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Author ORCID Identifier

https://orcid.org/ 0009-0005-1625-4894

Date Available

5-1-2028

Year of Publication

2026

Document Type

Master's Thesis

Degree Name

Master of Epidemiology (MS EPI)

College

Public Health

Department/School/Program

Epidemiology

Faculty

Kathleen Winter

Faculty

Amanda Ellis

Abstract

Background: Prior to the COVID-19 Pandemic, central line-associated bloodstream infection (CLABSI) rates in the United States (U.S.) were on a sustained downward trajectory. The pandemic abruptly reversed this progress, with national CLABSI rates increasing approximately 24% between 2019 and 2020. Oncology inpatient locations carry disproportionately high baseline CLABSI rates, driven largely by mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBI), yet no studies have directly examined how the pandemic differentially affected CLABSI rates in oncology versus non-oncology inpatient settings.

Objective: To assess whether the onset of the COVID-19 pandemic was associated with differential changes in LCBI-only and MBI-LCBI rates in oncology inpatient locations compared to non-oncology inpatient locations within the same U.S. hospitals.

Methods: A retrospective controlled interrupted time series analysis was conducted using NHSN inpatient location-level data from January 2018 through December 2024. The interruption was defined as March 2020. The primary cohort included 3,686 locations across 339 hospitals. Outcomes were analyzed separately for LCBI-only and MBI-LCBI-only. Negative binomial generalized linear mixed models estimated immediate level changes, post-interruption slope changes, and differential effects for oncology versus non-oncology locations, with non-oncology locations within the same hospital serving as the comparison group.

Results: Contrary to our hypothesis, oncology locations experienced a smaller immediate pandemic-associated increase in LCBI-only rates than non-oncology locations (differential IRR 0.740, 95% CI 0.678–0.807), converging to near-equivalence by 48 months (IRR 0.978, 95% CI 0.886–1.079). No statistically significant differential effect was identified for MBI-LCBI. Observed rates in both location types remained substantially above no-interruption counterfactual predictions through December 2024, with oncology LCBI-only and MBI-LCBI rates exceeding predicted levels by 96% and 36%, respectively.

Conclusion: The COVID-19 pandemic produced sustained CLABSI increases that had not returned to pre-pandemic trajectories by December 2024, and those increases did not affect oncology locations as hypothesized. These findings underscore that LCBI-only and MBI-LCBI are distinct outcomes requiring distinct prevention strategies.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2026.188

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