Characterizing the relationship between coronavirus disease 2019 (COVID-19) and central-line-associated bloodstream infection (CLABSI) and assessing the impact of a nursing-focused CLABSI reduction intervention during the COVID-19 pandemic

Abstract

Objective: To examine the impact of SARS-CoV-2 infection on CLABSI rate and characterize the patients who developed a CLABSI. We also examined the impact of a CLABSI-reduction quality-improvement project in patients with and without COVID-19. Design: Retrospective cohort analysis. Setting: Academic 889-bed tertiary-care teaching hospital in urban Los Angeles. Patients or participants: Inpatients 18 years and older with CLABSI as defined by the National Healthcare Safety Network (NHSN). Intervention(s): CLABSI rate and patient characteristics were analyzed for 2 cohorts during the pandemic era (March 2020-August 2021): COVID-19 CLABSI patients and non-COVID-19 CLABSI patients, based on diagnosis of COVID-19 during admission. Secondary analyses were non-COVID-19 CLABSI rate versus a historical control period (2019), ICU CLABSI rate in COVID-19 versus non-COVID-19 patients, and CLABSI rates before and after a quality- improvement initiative. Results: The rate of COVID-19 CLABSI was significantly higher than non-COVID-19 CLABSI. We did not detect a difference between the non-COVID-19 CLABSI rate and the historical control. COVID-19 CLABSIs occurred predominantly in the ICU, and the ICU COVID-19 CLABSI rate was significantly higher than the ICU non-COVID-19 CLABSI rate. A hospital-wide quality-improvement initiative reduced the rate of non-COVID-19 CLABSI but not COVID-19 CLABSI. Conclusions: Patients hospitalized for COVID-19 have a significantly higher CLABSI rate, particularly in the ICU setting. Reasons for this increase are likely multifactorial, including both patient-specific and process-related issues. Focused quality-improvement efforts were effective in reducing CLABSI rates in non-COVID-19 patients but were less effective in COVID-19 patients.