Skip to main content Accessibility help
×
Home

Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and “Other” Types of Infection

  • Hajime Kanamori (a1) (a2), David J. Weber (a1) (a2), Lauren M. DiBiase (a1) (a2), Emily E. Sickbert-Bennett (a1) (a2), Rebecca Brooks (a1), Lisa Teal (a1), David Williams (a1), Elizabeth M. Walters (a1) and William A. Rutala (a1) (a2)...

Abstract

OBJECTIVE

Targeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001–2012).

METHODS

This retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time.

RESULTS

A total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (−3.4 infections per 1,000 patient days), in ICUs (−8.4 infections per 1,000 patient days), and in non-ICU settings (−1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million.

CONCLUSIONS

We demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non–device-associated HAIs, and for CDI.

Infect Control Hosp Epidemiol 2015;36(10):1139–1147

Copyright

Corresponding author

Address correspondence to Hajime Kanamori, MD, PhD, MPH, Hospital Epidemiology, UNC Health Care, 1001 West Wing CB #7600, 101 Manning Drive, Chapel Hill, NC 27514 (kanamori@med.unc.edu).

References

Hide All
1. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160166.
2. Calfee, DP, Farr, BM. Infection control and cost control in the era of managed care. Infect Control Hosp Epidemiol 2002;23:407410.
3. Yokoe, DS, Mermel, LA, Anderson, DJ, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29:S12S21.
4. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.
5. Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315322.
6. Centers for Disease Control and Prevention; National Healthcare Safety Network. Surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Accessed August 30, 2014.
7. Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Comparison of hospitalwide surveillance and targeted intensive care unit surveillance of healthcare associated infections. Infect Control Hosp Epidemiol 2007;28:13611366.
8. Centers for Disease Control and Prevention; National Healthcare Safety Network. Key terms. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/16pscKeyTerms_current.pdf. Accessed August 30, 2014.
9. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101114.
10. Scott, RD II. The direct medical costs of healthcare-associated infections in US hospitals and benefits of prevention. Centers for Disease Control and Prevention website. http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Published 2009. Accessed 30 August 2014.
11. Magill, SS, Edwards, JR, Bamberg, W, et al. Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:11981208.
12. Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Completeness of surveillance data reported by the national healthcare safety network: an analysis of healthcare-associated infections ascertained in a tertiary care hospital, 2010. Infect Control Hosp Epidemiol 2012;33:9496.
13. Lempp, JM, Cummings, MJ, Birnbaum, DW. Distribution of central line associated bloodstream infections in Washington State, 2009–2013. Council of State & Territorial Epidemiologists Annual Conference; June 22–26, 2014; Nashville, TN. Abstract 137.
14. Climo, M, Diekema, D, Warren, DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24:942945.
15. Kallen, AJ, Patel, PR, O’Grady, NP. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clin Infect Dis 2010;51:335341.
16. Wright, SB, Ostrowsky, B, Fishman, N, Deloney, VM, Mermel, L, Perl, TM. Expanding roles of healthcare epidemiology and infection control in spite of limited resources and compensation. Infect Control Hosp Epidemiol 2010;31:127132.
17. Della Vecchia KN. Infection prevention. Average IP salary on an upswing. Healthcare Purchasing News website. Published May 2013. http://www.hpnonline.com/inside/2013-05/1305-IP-Salary-web.pdf. Accessed April 27, 2015.
18. Kanamori, H, Weber, DJ, Sickbert-Bennett, EE, Brown, V, Kaku, M, Rutala, WA. Descriptive analysis of healthcare-associated infections other than bloodstream, respiratory, urinary tract, or surgical site infections, 2001–2011. Infect Control Hosp Epidemiol 2012;33:12761278.
19. Kang, J, Sickbert-Bennett, EE, Brown, VM, Weber, DJ, Rutala, WA. Changes in the incidence of health care-associated pathogens at a university hospital from 2005 to 2011. Am J Infect Control 2014;42:770775.
20. Weber, DJ, Anderson, DJ, Sexton, DJ, Rutala, WA. Role of the environment in the transmission of Clostridium difficile in health care facilities. Am J Infect Control 2013;41:S105S110.
21. Loo, VG, Bourgault, AM, Poirier, L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 2011;365:16931703.
22. Eyre, DW, Cule, ML, Wilson, DJ, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 2013;369:11951205.
23. Weber, DJ, Brown, VM, Sickbert-Bennett, EE, Rutala, WA. Sustained and prolonged reduction in central line-associated bloodstream infections as a result of multiple interventions. Infect Control Hosp Epidemiol 2010;31:875877.
24. Changes to prevent healthcare-associated infections. Institute for Healthcare Improvement website. http://www.ihi.org/resources/Pages/Changes/ChangestoPreventHAIs.aspx. Accessed July 9, 2014.
25. Infectious Diseases Society of America. Compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Society for Healthcare Epidemiology of America website. Available at http://www.shea-online.org/View/ArticleId/290/Compendium-of-Strategies-to-Prevent-Healthcare-Associated-Infections-in-Acute-Care-Hospitals.aspx. Accessed July 9, 2014.
26. DiBiase, LM, Weber, DJ, Sickbert-Bennett, EE, Anderson, DJ, Rutala, WA. The growing importance of non-device-associated healthcare-associated infections: a relative proportion and incidence study at an academic medical center, 2008–2012. Infect Control Hosp Epidemiol 2014;35:200202.
27. Zarate, R, Birnbaum, D. Postdischarge surgical site infection surveillance practices in Washington acute care hospitals. Infect Control Hosp Epidemiol 2012;33:8789.
28. Owens, PL, Barrett, ML, Raetzman, S, Maggard-Gibbons, M, Steiner, CA. Surgical site infections following ambulatory surgery procedures. JAMA 2014;311:709716.
29. Berthelot, P, Garnier, M, Fascia, P, et al. Conversion of prevalence survey data on nosocomial infections to incidence estimates: a simplified tool for surveillance? Infect Control Hosp Epidemiol 2007;28:633636.
Type Description Title
WORD
Supplementary materials

Kanamori supplementary material
Appendix

 Word (18 KB)
18 KB

Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and “Other” Types of Infection

  • Hajime Kanamori (a1) (a2), David J. Weber (a1) (a2), Lauren M. DiBiase (a1) (a2), Emily E. Sickbert-Bennett (a1) (a2), Rebecca Brooks (a1), Lisa Teal (a1), David Williams (a1), Elizabeth M. Walters (a1) and William A. Rutala (a1) (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed