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Data from the National Healthcare Safety Network were analyzed to assess the impact of COVID-19 on the incidence of healthcare-associated infections (HAI) during 2021. Standardized infection ratios were significantly higher than those during the prepandemic period, particularly during 2021-Q1 and 2021-Q3. The incidence of HAI was elevated during periods of high COVID-19 hospitalizations.
To assess potential changes in the pathogens attributed to central-line–associated bloodstream infections between 2019 and 2020, hospital data from the National Healthcare Safety Network were analyzed. Compared to 2019, increases in the proportions of pathogens identified as Enterococcus faecalis and coagulase-negative staphylococci were observed during 2020.
To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) incidence in US hospitals, national- and state-level standardized infection ratios (SIRs) were calculated for each quarter in 2020 and compared to those from 2019.
Central–line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. SIRs were calculated for each HAI and quarter by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data. Percentage changes between 2019 and 2020 SIRs were calculated. Supporting analyses, such as an assessment of device utilization in 2020 compared to 2019, were also performed.
Significant increases in the national SIRs for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020. Changes in the SIR varied by quarter and state. The largest increase was observed for CLABSI, and significant increases in VAE incidence and ventilator utilization were seen across all 4 quarters of 2020.
This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics.
During March 27–July 14, 2020, the Centers for Disease Control and Prevention’s National Healthcare Safety Network extended its surveillance to hospital capacities responding to COVID-19 pandemic. The data showed wide variations across hospitals in case burden, bed occupancies, ventilator usage, and healthcare personnel and supply status. These data were used to inform emergency responses.
We analyzed 2017 healthcare facility-onset (HO) vancomycin-resistant Enterococcus (VRE) bacteremia data to identify hospital-level factors that were significant predictors of HO-VRE using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) multidrug-resistant organism and Clostridioides difficile reporting module. A risk-adjusted model that can be used to calculate the number of predicted HO-VRE bacteremia events in a facility was developed, thus enabling the calculation of VRE standardized infection ratios (SIRs).
Acute-care hospitals reporting at least 1 month of 2017 VRE bacteremia data were included in the analysis. Various hospital-level characteristics were assessed to develop a best-fit model and subsequently derive the 2018 national and state SIRs.
In 2017, 470 facilities in 35 states participated in VRE bacteremia surveillance. Inpatient VRE community-onset prevalence rate, average length of patient stay, outpatient VRE community-onset prevalence rate, and presence of an oncology unit were all significantly associated (all 95% likelihood ratio confidence limits excluded the nominal value of zero) with HO-VRE bacteremia. The 2018 national SIR was 1.01 (95% CI, 0.93–1.09) with 577 HO bacteremia events reported.
The creation of an SIR enables national-, state-, and facility-level monitoring of VRE bacteremia while controlling for individual hospital-level factors. Hospitals can compare their VRE burden to a national benchmark to help them determine the effectiveness of infection prevention efforts over time.
Using data from the National Healthcare Safety Network (NHSN), we assessed changes to intensive care unit (ICU) bed capacity during the early months of the COVID-19 pandemic. Changes in capacity varied by hospital type and size. ICU beds increased by 36%, highlighting the pressure placed on hospitals during the pandemic.
Data reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC NHSN) were analyzed to understand the potential impact of the COVID-19 pandemic on central-line–associated bloodstream infections (CLABSIs) in acute-care hospitals. Descriptive analysis of the standardized infection ratio (SIR) was conducted by location, location type, geographic area, and bed size.
The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), the nation’s largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020.
From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near–real-time daily national and state estimates to be computed.
During the pandemic’s April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July.
The NHSN hospital capacity estimates served as important, near–real-time indicators of the pandemic’s magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.
Background:Clostridioides difficile infection (CDI) is one of the most common laboratory-identified (LabID) healthcare-associated events reported to the National Healthcare Safety Network (NHSN). CDI prevention remains a national priority, and efforts to reduce infection burden and improve antibiotic stewardship continue to expand across the healthcare spectrum. Beginning in 2013, the Centers for Medicare and Medicaid Services (CMS) required acute-care hospitals participating in CMS’ Inpatient Quality Reporting program to report CDI LabID data to NHSN and, in 2015, extended this reporting requirement to emergency departments (ED) and 24-hour observation units. To assess national progress, we evaluated changes in hospital onset CDI (HO-CDI) incidence during 2010–2018. Methods: Cases of HO-CDI were reported to NHSN by hospitals using the NHSN’s LabID criteria. Generalized linear mixed-effects modeling was used to assess trends of HO-CDI by treating the hospital as a random intercept to account for the correlation of the repeated responses over time. The data were summarized at the quarterly level, the main effect was time, and the covariates of interest were the following: CDI test type, inpatient community-onset (CO) infection rate, hospital type, average length of stay, medical school affiliation, number of beds, number of ICU beds, number of infection control professionals, presence of an ED or observation unit , and an indicator for 2015 to account for CDI protocol changes that required hospitals to conduct surveillance in both inpatient and ED or observation unit setting. Results: During 2010–2013, the number of hospitals reporting CDI increased and then stabilized after 2013 (Table 1). Crude HO-CDI rates decreased over time, except for an increase in 2015 and steeper reduction thereafter. (Table 2). During 2010–2014, the adjusted quarterly rate of change was −0.45% (95% CI, −0.57% to −0.33%; P < .0001). The rate of reduction was smaller in 2010–2014 compared to those of 2015–2018 (−2.82%; 95% CI, −3.10% to −2.54%; P < .0001). Compared to 2014, the adjusted rate in 2015 increased by 79.14% (95% CI, 72.42%–86.11%; P < .0001). Conclusions: The number of hospitals reporting CDI LabID data grew substantially in 2013 as a result of the CMS requirement for reporting. Adjusted HO-CDI rates decreased over time, with a rate hike in the year of 2015 and a rapid decrease thereafter. The increase in 2015 may be explained by changes in the NHSN CDI surveillance protocol and better test type classification in later years. Overall decreases in HO-CDI rates may be influenced by prevention strategies.
Background: The Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) has included surveillance of laboratory-identified (LabID) methicillin-resistant Staphylococcus aureus (MRSA) bacteremia events since 2009. In 2013, the Centers for Medicare & Medicaid Services (CMS) began requiring acute-care hospitals (ACHs) that participate in the CMS Inpatient Quality Reporting program to report MRSA LabID events to the NHSN and, in 2015, ACHs were required to report MRSA LabID events from emergency departments (EDs) and/or 24-hour observation locations. Prior studies observed a decline in hospital-onset MRSA (HO-MRSA) rates in national studies over shorter periods or other surveillance systems. In this analysis, we review the national reporting trend for HO-MRSA bacteremia LabID events, 2010–2018. Method: This analysis was limited to MRSA bacteremia LabID event data reported by ACHs that follow NHSN surveillance protocols. The data were restricted to events reported for overall inpatient facility-wide and, if applicable, EDs and 24-hour observation locations. MRSA events were classified as HO (collected >3 days after admission) or inpatient or outpatient community onset (CO, collected ≤3 days after admission). An interrupted time series random-effects generalized linear model was used to examine the relationship between HO-MRSA incidence rates (per 1,000 patient days) and time (year) while controlling for potential risk factors as fixed effects. The following potential risk factors were evaluated: facility’s annual survey data (facility type, medical affiliation, length of facility stay, number of beds, and number of intensive care unit beds) and quarterly summary data (inpatient and outpatient CO prevalence rates). Result: The number of reporting ACHs increased during this period, from 473 in 2010 to 3,651 in 2018. The crude HO-MRSA incidence rates (per 1,000 patient days) have declined over time, from a high of 0.067 in 2011 to 0.052 in 2018 (Table 1). Compared to 2014, the adjusted annual incidence rate increased in 2015 by 16.38%, (95% confidence interval [CI], 10.26%–22.84%; P < .0001). After controlling for all significant risk factors, the estimated annual HO-MRSA incidence rates declined by 5.98% (95% CI, 5.17%–6.78%; P < .0001) (Table 2). Conclusions: HO-MRSA bacteremia incidence rates have decreased over the past 9 years, despite a slight increase in 2015. This national trend analysis reviewed a longer period while analyzing potential risk factors. The decline in HO-MRSA incidence rates has been gradual; however, given the current trend, it is not likely to meet the Healthy People 2020 objectives. This analysis suggests the need for hospitals to continue and/or enhance HO-MRSA infection prevention efforts to reduce rates further.
Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.
Background: An indwelling urinary catheter is used in ~12%–16% of adult hospital inpatients during their hospitalization, which poses risks for acquiring a catheter-associated urinary tract infection (CAUTI). CAUTI data have been reported to the NHSN since 2005, and national benchmarks are annually reported in NHSN progress reports. Trends analyses in the incidence of CAUTI reported to the NHSN over long time have not been previously assessed. Objective: We investigated the national trends of CAUTI incidence separately for intensive care units (ICUs) and wards in acute-care hospitals (ACHs) from 2009 through 2018. Methods: We analyzed CAUTI data from ACHs reported to NHSN in 2009–2018. To evaluate trends of CAUTI incidence (per 1,000 catheter days), we conducted interrupted time-series analysis using negative-binomial mixed-effects modeling, separately for ICUs (nonneonatal ICUs) and wards. Due to the reporting requirement for adult and pediatric ICUs in 2012, and medical, surgical, and medical-surgical wards in 2015 by the CMS and the institution of the NHSN CAUTI definitional changes in 2015, calendar years 2012 and 2015 were treated as interruptions to the outcome in ICU models, and year 2015 was treated as a single interruption in the ward models. Regression models were assessed and adjusted, as appropriate, for patient care location type and facility-level characteristics such as hospital type, teaching status, bed size, number (and percentage) of ICU beds, and average length of inpatient stay. Random intercept and slope models were evaluated with covariance tests and were included to account for differential baseline incidence and trends among reporting hospitals. Results: The volume of patient care locations and hospitals reporting to the NHSN increased over time. Among the ICUs, the CAUTI incidence rate did not change in 2009–2012 and increased at an average of 5.6% per year in 2012–2014 (Fig. 1). CAUTI incidence rate dropped nearly 40% in 2015; thereafter, it decreased at an average of 8.9% per year. Among the wards, CAUTI incidence rate decreased at an average of 4.3% per year beginning 2009 (Fig. 2). The CAUTI incidence rate dropped almost 28% in 2015 and then decreased at an average of 4.3% per year. Conclusions: CAUTI incidence decreased substantially in 2015 among both ICUs and wards, which was partially attributable to CAUTI definitional change (see also Fig. 7 at https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html). The significant decline of CAUTI incidence in both location types since 2015 is encouraging, and continued efforts in prevention of CAUTI are vital to sustaining this decline in the future.
Background:Staphylococcus aureus has long been an important cause of healthcare-associated infections (HAIs) and remains the second most common HAI pathogen in the United States. Often resistant to several antibiotics, S. aureus infections are difficult to treat and can leave patients at risk for serious complications such as pneumonia and sepsis. HAI pathogens and their antimicrobial susceptibility testing (AST) results have been reported to NHSN since its inception in 2005. Previous NHSN surveillance reports have presented national annual benchmarks for antimicrobial resistance phenotypes, such as methicillin-resistant S. aureus (MRSA). Whether there have been any significant changes over time in the prevalence of methicillin resistance among S. aureus infections reported to NHSN has not been previously assessed. Methods:S. aureus AST data from central-line–associated bloodstream infections, catheter-associated urinary tract infections, and inpatient surgical site infections reported from acute-care hospitals between 2009 and 2018 were analyzed. S. aureus was defined as MRSA if it was reported as resistant to oxacillin, cefoxitin, or methicillin. A national percentage resistant (%R) was calculated for each year as the number of resistant pathogens divided by the number of pathogens tested for susceptibility multiplied by 100. A generalized linear mixed model with logistic function was created to evaluate annual changes in the percentage resistant. Several patient-level and hospital-level characteristics were assessed as potential covariates. To account for differential baseline %R values between individual hospitals, specification of random intercept and slope were used during model creation. Differences in the trend of %R between HAI types were assessed using interaction terms. Data were analyzed using SAS v 9.3 software, and P < .05 was considered significant. Results: Overall, 3,317 hospitals reported at least 1 S. aureus pathogen tested for susceptibility between 2009 and 2018. The national unadjusted %R decreased from 49.2% (2009) to 41.2% (2018), with similar decreases seen in each HAI type (Table 1). After adjusting for significant covariates, a statistically significant annual 3% decrease in the prevalence of resistance was observed (Fig. 1). Significant differences between HAI types did not exist. Conclusions: The percentage of healthcare-associated S. aureus resistant to oxacillin, cefoxitin, or methicillin has declined consistently over the past 10 years. Continued efforts in infection prevention and antimicrobial stewardship are vital to sustaining this decline.
Background: The NHSN is the nation’s most widely used healthcare-associated infection surveillance system. Nearly all acute-care hospitals reporting to the NHSN do so in fulfillment of state mandates and/or as required for participation in the CMS Quality Reporting program, since 2011. All NHSN-participating acute-care hospitals (ACHs) reporting in the Patient Safety Component are required to complete an annual survey and to self-report on the hospital’s general characteristics, including hospital size and type, and patient volume. Due to the compulsory nature of the survey, the NHSN receives nearly a 100% completion rate each year. Furthermore, hospital-level characteristics are often used by the CDC to develop risk-adjusted summary measures and national benchmarks. This study is the first to evaluate ACH characteristics over an 11-year period. Methods: All ACHs that completed an annual survey during 2008–2018 were included. The data were divided into subsets to evaluate consistent reporters, defined as facilities that were enrolled in 2008 and completed surveys through 2018. Medical teaching status is defined as a facility that trains either medical students, nursing students, residents and fellows. Medical teaching status is grouped into 3 categories: (1) undergraduate facility that trains medical school students, (2) graduate facility that trains residents or fellows, and (3) major facility that trains both medical and residents or fellows. We used univariate analyses to assess characteristics of acute-care hospitals (ACHs). Results: Overall, the number of ACHs enrolled in the NHSN increased by 119%, from 1,772 in 2008 to 3,883 in 2018. More general acute-care hospitals (89%) were enrolled than all other facility types, with women’s and children’s hospitals were the least frequently enrolled (0.34%). Hospitals with any level of medical teaching status, increased from 38.5% in 2008 to 60% in 2018 (Fig. 1). We observed a modest reduction in the median hospital bed size of 20 beds. When reviewing hospital bed size by category, ACHs with 51–200 beds made up the largest proportion of hospitals and the number of hospitals within this bed size category has remained above 1,500 since 2010. Conclusions: Among all ACHs, the proportion of hospitals affiliated with a medical school increased over the 10-year period. Although hospitals with a major teaching status had been steadily increasing, there were more hospitals using this designation after 2013. Despite the increase in the number of hospitals reporting to NHSN, since 2011, the proportion of hospitals within each bed size category has seen minimal change.
Background: The NHSN has used positive laboratory tests for surveillance of Clostridioides difficile infection (CDI) LabID events since 2009. Typically, CDIs are detected using enzyme immunoassays (EIAs), nucleic acid amplification tests (NAATs), or various test combinations. The NHSN uses a risk-adjusted, standardized infection ratio (SIR) to assess healthcare facility-onset (HO) CDI. Despite including test type in the risk adjustment, some hospital personnel and other stakeholders are concerned that NAAT use is associated with higher SIRs than are EIAs. To investigate this issue, we analyzed NHSN data from acute-care hospitals for July 1, 2017 through June 30, 2018. Methods: Calendar quarters for which CDI test type was reported as NAAT (includes NAAT, glutamate dehydrogenase (GDH)+NAAT and GDH+EIA followed by NAAT if discrepant) or EIA (includes EIA and GDH+EIA) were selected. HO CDI SIRs were calculated for facility-wide inpatient locations. We conducted the following analyses: (1) Among hospitals that did not switch their test type, we compared the distribution of HO incident rates and SIRs by those reporting NAAT vs EIA. (2) Among hospitals that switched their test type, we selected quarters with a stable switch pattern of 2 consecutive quarters of each of EIA and NAAT (categorized as pattern EIA-to-NAAT or NAAT-to-EIA). Pooled semiannual SIRs for EIA and NAAT were calculated, and a paired t test was used to evaluate the difference of SIRs by switch pattern. Results: Most hospitals did not switch test types (3,242, 89%), and 2,872 (89%) reported sufficient data to calculate SIRs, with 2,444 (85%) using NAAT. The crude pooled HO CDI incidence rates for hospitals using EIA clustered at the lower end of the histogram versus rates for NAAT (Fig. 1). The SIR distributions of both NAAT and EIA overlapped substantially and covered a similar range of SIR values (Fig. 1). Among hospitals with a switch pattern, hospitals were equally likely to have an increase or decrease in their SIR (Fig. 2). The mean SIR difference for the 42 hospitals switching from EIA to NAAT was 0.048 (95% CI, −0.189 to 0.284; P = .688). The mean SIR difference for the 26 hospitals switching from NAAT to EIA was 0.162 (95% CI, −0.048 to 0.371; P = .124). Conclusions: The pattern of SIR distributions of both NAAT and EIA substantiate the soundness of NHSN risk adjustment for CDI test types. Switching test type did not produce a consistent directional pattern in SIR that was statistically significant.
Background: Hospitals have submitted surveillance data for surgical site infections (SSIs) following colon surgeries (COLO) to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) since 2005. COLO SSI data submissions to NHSN have increased substantially beginning in 2012 as result of a Centers for Medicare and Medicaid Services (CMS) mandatory reporting requirement that began that year. A trend analysis of COLO SSIs, using data submitted to NHSN, has not been previously reported. To estimate the national trend of COLO SSI rates, we analyzed data reported from acute-care hospitals during 2009–2018. Methods: We analyzed inpatient adult COLO procedures with primary closure and resulting deep incisional primary and organ-space SSIs detected during the same hospitalization or rehospitalization in the same hospital. SSIs reported as infection present at time of surgery (PATOS) were included in the analysis. A protocol change that reprioritized COLO above small bowel surgery (SB) in the multiprocedural abdominal operations selection list for SSI attribution beginning in 2013 was a potential interruption to COLO SSI outcome. An interrupted time series with mixed-effects logistic regression was used to estimate the annual change in the log odds of COLO SSI. The estimates were adjusted for the following variables: hospital bed size, gender, emergency, trauma, general anesthesia, scope, ASA score, wound classification, medical school affiliation type, procedure duration and age. We also assessed the slope and level change of log odds before and after 2013. Results: The number of hospitals and procedures increased and then stabilized after 2012 (Table 1). The annual crude SSI rates ranged from 2.40% to 3.10%. There was no statistically significant slope change in 2013 and after. Compared to 2009–2012, the log odds of COLO SSI increased in 2013–2018 (OR, 1.1975; P < .0001). Based on this model, we estimate a 0.58% annual decrease in the odds of having a COLO SSI during 2009–2012 and 2013–2018 after controlling for the aforementioned variables (Table 2). Conclusions: We observed a substantial increase in the volume of hospitals and procedures reported to the NHSN since 2012 and an increase in odds of having a COLO SSI in 2013–2018 associated with surveillance protocol changes. After adjusting for these changes, we found a slight annual decrease in the overall odds of COLO SSI. Greater prevention efforts are needed for COLO SSI.
Background: Central-line–associated bloodstream infections (CLABSIs) are a major source of healthcare-associated infections (HAIs) in neonatal intensive care unit (NICU) patients, and they are associated with increased morbidity, mortality, and costs. CLABSI surveillance has been a critical component for hospitals participating in the Center for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) for many years. CLABSI reporting grew substantially as a result of state reporting mandates first introduced in 2005 and federal reporting requirements for all intensive care units that began in 2011. However, no recent assessment of NHSN CLABSI incidence rate changes have been performed. The objective of this analysis was to estimate the overall trends in annual CLABSI incidence rates in NICUs from 2009 to 2018. Methods: We analyzed NHSN CLABSI data reported from NICUs during 2009–2018. CLABSIs further classified as mucosal barrier injury were included in this analysis. To evaluate the trends of CLABSI incidence (per 1,000 central-line days), and to account for the potential impact of definition changes introduced in 2015, we conducted an interrupted time-series analysis using mixed-effects negative binomial regression modeling. Birth weight category, patient care location type and hospital-level characteristics such as hospital type, medical affiliation, teaching status, bed size, and average length of inpatient stay) were assessed as potential covariates in regression analysis. Random intercept and slope models were evaluated with covariance tests and used to account for differential baseline incidence and trends among reporting NICUs. Results: The number of NICUs reporting to NHSN increased significantly following the federal mandate and has remained slightly >1,000 NICUs since 2013. The crude incidence of CLABSI dropped from 2.24 in 2009 to 0.98 infections per 1,000 central-line days in 2018, except for an increase in 2015 (Table 1). The CLABSI incidence, adjusted for birth weight category, decreased by an average of 11.6% per year from 2009 to 2018 except for a 35.8% increase in 2015 (Table 2). Conclusion: These findings suggest that hospitals have made significant strides in reducing the occurrence of CLABSIs in NICUs over the last 10 years. The increase in 2015 could be explained in part by the implementation and application of new definitional changes. Continued practices and policies that target, assess and prevent CLABSI in this setting may have been effective and remain vital to sustaining this decline nationally in subsequent years.
Background: Central-line–associated bloodstream infections (CLABSIs) are an important cause of healthcare-associated morbidity and mortality in the United States. CLABSI surveillance in the CDC NHSN began in 2005 and has been propelled by state CLABSI reporting requirements, first introduced in 2005, and subsequently by the CMS requirements for intensive care units (ICUs) in 2011 and select ward locations in 2015. Although trend analyses were previously reported, no recent assessment of the NHSN CLABSI incidence rate changes has been performed. In this analysis, we evaluated trends in CLABSI rates in nonneonatal ICUs and all wards reported from acute-care hospitals. Methods: CLABSI rates, including blood stream infections attributed to mucosal barrier injury reported to the NHSN from 2009 to 2018, were analyzed. To evaluate trends in CLABSI incidence and to account for the potential impact of definitional changes in catheter-associated urinary tract infections (CAUTIs) that indirectly impacted CLABSI rates, as well as the CMS mandate for select wards, we conducted an interrupted time-series analysis using negative binomial random-effects modeling with an interruption in 2015. ICUs and ward locations were analyzed separately. Models were adjusted for patient care location type and hospital-level characteristics: hospital type, medical affiliation, teaching status, bed size, number of ICU beds, and average length of inpatient stay. Random intercept and slope models were used to account for differential baseline incidence and trends among reporting hospitals. Results: The overall crude incidence of CLABSI per 1,000 central-line days decreased from 1.6 infections in 2009 to 0.9 infections in 2018, except for an increase in 2015. Similar trends were observed by location type. Among the ICUs, adjusted CLABSI incidence decreased by 10% annually in 2009–2014, increased nearly 29% in 2015, and thereafter decreased at an average of 6.8% per year. Among the wards, adjusted CLABSI incidence decreased at an average of 7.9% annually, except for a 29.3% increase in 2015. Conclusions: Substantial progress has been made in reducing CLABSIs in both ICUs and wards over the last 10 years. Indirect effects of CAUTI definitional changes may explain the immediate increase in ICUs, whereas the CMS mandate may explain the similar increase in wards in 2015. Despite this increase, these findings suggest that policies and practices aimed at prevention of CLABSI have likely been effective on a national level.