{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:57:49Z","timestamp":1793109469556,"version":"4.5.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T00:00:00Z","timestamp":1628467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The profound changes wrought by coronavirus disease 2019 (COVID-19) on routine hospital operations may have influenced performance on hospital measures, including healthcare-associated infections (HAIs). We aimed to evaluate the association between COVID-19 surges and HAI and cluster rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In 148 HCA Healthcare-affiliated hospitals, from 1 March 2020 to 30 September 2020, and a subset of hospitals with microbiology and cluster data through 31 December 2020, we evaluated the association between COVID-19 surges and HAIs, hospital-onset pathogens, and cluster rates using negative binomial mixed models. To account for local variation in COVID-19 pandemic surge timing, we included the number of discharges with a laboratory-confirmed COVID-19 diagnosis per staffed bed per month.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as COVID-19 burden increased. There were 60% (95% confidence interval [CI]: 23\u2013108%) more CLABSI, 43% (95% CI: 8\u201390%) more CAUTI, and 44% (95% CI: 10\u201388%) more cases of MRSA bacteremia than expected over 7 months based on predicted HAIs had there not been COVID-19 cases. Clostridioides difficile infection was not significantly associated with COVID-19 burden. Microbiology data from 81 of the hospitals corroborated the findings. Notably, rates of hospital-onset bloodstream infections and multidrug resistant organisms, including MRSA, vancomycin-resistant enterococcus, and Gram-negative organisms, were each significantly associated with COVID-19 surges. Finally, clusters of hospital-onset pathogens increased as the COVID-19 burden increased.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>COVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab688","type":"journal-article","created":{"date-parts":[[2021,8,8]],"date-time":"2021-08-08T07:44:55Z","timestamp":1628408695000},"page":"1748-1754","source":"Crossref","is-referenced-by-count":261,"title":["The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections"],"prefix":"10.1093","volume":"74","author":[{"given":"Meghan A","family":"Baker","sequence":"first","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"},{"name":"Brigham and Women\u2019s Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E","family":"Sands","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"},{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan S","family":"Huang","sequence":"additional","affiliation":[{"name":"University of California Irvine School of Medicine , Orange, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kleinman","sequence":"additional","affiliation":[{"name":"University of Massachusetts Amherst , Amherst, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J","family":"Septimus","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"},{"name":"Texas A&M College of Medicine , Houston, Texas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Varma","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackie","family":"Blanchard","sequence":"additional","affiliation":[{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell E","family":"Poland","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"},{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela H","family":"Coady","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah S","family":"Yokoe","sequence":"additional","affiliation":[{"name":"University of California San Francisco , San Francisco, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Fraker","sequence":"additional","affiliation":[{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Froman","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Moody","sequence":"additional","affiliation":[{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel","family":"Goldin","sequence":"additional","affiliation":[{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Isaacs","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kacie","family":"Kleja","sequence":"additional","affiliation":[{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly M","family":"Korwek","sequence":"additional","affiliation":[{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Stelling","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Clark","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Platt","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan B","family":"Perlin","sequence":"additional","affiliation":[{"name":"HCA Healthcare , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CDC Prevention Epicenters Program","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,9]]},"reference":[{"key":"2022053122501630000_CIT0001","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1016\/j.ajic.2020.06.209","article-title":"Impact of SARS-CoV-2 on hospital acquired infection rates in the United States: predictions and early results","volume":"48","author":"McMullen","year":"2020","journal-title":"Am J Infect Control"},{"key":"2022053122501630000_CIT0002","first-page":"1","article-title":"Coronavirus disease 2019 (COVID-19) pandemic, central-line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): the urgent need to refocus on hardwiring prevention efforts","author":"Fakih","year":"2021","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2022053122501630000_CIT0003","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ajic.2020.08.021","article-title":"The impact of COVID-19 pandemic on hand hygiene performance in hospitals","volume":"49","author":"Moore","year":"2021","journal-title":"Am J Infect Control"},{"key":"2022053122501630000_CIT0004","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.ajic.2020.10.019","article-title":"Unintended consequences of infection prevention and control measures during COVID-19 pandemic","volume":"49","author":"Wee","year":"2021","journal-title":"Am J Infect Control"},{"key":"2022053122501630000_CIT0005","first-page":"1","article-title":"Silver linings of the coronavirus disease 2019 (COVID-19) pandemic from an infection prevention and control perspective","author":"Tsang","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2022053122501630000_CIT0006","doi-asserted-by":"crossref","first-page":"e1000238","DOI":"10.1371\/journal.pmed.1000238","article-title":"Automated detection of infectious disease outbreaks in hospitals: a retrospective cohort study","volume":"7","author":"Huang","year":"2010","journal-title":"PLoS Med"},{"key":"2022053122501630000_CIT0007","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.1371\/journal.pmed.0020059","article-title":"A space-time permutation scan statistic for disease outbreak detection","volume":"2","author":"Kulldorff","year":"2005","journal-title":"PLoS Med"},{"key":"2022053122501630000_CIT0008","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.2105\/AJPH.88.9.1377","article-title":"Evaluating cluster alarms: a space-time scan statistic and brain cancer in Los Alamos, New Mexico","volume":"88","author":"Kulldorff","year":"1998","journal-title":"Am J Public Health"},{"key":"2022053122501630000_CIT0009","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/1467-985X.00186","article-title":"Prospective time periodic geographical disease surveillance using a scan statistic","volume":"164","author":"Kulldorff","year":"2001","journal-title":"J Roy Stat Soc"},{"key":"2022053122501630000_CIT0010","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care"},{"key":"2022053122501630000_CIT0011","author":"Centers for Disease Control and Prevention.","year":"2021"},{"key":"2022053122501630000_CIT0012","author":"Centers for Disease Control and Prevention."},{"key":"2022053122501630000_CIT0013","author":"Centers for Disease Control and Prevention.","year":"2021"},{"key":"2022053122501630000_CIT0014","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1017\/ice.2020.233","article-title":"Automated outbreak detection of hospital-associated pathogens: value to infection prevention programs","volume":"41","author":"Baker","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2022053122501630000_CIT0015","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1093\/aje\/kwh029","article-title":"A generalized linear mixed models approach for detecting incident clusters of disease in small areas, with an application to biological terrorism","volume":"159","author":"Kleinman","year":"2004","journal-title":"Am J Epidemiol"},{"key":"2022053122501630000_CIT0016","author":"Centers for Disease Control and Prevention.","year":"2020"},{"key":"2022053122501630000_CIT0017","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1086\/675821","article-title":"The evolving landscape of healthcare-associated infections: recent advances in prevention and a road map for research","volume":"35","author":"Safdar","year":"2014","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2022053122501630000_CIT0018","doi-asserted-by":"crossref","first-page":"56","DOI":"10.15585\/mmwr.mm7002e3","article-title":"Candida auris outbreak in a COVID-19 specialty care unit - Florida, July\u2013August 2020","volume":"70","author":"Prestel","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2022053122501630000_CIT0019","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.15585\/mmwr.mm6948e1","article-title":"Increase in hospital-acquired carbapenem-resistant Acinetobacter baumannii infection and colonization in an acute care hospital during a surge in COVID-19 admissions - New Jersey, February\u2013July 2020","volume":"69","author":"Perez","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2022053122501630000_CIT0020","doi-asserted-by":"crossref","DOI":"10.1136\/emermed-2020-210030","article-title":"Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study","author":"Lyall","year":"2021","journal-title":"Emerg Med J"},{"key":"2022053122501630000_CIT0021","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.ajic.2020.09.010","article-title":"Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection","volume":"49","author":"Bentivegna","year":"2021","journal-title":"Am J Infect Control"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciab688\/40417225\/ciab688.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/74\/10\/1748\/43893740\/ciab688.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/74\/10\/1748\/43893740\/ciab688.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T18:54:31Z","timestamp":1654023271000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/74\/10\/1748\/6346721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,9]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,8,9]]},"published-print":{"date-parts":[[2022,5,30]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciab688","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,5,15]]},"published":{"date-parts":[[2021,8,9]]}}}