1140 infection control & hospital epidemiology october 2015, vol. 36, no. 10


respiratory tract infection (RTI), SSI, and other types of HAI. Furthermore, we assessed outcomes (ie, HAIs prevented, lives saved, and cost savings) as a result of our infection control activities over the last decade.


methods


This study was conducted at UNC Hospitals, an 806-bed tertiary care academic facility using the Hospital Epidemiology HAI data for 12 years from 2001 to 2012. Comprehensive hospital-wide surveillance for allHAIs that included all CDC- defined sites was performed through a chart review of each patient in accordance with CDC criteria as recommended that year6 by 5 infection preventionists and 3 full-time faculty members. Sources for HAI identification included laboratory reports of positive culture results, results of serological testing or molecular-based diagnostic tests, morbidity and mortality conferences, autopsies, and reports of infections from clinics and physicians. For analyses by unit category within UNC Hospitals, all HAIs and units were classified as ICUs or non- ICUs. Step-down units were classified as non-ICUs because those units had infection rates more similar to those of gen- eral wards than those of the ICUs.7 According to CDC cri- teria, all HAIs were categorized as 1 of the following 5 major infections with 14 specific infection sites: BSIs, UTIs, RTIs (pneumonia; lower respiratory tract infections [LRTIs]), SSIs, and other types of HAI (gastrointestinal infections; eye, ear, nose, throat, or mouth infections; skin and soft-tissue infections; cardiovascular system infections; bone and joint infections; central nervous system infections; reproductive tract infections; systemic infections).6 All surveillance data regarding HAIs during the study period were entered into an electronic database.


Relative proportions were calculated as each infection site


versus all HAIs per year that were available from 2001 to 2012. Incidences of device-associated infection (CLABSI, VAP, and CAUTI) were calculated as infections per 1,000 device days and SSI incidence was calculated as infections per 100 proce- dures. Incidences of HAIs other than these device-associated infections and SSI were calculated as the number of HAIs per 1,000 patient days. Denominator data were collected according toCDC criteria8 and were classified into the same infection site and unit category as the numerator data. Denominators for the incidences were available in the following areas and periods (the first year listed was considered the baseline year): patient days at overall hospitals, ICUs, and non-ICUs in 2003–2012; central-line days at ICUs in 2003–2012 and at overall hospitals and non-ICUs in 2007–2012; ventilator days at ICUs in 2004–2012; catheter days at overall hospitals, ICUs, and non-ICUs in 2006–2012; and procedures at overall hospitals in 2005–2012 (Table 1). We estimated the annual number of HAIs prevented


through our infection control activities in each year by calculating the risk reduction from the difference in incidences between the given year and the last year, and then we calcu- lated the average annual number of HAIs prevented and the total number of HAIs prevented over the last decade. We also estimated the number of lives saved by multiplying the estimated number of infections prevented by the case fatality rates of specific HAIs and overall,1,9 and we calculated the cost savings using low and high cost estimates as previously described (Online Table S1).5,10 SAS® version 9.3 (SAS Institute Inc.,Cary,NC,USA) was used


for statistical analysis. Generalized linear models were used to examine the incidence rate difference by infection type over time. Statistical significance was calculated by comparing these regression lines to a line with a zero slope. P<.05was considered


table 1. A List of Denominator Data Used to Calculate Incidences of Healthcare-Associated Infections (HAIs) in this Study 2003


2004


Overall hospitals Patient days


No. of procedures (SSI)a Central-line days (CLABSI) Catheter days (CAUTI)


Intensive care units Patient days


Outside of intensive care units Patient days


Central-line days (CLABSI) Catheter days (CAUTI)


2005 2006 2007 2008 2009 2010


2011


2012


200,914 207,783 207,570 216,716 227,623 211,889 234,054 234,637 244,131 248,974 20,161 21,510 23,449 25,311 25,929 28,616 31,250 31,501 80,869 78,469 80,838 84,025 87,448 88,134


62,147 63,050 62,387 61,327 60,357 58,981 57,740


Central-line days (CLABSI) 25,150 26,901 28,780 30,751 29,318 27,333 29,570 28,190 29,048 28,315 Catheter days (CAUTI) Ventilator days (VAP)


41,341 42,122 42,807 47,309 41,171 38,286 41,964 41,747 51,146 45,422 27,537 27,993 27,162 26,221 26,011 25,911 25,150


16,591 18,681 21,007 19,822 17,765 18,721 17,779 19,855 18,887 159,573 165,661 164,763 169,407 186,452 173,603 192,090 192,890 192,985 203,552 34,610 35,057 35,225 35,106 34,346 33,070 32,590


51,551 51,136 51,268 55,835 58,400 59,819


aThroughout, the parentheses indicate denominators used to calculate incidences of specific HAI. NOTE. SSI, surgical site infection; CLABSI, central line-associated bloodstream infection; CAUTI, catheter-associated urinary tract infection; VAP, ventilator-associated pneumonia.


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