 (figure 1). However, SIRs for most infections tracked in the report for acute care hospitals increased between 2020 and 2021 (figure 2).

The report includes data from the National Healthcare Safety Network (NHSN) across four healthcare settings, three of which are included in the Antimicrobial Resistance & Patient Safety Portal (AR&PSP): acute care hospitals, inpatient rehabilitation facilities (IRFs), and long-term acute care hospitals (LTACHs).

In 2021, many acute care hospitals continued to face extraordinary challenges due to the COVID-19 pandemic, which may have reduced the implementation of standard IPC practices. ¹ U.S. healthcare facilities saw more HAIs resistant to antibiotics or antifungals, especially in hospitals, and treated sicker patients who required more frequent and longer use of medical devices like catheters and ventilators.² These facilities also experienced PPE supply challenges, staffing shortages, and longer patient visits. In acute care hospitals, the increases in some HAIs in 2021 contrast with the success in reducing these infections prior to the pandemic. Despite the challenges of the COVID-19 pandemic, acute care hospitals in more than half of U.S. states performed better in 2021 than in 2015 in preventing CLABSI, CAUTI, surgical site infections (SSIs) following colon surgeries, or C. difficile infections (CDI).

The 2021 HAI Progress Report also shows progress in reducing some HAIs in other healthcare settings. Compared with the 2015 national baseline SIR of 1, the 2021 LTACH SIRs for all HAIs were significantly lower (figure 1). In the same setting, there were significant reductions in the 2021 laboratory-identified MRSA bacteremia and CDI SIRs compared with 2020. No significant changes were observed in the device-associated HAIs (figure 2). In IRFs, all but CAUTI displayed significant decreases in 2021 SIRs compared to the 2015 baseline SIRs (figure 1). Compared with the previous year, no significant changes were observed in CLABSI, IRF-onset MRSA bacteremia, and IRF-onset CDI (figure 2). However, there was a significant increase seen in CAUTI.

The 2021 HAI Progress Report highlights the need for healthcare facilities to continue reinforcing IPC practices, regularly reviewing HAI surveillance data to identify areas that need improvement and addressing any gaps in prevention practices. CDC remains committed to protecting patients and promoting safety, quality, and value in healthcare delivery and will continue to partner with healthcare facilities to achieve this goal.

Explore the Antimicrobial Resistance & Patient Safety Portal (AR&PSP) for data from this most recent HAI Progress Report. You may also read the full 2021 HAI Progress Report for additional national and state-specific HAI data.