No abstract

workload due to COVID-19 triggered the outbreak is not supported by its persistence into March 2021, at which point the number of COVID-19 patients hospitalized in Omaha was greatly reduced.One hospital system has reported an increase in CLABSI rates >50% associated with the pandemic. 6 Others have noted that prone positioning of COVID-19 patients interfered with regular inspections and ready access to central-line sites, compromising their care and increasing the frequency of CLABSI. 7 However, none of the patients had been placed in the prone position. Other hospitals reported an increase in CLABSIs secondary to changes in infection prevention protocol among nurses to reduce the frequency of contact with patients and to combat the shortage of PPE and supplies during the COVID-19 pandemic. 8 In contrast to our experience, some hospitals reported that the rate of CLABSI and other healthcare-associated infections decreased significantly due to stricter precautions put in place due to COVID-19. 9 The Swiss cheese model of error prevention hypothesizes that undesirable events occur when multiple measures intended to prevent errors are simultaneously compromised. 10 In the face of COVID-19, this outbreak developed at a time that at least 3 separate barriers were compromised, which may be consistent with the Swiss cheese model.Our conclusions have limitations. First, we do not know whether CHG discs were absent in all the CLABSI patients. However, we suspect that was the case. Several factors may have led to less use of discs during the ouotbreak, and efforts to reinforce the importance of discs were associated with termination of the outbreak. Second, changes in nursing staff deployment might explain the occurrence of the outbreak. Nonetheless, even though the number of patients hospitalized in Omaha with COVID-19 during the outbreak period decreased, the outbreak persisted for five months.