Long-Term Care Healthcare-Associated Infections in 2021: An Analysis of 17,971 Reports





long-term care, nursing homes, annual report, healthcare-associated infections, HAI, infection rates, resident days


Visual Abstract

Background: The Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest repository of patient safety data in the United States. In addition to over 4.2 million acute care reports, the PA-PSRS database contains more than 375,000 long-term care (LTC) healthcare-associated infection (HAI) reports.

Methods: LTC HAI data from PA-PSRS were extracted on February 10, 2022. Reports submitted by LTC facilities and specific care areas were included for infection rates each month if resident and device days were also entered in PA-PSRS for the facility and care area.

Results: A total of 17,971 infections were reported in 2021, representing a 31.7% decrease from the prior year. Overall, the reporting rate from LTC facilities decreased notably, from 1.06 in 2020 to 0.78 in 2021, due in large part to a drop in respiratory tract infections, which had an infection rate of 0.431 in 2020 and 0.191 in 2021. The North Central region of the state had the highest overall infection rate, with 0.94 reports per 1,000 resident days, and the Southeast region had the lowest rate at 0.62. The number of reports decreased for all five infection types from 2020 to 2021, with respiratory tract infections decreasing the most, by 58.4%. The number of reports for all infection subtypes decreased as well, with the exception of scabies, which increased by 7.1%. Among all infection subtypes, the number of reports for lower respiratory tract infections decreased the most, with 2,553 fewer reports in 2021 than in 2020. In terms of percentage, influenza-like illness decreased the most, dropping 93.9% from 2020 to 2021. In terms of infection rate, catheter-associated urinary tract infections showed the greatest decrease, and infections involving cellulitis, soft tissue, and wounds showed the greatest increase.

Conclusions: In 2021, there were notable decreases in both the infection rate and the number of infection reports submitted by Pennsylvania LTC facilities. Currently, it is unknown whether these decreases are reflective of fewer infections in LTC facilities or a lack of identifying and reporting infections, or a combination of both. Patient Safety Authority infection preventionists (IPs) continue to work with LTC IPs to provide support, education, and tools to assist them in their role.

Author Biographies

Shawn Kepner, MS, Patient Safety Authority

Shawn Kepner (shawkepner@pa.gov) is a statistician at the Patient Safety Authority.

JoAnn Adkins, BSN, RN, Patient Safety Authority

JoAnn Adkins is a registered nurse and a senior infection preventionist for the Patient Safety Authority.

Rebecca Jones, MBA, RN, Patient Safety Authority

Rebecca Jones is director of Data Science and Research at the Patient Safety Authority (PSA) and founder and director of the PSA’s Center of Excellence for Improving Diagnosis.


Pennsylvania Department of Health. Medical Care Availability and Reduction of Error (MCARE) Act, Pub. L. No. 154 Stat. 13 (2002). DOH website. https://www.health.pa.gov/topics/Documents/Laws%20and%20Regulations/Act%2013%20of%202002.pdf. Published 2002. Accessed April 28, 2022.

Long-Term Care Health-Associated Infections in 2021 article on light blue abstract background.



How to Cite

Kepner, S., Adkins, J., & Jones, R. (2022). Long-Term Care Healthcare-Associated Infections in 2021: An Analysis of 17,971 Reports. Patient Safety, 4(2), 6–17. https://doi.org/10.33940/data/2022.6.1



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