Reduction in the Prevalence of Healthcare-Associated Infections in U.S. Acute Care Hospitals, 2015 vs 2011

Abstract Background A 2011 prevalence survey conducted by CDC and the Emerging Infections Program (EIP) showed that 1 in 25 hospital patients had ≥1 healthcare-associated infection (HAI). We repeated the survey in 2015 to assess changes in HAI prevalence. Methods In EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) hospitals that participated in the 2011 survey were recruited for the 2015 survey. Hospitals selected 1 day from May–September 2015 on which a random patient sample was identified from the morning census. Trained EIP staff reviewed patient medical records using comparable methods and the same National Healthcare Safety Network HAI definitions used in 2011. Proportions of patients with HAIs were compared using chi-square tests; patient characteristics were compared using chi-square or median tests (OpenEpi 3.01, SAS 9.3). Results Data were available from 143 hospitals that participated in both surveys; data from 8954 patients in the 2011 survey were compared with preliminary data from 8833 patients in the 2015 survey. Patient characteristics such as median age, days from admission to survey, and critical care location were similar. Urinary catheter prevalence was lower in 2015 (1,589/8,833, 18.0%) compared with 2011 (2,052/8,954, 22.9%, P < 0.0001), as was central line prevalence (2015: 1,539/8,833, 17.4%, vs. 2011: 1,687/8,954, 18.8%, P = 0.02). The proportion of patients with HAIs was lower in 2015 (284/8,833, 3.2%, 95% confidence interval [CI] 2.9–3.6%) than in 2011 (362/8,954, 4.0%, 95% CI 3.7–4.5%, P = 0.003). Of 309 HAIs in 2015, pneumonia (PNEU) and Clostridium difficileinfections (CDI) were most common (Figure); proportions of patients with PNEU and/or CDI were similar in 2015 (130/8833, 1.5%) and 2011 (133/8954, 1.5%, P = 0.94). A lower proportion of patients had surgical site (SSI) and/or urinary tract infections (UTI) in 2015 (77/8833, 0.9%) vs. 2011 (136/8954, 1.5%, P < 0.001). Conclusion HAI prevalence was significantly lower in 2015 compared with 2011. This is partially explained by fewer SSI and UTI, suggesting national efforts to prevent SSI, reduce catheter use and improve UTI diagnosis are succeeding. By contrast, there was no change in the prevalence of the most common HAIs in 2015, PNEU and CDI, indicating a need for increased prevention efforts in hospitals. Disclosures All authors: No reported disclosures.

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Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011

Clinical Infectious Diseases ◽

10.1093/cid/ciaa373 ◽

2020 ◽

Author(s):

Shelley S Magill ◽

Erin O’Leary ◽

Susan M Ray ◽

Marion A Kainer ◽

Christopher Evans ◽

...

Keyword(s):

Medical Records ◽

Generation Cephalosporin ◽

Fourth Generation ◽

Antimicrobial Use ◽

Emerging Infections ◽

Prevalence Survey ◽

Factors Associated ◽

Binomial Regression ◽

Healthcare Associated ◽

Critical Care Patients

Abstract Background In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. Methods The Centers for Disease Control and Prevention’s Emerging Infections Program sites in 10 states each recruited ≤25 general and women’s and children’s hospitals. Hospitals selected a survey date from May–September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. Results Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6–50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). Conclusions Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

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Validation Methodology of Healthcare-Associated Infection Device Day Denominators When Switching Electronic Medical Records

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1090 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s428-s429

Author(s):

Lan Luong ◽

Michelle Simkins ◽

Rachael Snyders ◽

Kathleen Anne Gase ◽

Carole Leone ◽

...

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Urinary Catheter ◽

Central Line ◽

Prediction Methods ◽

Healthcare Associated Infection ◽

Nursing Documentation ◽

Validation Process ◽

Validation Phase ◽

Healthcare Associated

Background: From August 2017 to June 2018, 11 hospitals within a large healthcare system switched from multiple different electronic medical records (EMRs) to 1 EMR. At the time of this transition, the NHSN provided guidelines to validate healthcare-associated infection (HAI) denominators when switching from manual denominator collection to electronic denominator collection, but the NHSN did not give guidelines for validation when switching from 1 EMR to another. We aimed to build a validation process to ensure the accuracy of central-line and urinary catheter days reported to the NHSN after switching EMRs. Methods: Our validation process began with a statistical phase followed by a targeted manual validation phase. The statistical phase used 3 prediction methods (linear regression, time series analysis, and statistical process control [SPC] charts) to forecast device days after the EMR switch for units within hospitals. Models were developed using baseline data from the old EMR (January 2015 through the new EMR implementation). Using prespecified criteria for each method to determine discrepancies, we built a decision tree to identify units needing manual validation. Any unit that failed the statistical phase would need to participate in the manual validation phase, using a midnight census and direct visualization of devices. The manual validation process was composed of 14-day blocks. At the end of each block, if manual device days were within ±5% of EMR device days, they were considered validated. Manual validation would be repeated in 14-day blocks until 2 consecutive blocks passed within ±5%. Results: Overall, 157 units were evaluated for urinary catheter days and central-line days. Among them, 143 units passed the statistical validation test for urinary catheter days and 151 passed for central-line days. There was no specific pattern when comparing forecasted versus actual device days. The manual validation process for the 20 failing units (14 urinary catheter and 6 central-line units) is ongoing; preliminary results identified issues with missing nursing documentation in the EMR and with inaccurate manual counting of device days. There were no systematic discrepancies associated with the new EMR. Conclusions: We developed a novel validation process using statistical prediction methods supplemented with a targeted manual process. This process saved resources by identifying the units that need manual validation. Discrepancies were largely related to nursing documentation, which the infection prevention team addressed with additional training.Funding: NoneDisclosures: None

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Improving Surveillance of Pneumonia in Nursing Homes

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.865 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s290-s291

Author(s):

Theresa Rowe ◽

Taniece Eure ◽

Nimalie Stone ◽

Nicola Thompson ◽

Angela Anttila ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Diagnostic Testing ◽

Nursing Home Residents ◽

Emerging Infections ◽

Healthcare Associated Infection ◽

Prevalence Survey ◽

Point Prevalence Survey ◽

Chest X Ray ◽

Healthcare Associated

Background: Pneumonia (PNA) is an important cause of morbidity and mortality among nursing home residents. The McGeer surveillance definitions were revised in 2012 to help NHs better monitor infections for quality improvement purposes. However, the concordance between surveillance definitions and clinically diagnosed PNA has not been well studied. Our objectives were to identify nursing home residents who met the revised McGeer PNA definition, to compare them with residents with clinician documented PNA, and determine whether modifications to the surveillance criteria could increase concordance. Methods: We analyzed respiratory tract infection (RTI) data from 161 nursing homes in 10 states that participated in a 1-day healthcare-associated infection point-prevalence survey in 2017. Trained surveillance officers from the CDC Emerging Infections Program collected data on residents with clinician documentation, signs, symptoms, and diagnostic testing potentially indicating an RTI. Clinician-documented pneumonia was defined as any resident with a diagnosis of pneumonia identified in the medical chart. We identified the proportion of residents with clinician documented PNA who met the revised McGeer PNA definition. We evaluated the criteria reported to develop 3 modified PNA surveillance definitions (Box), and we compared them to residents with clinician documented PNA.Results: Among the 15,296 NH residents surveyed, 353 (2%) had >1 signs and/or symptoms potentially indicating RTI. Among the 353 residents, the average age was 76 years, 105 (30%) were admitted to postacute care or rehabilitation, and 108 (31%) had clinician-documented PNA. Among those with PNA, 28 (26%) met the Revised McGeer definition. Among 81 residents who did not meet the definition, 39 (48%) were missing the chest x-ray requirement, and among the remaining 42, only 3 (7%) met the constitutional criteria requirement (Fig. 1). Modification of the constitutional criteria requirement increased the detection of clinically documented PNA from 28 (26%) to 36 (33%) using modified definition 1; to 51 (47%) for modified definition 2; and to 55 (51%) for modified definition 3. Conclusions: Tracking PNA among nursing home residents using a standard definition is essential to improving detection and, therefore, informing prevention efforts. Modifying the PNA criteria increased the identification of clinically diagnosed PNA. Better concordance with clinically diagnosed PNA may improve provider acceptance and adoption of the surveillance definition, but additional research is needed to test its validity.Funding: NoneDisclosures: None

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Characteristics of Healthcare-Associated Infections Contributing to Unexpected In-Hospital Deaths

Infection Control and Hospital Epidemiology ◽

10.1086/655018 ◽

2010 ◽

Vol 31 (8) ◽

pp. 864-866 ◽

Cited By ~ 10

Author(s):

Daniel J. Morgan ◽

Lucia L. Lomotan ◽

Kathleen Agnes ◽

Linda McGrail ◽

Mary-Claire Roghmann

Keyword(s):

Bloodstream Infection ◽

Medical Records ◽

Central Line ◽

Multidrug Resistant ◽

Healthcare Associated Infections ◽

Bacterial Isolates ◽

Healthcare Associated Infection ◽

Hospital Deaths ◽

Healthcare Associated

We reviewed the medical records of all the patients who died in our hospital during the period from 2004 through 2008 to determine the contribution of healthcare-associated infections to mortality. Of the 179 unexpected in-hospital deaths during that period, 55 (31%) were related to 69 healthcare-associated infections. The most common healthcare-associated infection was central line-associated bloodstream infection, and the most common organisms identified were members of the Enterobacteriaceae family. Overall, 45% of bacterial isolates were multidrug resistant.

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Four country healthcare-associated infection prevalence survey: pneumonia and lower respiratory tract infections

Journal of Hospital Infection ◽

10.1016/j.jhin.2009.10.010 ◽

2010 ◽

Vol 74 (3) ◽

pp. 266-270 ◽

Cited By ~ 12

Author(s):

H. Humphreys ◽

R.G. Newcombe ◽

J. Enstone ◽

E.T.M. Smyth ◽

G. McIlvenny ◽

...

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Infection Prevalence ◽

Healthcare Associated Infection ◽

Lower Respiratory Tract Infections ◽

Prevalence Survey ◽

Tract Infections ◽

Healthcare Associated

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Prevalence of Healthcare-Associated Infections in Acute Care Hospitals in Jacksonville, Florida

Infection Control and Hospital Epidemiology ◽

10.1086/664048 ◽

2012 ◽

Vol 33 (3) ◽

pp. 283-291 ◽

Cited By ~ 152

Author(s):

Shelley S. Magill ◽

Walter Hellinger ◽

Jessica Cohen ◽

Robyn Kay ◽

Christine Bailey ◽

...

Keyword(s):

Data Collection ◽

Acute Care ◽

Antimicrobial Therapy ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Healthcare Associated Infection ◽

Prevalence Survey ◽

Proxy Indicators ◽

Tract Infections ◽

Healthcare Associated

Objective.To determine healthcare-associated infection (HAI) prevalence in 9 hospitals in Jacksonville, Florida; to evaluate the performance of proxy indicators for HAIs; and to refine methodology in preparation for a multistate survey.Design.Point prevalence survey.Patients.Acute care inpatients of any age.Methods.HAIs were defined using National Healthcare Safety Network criteria. In each facility a trained primary team (PT) of infection prevention (IP) staff performed the survey on 1 day, reviewing records and collecting data on a random sample of inpatients. PTs assessed patients with one or more proxy indicators (abnormal white blood cell count, abnormal temperature, or antimicrobial therapy) for the presence of HAIs. An external IP expert team collected data from a subset of patient records reviewed by PTs to assess proxy indicator performance and PT data collection.Results.Of 851 patients surveyed by PTs, 51 had one or more HAIs (6.0%; 95% confidence interval, 4.5%–7.7%). Surgical site infections (n = 18), urinary tract infections (n = 9), pneumonia (n = 9), and bloodstream infections (n = 8) accounted for 75.8% of 58 HAIs detected by PTs. Staphylococcus aureus was the most common pathogen, causing 9 HAIs (15.5%). Antimicrobial therapy was the most sensitive proxy indicator, identifying 95.5% of patients with HAIs.Conclusions.HAI prevalence in this pilot was similar to that reported in the 1970s by the Centers for Disease Control and Prevention's Study on the Efficacy of Nosocomial Infection Control. Antimicrobial therapy was a sensitive screening variable with which to identify those patients at higher risk for infection and reduce data collection burden. Additional work is needed on validation and feasibility to extend this methodology to a national scale.Infect Control Hosp Epidemiol 2012;33(3):283-291

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Healthcare-Associated Infection in Italy Annual Point-Prevalence Surveys, 2002–2004

Infection Control and Hospital Epidemiology ◽

10.1086/597596 ◽

2009 ◽

Vol 30 (7) ◽

pp. 659-665 ◽

Cited By ~ 21

Author(s):

Simone Lanini ◽

William R. Jarvis ◽

Emanuele Nicastri ◽

Gaetano Privitera ◽

Giovanni Gesu ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Univariate Analysis ◽

National Health System ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Point Prevalence ◽

Healthcare Associated Infection ◽

Tract Infections ◽

Healthcare Associated

Objective.Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality worldwide. During the period from 2002 through 2004, a group of Italian hospitals was recruited to conduct HAI point-prevalence surveys.Design.Three point-prevalence surveys.Methods.A total of 9,609 patients were surveyed.Results.The overall frequency of HAI was 6.7% (645 infections among the 9,609 surveyed patients). The most frequent HAIs were lower respiratory tract infections, which accounted for 35.8% (231 of 645 HAIs) of all HAIs, followed by urinary tract infections (152 [23.6%] of 645 HAIs), bloodstream infections (90 [14.0%] of 645 HAIs), and surgical site infections (79 [12.2%] of 645 HAIs). In both multivariate and univariate analysis, invasive procedures, duration of stay, chemotherapy, trauma, coma, and the location of the hospital were all factors statistically significantly associated with the occurrence of an HAL Enterobacteriaceae were the most common isolates recovered in medical and surgical wards, whereas gram-negative aerobic bacilli were the most common isolates recovered in intensive care units. Approximately one-half of all of the patients surveyed were receiving antibiotics at the time of our study; the most used antibiotic classes were fluoroquinolones in medical wards, cephalosporins in surgical wards, and penicillins and glycopeptides in intensive care units.Conclusion.Our study emphasizes the need for implementing further HAI surveillance to provide the National Health System with proper tools to prevent and manage infection in hospitalized patients.

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The Past, Present, and Future of Healthcare-Associated Infection Prevention in Pediatrics: Catheter-Associated Bloodstream Infections

Infection Control and Hospital Epidemiology ◽

10.1086/655994 ◽

2010 ◽

Vol 31 (S1) ◽

pp. S27-S31 ◽

Cited By ~ 18

Author(s):

Kristina A. Bryant ◽

Danielle M. Zerr ◽

W. Charles Huskins ◽

Aaron M. Milstone

Keyword(s):

Infection Prevention ◽

Bloodstream Infections ◽

Central Line ◽

Morbidity And Mortality ◽

Prevention Strategies ◽

Healthcare Associated Infection ◽

Research Topics ◽

The Past ◽

Healthcare Associated ◽

Current Practices

Central line–associated bloodstream infections cause morbidity and mortality in children. We explore the evidence for prevention of central line–associated bloodstream infections in children, assess current practices, and propose research topics to improve prevention strategies.

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Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.305 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1292-1297

Author(s):

Michael L. Rinke ◽

Suzette O. Oyeku ◽

William J. H. Ford ◽

Moonseong Heo ◽

Lisa Saiman ◽

...

Keyword(s):

Urinary Tract ◽

Ambulatory Surgery ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Central Line ◽

Healthcare Associated Infections ◽

Retrospective Case ◽

Additional Costs ◽

Tract Infections ◽

Healthcare Associated

AbstractObjective:Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.Design:Retrospective case-control study.Setting:Four academic medical centers.Patients:Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.Methods:Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.Results:Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).Conclusions:Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

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