a reluctance to try to manage patients with lower risk venous access , such as midlines or peripheral catheters . Furthermore , several hallmarks of care of COVID-19 patients are important factors that increase risk of CLABSI . To minimize exposures of healthcare personnel to COVID-19 , many facilities are limiting completion of imaging studies that may be deemed less critical . These missing imaging studies would have been important to support alternative HAI definitions ( for example , lack of abdominal imaging to support an intraabdominal infection process ). There have been good results with increasing oxygenation to patients through prone positioning . However , the process to turn these patients can result in pulling , tugging and friction at central line insertion sites . Also , as patients lay prone for many hours , there will be decreased visualization of the insertion site and other fluid build-up to compromise dressing integrity .”
The researchers emphasized that nursing-related practices will have important impacts on CLABSI risk : “ Care staff are encouraged to batch their tasks to care for these patients to decrease use of personal protective equipment ( PPE ). This will lead to more tasks during each visit to the room and fatigue during these care visits could lead to rushing through important time-critical tasks , such as disinfecting needleless access devices . To further decrease the need to enter rooms , hospitals are trying innovative care configurations , such as moving medication pumps and dialysis machinery out of the patient care room and into hallways . These ideas also increase risk of CLABSI as they can lead to substandard infection prevention practice ( such as tubing laying on the floor , increasing risk of contamination ) as well as other medication administration risks . In some cases where patient surges result in high numbers of critical care cases , there may be need to pull support staff from noncritical care areas where experience with high-risk central lines and CLABSI prevention practices may be lower .”
Although a 46 percent decrease in CLABSIs has occurred in hospitals across the U . S . from 2008 to 2013 , an estimated 30,100 CLABSIs still occur in intensive care units and wards of U . S . acute-care facilities each year ( CDC , 2018 ). CLABSIs had been steadily declining in hospitals before the pandemic ; overall , there has been about a 7 percent decrease in CLABSIs between 2018 and 2019 , according to the 2019 National and State HAI Progress Report , with the largest decrease in NICUs ( 13 percent ). The report also indicated about a 3 percent decrease in central line device utilization between 2018 and 2019 , with the largest decrease in ICUs ( 3 percent ). In acute-care hospitals , 48 states performed better than the 2015 national baseline when it came to CLABSI reduction ; 12 states performed better in long-term care facilities .
The trend may be reversing . A recent paper published in Infection Control & Hospital Epidemiology shows that according to NHSN data , CLABSIs increased by 28 percent in the second quarter of 2020 compared to 2019 , with the increase in infections coming as hospitals experienced high numbers of COVID-19 admissions , altering infection control practices .
“ We can only speculate that the larger CLABSI increase in critical-care settings may be due , in part , to a greater need for central lines as a part of providing critical care services , as well as the individual care services needed for critically ill patients with COVID-19 ( e . g ., proning ventilated patients ),” says David Kuhar ,
MD , lead expert of the CDC ’ s Hospital Infection Prevention Team . “ Ward locations may be second highest as they represent an area where many patients ( including those previously in critical-care units ) spend a lot of time during a hospital admission , while recovering from an illness . In NHSN , a CLABSI is attributed to the patient location at the time that it is diagnosed , and only considered a CLABSI if the central line has been present for three days . Typically , patients are only transiently located in an emergency room or an operating room and therefore , these patient-care areas are not included in the NHSN CLABSI surveillance protocol .”
To review , a CLABSI is a laboratory-confirmed bloodstream infection where an eligible BSI organism is identified , and an eligible central line is present on the LCBI DOE or the day before . For NHSN reporting purposes , types of central lines include : 1 ) a permanent central line including tunneled catheters ( including tunneled dialysis catheters ) and implanted catheters ( including ports ); 2 ) a temporary central line ( a non-tunneled , non-implanted catheter ); and 3 ) an umbilical catheter in a neonate . An eligible central line is one that has been in place for more than two consecutive calendar days ( on or after CL day three ), following the first access of the central line , in an inpatient location , during the current admission . Such lines are eligible for CLABSI events and remain eligible for CLABSI events until the day after removal from the body or patient discharge , whichever comes first , according to the 2021 NHSN Patient Safety Component Manual .
Patel , et al . ( 2021 ) analyzed data reported to the NHSN to examine the potential impact of the COVID-19 pandemic on CLABSIs in acute-care hospitals . To understand the impact of the early months of the COVID-19 pandemic on CLABSIs nationally , the researchers compared SIRs for 2020 quarter 2 ( Q2 : April , May , June ) to those from 2019 Q2 . They found that from 2015 to 2019 , there was a 31 percent decline in the national SIR for CLABSIs ; however , they emphasize that in the face of the pandemic , HAIs in hospitals may have increased .
The analysis by Patel , et al . ( 2021 ) included data as of Jan . 1 , 2021 from acute-care hospitals ( ACHs ) for April , May and June of 2019 and 2020 . Only locations that had continuous and consistent reporting , defined as ACHs reporting all three months of CLABSI data for the same location in both 2019 Q2 and 2020 Q2 , were included . The researchers calculated SIRs by dividing the number of observed infections by the predicted number determined from the logistic regression model generated from national data during a baseline period . Device utilization ratios were calculated by dividing central line days by patient days . The researchers also restricted their analysis to the units included in the Centers for Medicare and Medicaid Services ( CMS )’ HACRP and location-types that had at least 20 reporting locations nationwide . Because CMS suspended the HACRP reporting requirement for HAIs during 2020 Q2 , the number of reporting hospitals in 2020 Q2 was compared to 2019 Q2 .
Patel , et al . ( 2021 ) included 13,136 inpatient units from 2,986 ACHs ; 936 facilities had at least one predicted CLABSI and an SIR calculated . A 28 percent increase was observed in the national SIR from 0.68 in 2019 Q2 to 0.87 in 2020 Q2 . Device utilization increased nationally from 0.21 in 2019 Q2 to 0.23 in 2020 Q2 .
Critical-care units had the greatest percentage increase ( 39 percent ) in SIR , from 0.75 in 2019 to 1.04 in 2020 . Ward locations