infection control & hospital epidemiology october 2015, vol. 36, no. 10 original article
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, MD, PhD, MPH;1,2 David J. Weber, MD, MPH;1,2 Lauren M. DiBiase, MS;1,2 Emily E. Sickbert-Bennett, PhD, MS;1,2 Rebecca Brooks, RN, BSN;1 Lisa Teal, RN, BSN;1 David Williams, RN, BSN;1 Elizabeth M. Walters, BS, RNC;1 William A. Rutala, PhD, MPH1,2
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.
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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.
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
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 −
In the late 1990s, decreasing resources led many hospitals to shift from hospital-wide to targeted surveillance, which was codified in the 1998 National Nosocomial Infections Surveil- lance (NNIS) surveillance definitions.1,2 Targeted surveillance focuses on specific healthcare-associated infections (HAIs) (eg, device-associated infections, surgical-site infections [SSIs], and laboratory-based infections due to Clostridium difficile and methicillin-resistant Staphylococcus aureus) and high-risk areas (eg, intensive care units, [ICUs]) within the hospital. Infection prevention and control efforts have greatly reduced the inci- dence of HAIs, especially device–associated infections such as central-line–associated bloodstream infection (CLABSI),
ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI).3–5 However, longitudinal trends among all HAIs, including non–device-associated HAIs, other types of HAI, and HAIs outside of ICUs, remain unknown since many hospitals do not implement comprehensive hospital-wide surveillance. At the University of North Carolina (UNC) Hospitals, we
have conducted comprehensive hospital-wide surveillance for allHAIs in accordance with the Centers for Disease Control and Prevention (CDC) criteria since 1978. In this study, we investigated the trends and incidences of all HAIs, including bloodstream infection (BSI), urinary tract infection (UTI),
University of North Carolina, Chapel Hill, North Carolina. © 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0003. DOI: 10.1017/ice.2015.142
Affiliations: 1. Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina; 2. Division of Infectious Diseases, Received March 13, 2015; accepted May 24, 2015; electronically published June 25, 2015
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