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

C difficile: Taking Over the Top Spot

Medscape: C difficile and its prevention are still of great interest, and this study found a prevalence of 12%. Was this expected?

Dr. Magill: The importance of C difficile as a threat to patient safety has been well established. Although historically, we are used to thinking about S aureus (and particularly MRSA) as the top healthcare-associated pathogen, I don't think we were particularly surprised to find that in this survey that C difficile was more prevalent. CDI is a huge problem that needs continued attention.

Medscape: If CDI rates are still increasing, why do you think this is happening, with all the attention it has received?

Dr. Magill: This is a point-prevalence survey, so it's a snapshot in time -- the situation at the moment. A single prevalence survey in and of itself doesn't tell us anything about changes in how frequently infections are occurring. To get a sense of what is happening over time, we rely on the ongoing prospective surveillance systems that we have in place. Repeating prevalence surveys over time using the same methods can also provide information about what changes are happening. If we were to repeat the survey in the next few years, we might be able to say something about changes in the HAI distribution.

We expect to have more data about CDI rates in the coming years from the various ways that CDIs are tracked. We have hospital-specific CDI reporting from most hospitals in the United States through the NHSN starting in 2012, augmented by population-based surveillance in 10 states through the CDC's EIP, which spans both healthcare and community-associated infection.

Medscape: Does it suggest anything new that clinicians and hospitals should be doing different right now for the prevention of CDI?

Dr. Magill: We understand quite a bit about preventing C difficile transmission, and many hospitals are working very hard on that. It's the kind of thing that we need to be taking a look at consistently over time to see whether those efforts are having an impact. Correct and appropriate use of antibiotics is a very important component of efforts to control C difficile infection. A recent Vital Signs report[6] had quite a bit of information about C difficile and the potential benefits in reducing CDI through antimicrobial stewardship. (See also: Refining Our Approach to Clostridium difficile Prevention)

Medscape: What are your hoped-for outcomes of the survey overall? What do you recommend that clinicians and hospitals do differently right now?

Dr. Magill: The survey provides the "bigger picture" of some areas for increased focus going forward. That's very important. It suggests that we have been effective in our prevention efforts in certain areas and that it may be time to expand focus to some of these other areas, such as non-ventilator-associated pneumonia. There is still a lot of work to do in critical care units, but we want to make sure that we are expanding focus outside of the ICU to some of these other locations where a large number of HAIs are occurring.

Medscape: Is there anything else that you would like to say about the report?

Dr. Magill: This effort was a large amount of work for the facilities that participated and the facility staff, as well as our colleagues in the state health departments and their partners. We are very appreciative that people were willing to engage in this effort and allow us to achieve a better understanding of all types of HAIs affecting patients in acute care hospitals and where we may need to go in the future to make healthcare safer for everyone. It was a very large group effort, and we are very appreciative of everyone's hard work.

Even though we are seeing progress in the prevention of healthcare-associated infections, there is much more work to be done. Clinicians, facilities, and public health need to continue to work together so that we can use these data to focus on prevention gaps and identify additional ways to protect patients.

Shelley S. Magill, MD, PhD, is an infectious diseases physician and medical officer in the US Public Health Service. She received her MD from Harvard Medical School and completed training in Internal Medicine at the Brigham and Women's Hospital in Boston, Massachusetts. She received her PhD in clinical investigation at Johns Hopkins University, where she also completed an infectious diseases fellowship. She was a member of the Infectious Diseases Division faculty at Johns Hopkins from 2003 to 2007, conducting mycology clinical research and attending on the transplant infectious diseases clinical consultation service. She joined the Centers for Disease Control and Prevention in 2007 as a medical officer in the Mycotic Diseases Branch, where she helped implement population-based surveillance for Candida bloodstream infections. She began working in the CDC's Division of Healthcare Quality Promotion in 2009. Her work in DHQP has included leading the development and implementation of prevalence surveys of healthcare-associated infections and antimicrobial use as well as efforts to improve surveillance for ventilator-associated events.