Association of the coronavirus disease 2019 (COVID-19) pandemic with the incidence of healthcare-associated infections in California hospitals

To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of central-line-associated bloodstream infections (CLABSIs), Clostridioides difficile infections (CDIs), and methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections (BSIs) in California acute-care hospitals.Retrospective cohort and before-and-after study.We compared standardized infection ratios (SIRs) for CLABSI, CDI, and MRSA BSI from the second half of 2020 to the second half of 2019. We performed interrupted time-series (ITS) analyses for these infections to assess departures from long-term trends. We also examined the association between the proportion of facility beds that were occupied by COVID-19 patients in May and June of 2020 and the incidence of infections using negative binomial models. In addition, we compared standardized antimicrobial administration ratios (SAARs) for the second halves of 2019 and 2020.We detected substantial and significant increases in the SIRs for CLABSI and MRSA BSI from 2019 to 2020. For the ITS analysis, CLABSI and had significant positive values for the pandemic onset level-change parameters, and CLABSI and MRSA BSI had significant positive values for the postinterruption slope-change parameters. We also detected a positive association between facility COVID-19 patient occupancy and CLABSI and MRSA BSI incidence. We did not detect associations with the onset of the pandemic or COVID-19 patient occupancy and CDI. The SAAR for all antibacterial drugs decreased slightly, but the SAAR for drugs with a high risk for CDI increased slightly.This study adds to a body of literature documenting increases in CLABSI and MRSA BSI incidence during the pandemic.