HealthApril 15, 2022

It's time to get back to basics with preventing healthcare-associated infections

By: Collette Bishop Hendler, RN, MS, MA, CIC
When the COVID-19 pandemic spread through the United States, it was no secret that it wreaked havoc on the healthcare system.

Surges placed a burden on acute care facilities with increased numbers of critically ill patients. In response to the crisis, healthcare facilities ramped up critical care staffing by rapidly cross-training staff from other care areas and onboarding agency staff. Some facilities transitioned from a primary nursing care model to a team approach.

Additionally, healthcare facilities faced supply and equipment shortages, which led to the altered use of supplies and equipment, including personal protective equipment. Healthcare facilities moved into action doing the best they could for their patients with the resources they had. Now, as we transition from crisis mode, it’s time to look at the impact this healthcare crisis had on healthcare-associated infections (HAIs).

Infection reporting and the SIR

Most hospitals in the United States report HAIs to the National Healthcare Safety Network (NHSN) to fulfill federal, state, or local HAI reporting mandates. HAIs are tracked using NHSN data, specifically the standardized infection ratio (SIR)

The SIR is a risk-adjusted summary measure used to track HAIs over time. The SIR compares the actual number of HAIs at each facility to the predicted number of infections. The predicted number is based on the general population (or baseline data) of a facility, and is risk adjusted for factors significantly associated with infection incidence (Centers for Disease Control and Prevention, 2021a).

NHSN currently calculates SIRs for central line-associated bloodstream infections (CLABSI), mucosal barrier injury laboratory-confirmed bloodstream infections, catheter-associated urinary tract infections (CAUTI), surgical site infections, Clostridioides difficile infections, methicillin Staphylococcus aureus bloodstream infections, and ventilator-associated events (VAE) (Centers for Disease Control and Prevention 2021a).

One step forward, two steps back

Before the pandemic, healthcare facilities took a positive step forward in reducing SIRs for CLABSI, CAUTI, and laboratory-identified C. difficile infection. According to data reported to the National Healthcare Safety Network there were significant increases in CLABSI, CAUTI, VAE, and MRSA bacteremia in 2020 when compared to 2019 (Weiner-Lastinger 2021). The most significant percentage increases in SIRs were seen in CLABSI, CAUTI, and VAE during October, November, and December of 2020 (shown below) putting facilities steps back in their efforts to prevent these HAIs (Centers for Disease Control and Prevention 2021b).

Refocusing on infection prevention

As we shift from crisis mode to the new normal in healthcare, we need to get back to basics for preventing these costly infections. We need to reengage frontline and senior leadership and focus on a culture of safety that promotes teamwork, evidence-based processes, and accountability for HAI prevention. We need to share unit-specific outcome data regularly and reeducate staff as needed.

During the crisis, NHSN data revealed increases in device utilization, specifically central lines, urinary catheters, and ventilators. In fact, ventilator utilization increased by 31% in quarter 4 of 2020 (Centers for Disease Control and Prevention 2021b). We need to reeducate staff about indications for and alternatives to device use, and when devices are necessary, encourage staff to regularly evaluate their need, and remove them as soon as no longer clinically indicated.

Additionally, we need to support evidence-based insertion and maintenance practices. By getting back to basics, we can once again gain ground on preventing HAIs, infections that are costly not only to patients but our healthcare facilities.

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Collette Bishop Hendler, RN, MS, MA, CIC
Editor-in-Chief, Lippincott Solutions, Point-of-Care, Wolters Kluwer Health
Collette is certified by the Certification Board of Infection Control and Epidemiology, Inc. as an infection preventionist. She has more than 15 years of experience in critical care nursing and maintains Alumnus Status as a Critical-Care Registered Nurse.
  1. Centers for Disease Control and Prevention. (2021). The NHSN standardized infection ration (SIR): A guide to the SIR. Retrieved March 2022 from
  2. Centers for Disease Control and Prevention. (2021). COVID-19 Impact on HAIs in 2020. Retrieved March 2022 from
  3. Weiner-Lastinger, L.M., et al. (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, 43(1) 12-25. Retrieved March 2022 from
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