Healthcare-Associated Infections Down, Survey Finds

Troy Brown, RN

October 31, 2018

Healthcare-associated infections (HAIs) fell by 16% between 2011 and 2015, according to a point-prevalence survey. In 2011, 4% of inpatients in US hospitals developed HAIs compared with 3.2% in 2015.

"These results provide evidence of national success in preventing healthcare-associated infections, particularly surgical-site and urinary tract infections," the researchers write.

"In contrast, there was no significant reduction in the prevalence of pneumonia or Clostridioides difficile infection, nor in the percentage of patients with healthcare-associated infection who died during their hospitalization, which suggests that more work is needed to prevent these infection types and reduce mortality among patients with healthcare-associated infections.

Shelley S. Magill, MD, PhD, from the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, and colleagues, published their findings in the New England Journal of Medicine.

The researchers surveyed 11,282 patients in 183 hospitals in 2011 and 12,299 patients in 199 hospitals during 2015, applying the same definitions of HAIs for both surveys.

In 2015, 394 of the 12,299 surveyed patients had at least one HAI (3.2%; 95% CI, 2.9 - 3.5), compared with 452 of 11,282 patients (4.0%; 95% CI, 3.7 - 4.4) in the 2011 survey (P < 0.001). The decline was largely a result of a reduced prevalence of surgical-site and urinary tract infections. The most common HAIs were pneumonia, gastrointestinal infections (most with C. difficile), and surgical-site infections.

After adjusting for age, presence of devices, days from admission to survey, and status of being in a large hospital, the risk for HAI was 16% lower in 2015 than in 2011 (risk ratio, 0.84; 95% CI, 0.74 - 0.95; P = .005).

In the 2015 survey, one or more pathogens were reported for 300 of 427 HAIs (70.3%), for a total of 392 pathogens. The most common pathogens were C. difficile, Staphylococcus aureus, and Escherichia coli, with each being responsible for at least 10% of all HAIs.

Almost half (45%) of the 47 S. aureus isolates with susceptibility results were methicillin resistant (MRSA). Three (5%) of 66 E. coli, Klebsiella, and Enterobacter isolates with reported susceptibility results for at least one carbapenem were resistant.

"Using National Inpatient Sample data stratified according to the categories of age and length of stay, we estimated that there were 633,300 patients with a healthcare-associated infection (95% CI, 216,000 - 1,912,700) and 687,200 healthcare-associated infections (95% CI, 181,400 - 2,691,200) in US hospitals in 2015," the researchers write.

The researchers say a decrease in urinary catheter use spurred by evidence-based interventions, such as those in the Comprehensive Unit-based Safety Program between 2011 and 2013, may at least partially explain the decreased prevalence of urinary tract infections. The reduced prevalence of surgical-site infections may be linked to the use of preoperative infection-prevention practices, including the decolonization of patients colonized with S. aureus or the implementation of revised surgical prophylaxis guidelines.

"Although the prevention of ventilator-associated pneumonia remains an important goal, the majority of pneumonia events in hospitals in our survey were not ventilator-associated. The published literature contains relatively little regarding the prevention of nonventilator-associated pneumonia in hospitalized patients, despite the association of this infection with poor outcomes in some reports. Some investigators have called for increased attention and resources for this underappreciated healthcare-associated infection," the authors explain.

The survey included geographically diverse areas; however, the results may not be generalizable to all hospitals in the United States.

Although the prevalence of C. difficile infection was largely unchanged between 2011 and 2015, the researchers say an increased use of nucleic acid amplification tests for diagnosis of C. difficile infection may have "masked actual reductions in the prevalence of C. difficile infection." Nevertheless, "there is room for improvement. Because the use of antibiotics is a major driver of C. difficile infections as well as antimicrobial resistance, continued focus on improving practices for the prescribing of antibiotics is critical, in addition to infection-control measures to prevent transmission in hospitals," the researchers write.

One author reports receiving fees for serving on a data and safety monitoring board from Seres Therapeutics. Another author reports receiving fees for serving on the board of directors and consulting fees from Infectious Diseases Consultation and honoraria and travel support from Medscape. The remaining authors have disclosed no relevant financial relationships.

N Engl J Med. 2018;379:1732-1744. Abstract

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