research summary

Retrospective Study Finds Higher CAUTI/UTI and CLABSI Rates in Critical Care During COVID-19 Era

Edited by:
Anthony Calabro, MA

Key Highlights

  • This retrospective surveillance study included 30,263 patient-days, 16,943 Foley-days, and 11,891 central line-days across critical care and high-dependency units.
  • Overall, 43 CAUTI events and 138 CLABSI events were recorded, corresponding to rates of 2.54 per 1,000 Foley-days and 11.61 per 1,000 central line-days, respectively.
  • CLABSI rates increased from 4.92 per 1,000 central line-days before COVID-19 to 13.00 per 1,000 central line-days during the COVID-19 era.
  • Hand hygiene compliance remained low throughout the surveillance period and did not exceed 30.3% in any reporting month.

Device-associated infection rates remained high in critical care units at a tertiary care teaching hospital in northern India and worsened during the COVID-19 era, particularly for central line-associated bloodstream infections (CLABSI), according to findings published in Cureus. The study evaluated catheter-associated urinary tract infection (CAUTI), urinary tract infection (UTI), and CLABSI incidence and trends using routinely collected surveillance data from critical care and high-dependency units.

The investigators performed a retrospective descriptive surveillance study using de-identified institutional records from the Hospital Infection Control Committee at AIIMS Rishikesh. The study period ran from July 2019 through December 2020 and included 14 critical care and high-dependency units, including dedicated COVID-19 ICUs that became operational in July 2020. Patients were included in surveillance denominators if they were admitted to the study units and exposed to an indwelling urinary catheter or central vascular catheter for more than two consecutive calendar days. CAUTI and CLABSI were defined using National Healthcare Safety Network surveillance definitions.

Study Findings

Across the 18-month surveillance period, the researchers recorded 30,263 patient-days, 16,943 Foley-days, and 11,891 central line-days. The overall Foley device utilization ratio was 0.560, and the central line device utilization ratio was 0.393. A total of 43 CAUTI events were identified, corresponding to a CAUTI rate of 2.54 per 1,000 Foley-days. The highest unit-level CAUTI rates occurred in the pediatric medicine high-dependency unit, CCU fourth floor, neurosurgery ward, medicine allied ICU, and respiratory ICU.

The study identified 138 CLABSI events, corresponding to an overall CLABSI rate of 11.61 per 1,000 central line-days. The CLABSI rate increased from 4.92 per 1,000 central line-days during the pre-COVID-19 period from January to March 2020 to 13.00 per 1,000 central line-days during the COVID-19 era from July to December 2020, for a rate ratio of 2.64. CAUTI rates also increased from 1.78 to 2.86 per 1,000 Foley-days, although this change was not statistically significant. Hand hygiene compliance ranged from 3.7% to 30.3% across 14 reporting months, with a mean of 21.5%.

Clinical Implications

According to the study authors, the findings suggest that strengthening device-care practices, maintaining surveillance systems, improving hand hygiene compliance, and protecting infection surveillance infrastructure are essential to reducing CAUTI/UTI and CLABSI burden in tertiary critical care settings. The authors identified several priority areas, including structured CLABSI prevention bundles, daily catheter necessity review, formal device utilization review rounds, and birth-weight-stratified neonatal CLABSI prevention bundles.

The authors noted several limitations, including the retrospective design, lack of patient-level clinical data, absence of unit-level denominators for some months in 2019, a 3-month pandemic surveillance gap, potential under-ascertainment of CLABSI in units with lower surveillance staffing, inability to verify reported events against individual microbiological culture records, and limited generalizability to smaller or private-sector hospitals in India.

Expert Commentary

“This 18-month retrospective CAUTI and CLABSI surveillance study from AIIMS Rishikesh demonstrates that device-related infection rates substantially and persistently exceeded NHSN benchmarks, with a 2.64-fold worsening of CLABSI during the COVID-19 pandemic,” the researchers concluded.

Reference
Prasad A, Singh M, Gupta PK, et al. Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) in critical care units of a tertiary care hospital: a retrospective surveillance study. Cureus. 2026;18(7). doi:10.7759/cureus.112623