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).