Hospital-Associated Infections in the United States: CDC's Snapshot in Time

Laura A. Stokowski, RN, MS; Shelley S. Magill, MD, PhD


March 26, 2014

Editorial Collaboration

Medscape &

In This Article

The Prevalence of Healthcare-Associated Infections

In spite of their importance to patient morbidity and mortality and the cost of healthcare, we have no single mandatory reporting mechanism that can deliver an overall burden estimate for all types of healthcare-associated infections (HAIs) in the United States.[1] Prevalence data are considered valuable for estimating the burden of HAIs because they incorporate both new and established infections.[1] A point-prevalence survey measures the proportion of patients with HAIs on the day that data are collected. A point-prevalence survey also permits gathering related data of interest, such as the location of the patient; whether the patient has indwelling devices or catheters; whether the patient recently had surgery; and the treatment the patient is receiving, such as antibiotics.

The US Centers for Disease Control and Prevention (CDC) recently completed the largest prevalence survey of HAIs in US hospitals in more than 30 years. The survey was conducted in collaboration with the Emerging Infections Program (EIP), and included a random sample of patients in 183 acute care hospitals in 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee.

The objectives of this ambitious project were to estimate HAI prevalence among inpatients of participating acute healthcare facilities, and to determine the distribution of HAI by pathogen (including antimicrobial-resistant pathogens) and major infection site (eg, respiratory, bloodstream, gastrointestinal). Although each participating hospital selected a single day in 2011 to conduct the survey, the entire project began with a single-city pilot survey of 9 hospitals in Jacksonville, Florida, in 2009.[2] This pilot evaluated whether any proxy indicators of HAI would be useful in identifying patients more likely to have HAIs, and found that antimicrobial therapy was the most sensitive proxy indicator. About 96% of patients with HAIs were on antimicrobial therapy on the survey day or the day prior to the survey.

The results of the 2011 CDC point-prevalence survey have just been released. They reveal the overall proportion of patients with HAIs in acute care hospitals, the sites of these infections, and the major pathogens recovered. The survey also provides data on the location of infected patients within the hospital. Taken as a whole, the survey provides insight into new directions for the prevention of HAIs, and suggests trends that clinicians should be aware of.

Medscape recently spoke with CDC's Shelley S. Magill, MD, PhD, the survey project leader, about the findings of the point-prevalence survey, and the important implications they have for our continued efforts to reduce the rate of HAIs in all healthcare settings.