Background-Previous studies on coronavirus disease 2019 (COVID-19) were limited to specific geographical locations and small sample sizes. Therefore, we used the National Inpatient Sample (NIS) 2020 database to determine the risk factors for severe outcomes and mortality in COVID-19. Methods-We included adult patients with COVID-19. Univariate and multivariate logistic regression was performed to determine the predictors of severe outcomes and mortality in COVID-19. Results-1,608,980 (95% CI 1,570,803–1,647,156) hospitalizations with COVID-19 were included. Severe complications occurred in 78.3% of COVID-19 acute respiratory distress syndrome (ARDS) and 25% of COVID-19 pneumonia patients. The mortality rate for COVID-19 ARDS was 54% and for COVID-19 pneumonia was 16.6%. On multivariate analysis, age > 65 years, male sex, government insurance or no insurance, residence in low-income areas, non-white races, stroke, chronic kidney disease, heart failure, malnutrition, primary immunodeficiency, long-term steroid/immunomodulatory use, complicated diabetes mellitus, and liver disease were associated with COVID-19 related complications and mortality. Cardiac arrest, septic shock, and intubation had the highest odds of mortality. Conclusions-Socioeconomic disparities and medical comorbidities were significant determinants of mortality in the US in the pre-vaccine era. Therefore, aggressive vaccination of high-risk patients and healthcare policies to address socioeconomic disparities are necessary to reduce death rates in future pandemics.

Problem The United States Healthcare Systems is burdened heavily by healthcare-associated infections (HAI), as they pose significant risks for increased mortality and morbidity. The most common type of HAI is urinary tract infection (UTI), and these infections are preventable (Strassle et al., 2019). According to the CDC (2021), 12-16% of hospitalized adults will at some point require catheterization; and each day an indwelling catheter remains in place increases the patient’s risks of adverse outcomes by 3-7%. CAUTIs have been linked to increased mortality and morbidity rates across the world. The Centers for Disease Control report urinary tract infections (UTI) lead to more than 13,000 deaths each year (Centers for Disease Control [cdc], 2021). Objective This quality improvement (QI) project will focus on the prevention of hospital-acquired UTIs, specifically those infections related to indwelling devices such as foley catheters. The purpose of this manuscript is to review the current evidence-based literature related to CAUTI prevention, trial an intervention that parallels the literature in a local hospital and evaluate those results. Design The researcher focused on the problem of CAUTI, analyzed current evidence-based practices related to prevention, developed a plan to execute a high-value improvement tool, and evaluated its effectiveness. Setting QI project took place in a local community hospital. The focus area was the medical-surgical ICU. Participants The participants were nursing staff and nursing managers on the medical surgical units, specifically those in positions with unique or direct involvement with insertion, removal, or monitoring of foley catheters. The subjects in this quality improvement project included adult patients hospitalized in the medical surgical intensive care unit (ICU). Interventions A CAUTI GPS screening tool was used to identify current prevention practices and/or any roadblocks to the prevention of CAUTI within the facility. Then, TAP (targeted assessment for prevention) strategy was implemented, which prompted expedited removal of indwelling catheters and/or the use of external drainage devices where indicated. Results There was a marked increase in attention to and prompt removal of indwelling foleys throughout the critical care unit. The facility had no hospital-acquired CAUTI during the project period. Conclusions There must be an impetus to inspire compliance. If healthcare workers adhere to prevention guidelines, CAUTIs are preventable. When leadership team members within hospital systems are enthusiastic about CAUTI prevention, the organization as a whole has increased motivation (Chenoweth et al., 2014).