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Prevalence of health care-associated infections falls to 3.2% in US
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The prevalence of health care-associated infections in hospital patients in the United States decreased from 4% in 2011 to 3.2% in 2015, largely driven by reductions in surgical site and urinary tract infections, according to survey results reported today in The New England Journal of Medicine.
“Patients in the 2015 survey were significantly less likely to have a health care-associated infection (HAI) than patients in the 2011 survey, after accounting for factors such as patient age and time in the hospital from admission to the survey date,” Shelley S. Magill, MD, PhD, a medical officer in the CDC’s Division of Healthcare Quality Promotion, told Infectious Disease News. “Progress has been made in reducing the numbers of infections affecting hospital patients, but there is still work to be done, especially for those infection types where we did not see improvement, such as Clostridium difficile infections and pneumonia.”
Magill and colleagues repeated a point-prevalence survey conducted in 2011, which showed that 4% of hospitalized patients had a HAI. The 2015 survey measured changes in the prevalence of HAIs during a 4-year period in which Magill and colleagues said national attention was given to preventing infections. Initial results of the newer survey were shared last year at IDWeek.
Magill and colleagues recruited up to 25 hospitals at Emerging Infections Program sites in 10 states — California, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon and Tennessee — prioritizing hospitals that participated in the 2011 survey. The hospitals selected one date between May 1 and Sept. 30, 2015, identifying a random sample of patients to survey. Hospital staff used 2011 HAI definitions when reviewing medical records.
There were 12,299 patients surveyed in 199 hospitals in 2015, compared with 11,282 patients in 183 hospitals surveyed in 2011. The researchers reported that fewer patients had HAIs in 2015 (3.2%; 95% CI, 2.9-3.5) compared with 2011 (4%; 95% CI, 3.7-4.4), and that it was primarily due to reductions in surgical-site and urinary tract infections. The most commonly reported HAIs were pneumonia; gastrointestinal infections, mostly due to C. difficile; and surgical site infections.
According to the findings, a patient’s adjusted risk for having a HAI was 16% lower in 2015 compared with 2011 (RR = 0.84; 95% CI, 0.74-0.95).
“These results, in combination with data from the National Healthcare Safety Network and other sources, show that progress has been made, and highlight areas where more attention is needed,” Magill said. “Working together, health care providers, professional organizations, and public health partners can improve patient safety through the reduction of health care-associated infections.” – by Bruce Thiel
Disclosures: Magill reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
Back to TopIt is encouraging to see that the prevalence of health care-associated infections has decreased. This is likely secondary to significant improvements not only in infection prevention science, but also to heightened fidelity with implementation of risk reduction practices at the bedside.
To further improve the prevalence of health care-associated infections and to reduce risk, health care systems must focus on implementation science, with specific use of pragmatic, real-world interventions that reliably decrease risk. This includes consistent mechanisms to ensure hand hygiene, patient chlorhexidine bathing, the use of safety checklists/safety timeouts and heightened environmental disinfection.
In addition, more strategies are needed to improve antibiotic use so as to minimize overtreatment and selective pressure for drug-resistant bacteria. C. difficile reduction has lagged because of ongoing antibiotic overuse, overly sensitive testing mechanisms (PCR), less than optimal environmental disinfection and because of probable diverse reservoirs for transmission, including the community.
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