hospital-wide surveillance of overall hai 1141
− −
figure 1. Relative proportion (A) and incidences (B) of all healthcare-associated infections (HAIs) in intensive care units (ICUs) and outside of ICUs at University of North Carolina (UNC) Hospitals, 2001–2012. In ICU settings, HAI incidence fell from 16.84 to 8.37 infections per 1,000 patient days (50% reduction, incidence rate difference=
− from 5.58 to 3.75 infections per 1,000 patient days (33% reduction, incidence rate difference= 1.92, P<.001).
statistically significant. This study was approved by the Institu- tional Review Board of UNC Chapel Hill (IRB No. 06-0437).
results
Of a total of 16,579 HAIs that occurred during the 12-year study period, 6,397 HAIs occurred in ICUs (33%–44% of all HAIs each year) and 10,182 HAIs occurred in non-ICU settings (56%–67% of all HAIs each year) (Figure 1). The incidence of overall HAIs throughout UNC Hospitals decreased significantly from 7.90 in 2003 to 4.60 in 2012 infections per 1,000 patient days (ie, 42% reduction, incidence rate difference=
− 3.39, P<.001).
incidences of HAIs by specific infection site in overall UNC Hospitals are provided in Figure 2 and Table 2. Overall at UNC Hospitals, the relative proportions of BSI and UTI decreased by 13% and 5%, and the incidence of RTI remained unchanged, but the incidences of SSI and C. difficile infection (CDI) increased by 9% and 16%, respectively. The relative proportion of other types of HAI approximately doubled throughout UNC Hospitals from 2001 to 2012. Overall at UNC Hospitals, the
Relative proportion of HAIs by major infection site and
8.39, P<.001). In non-ICU settings, the HAI incidence fell −
− incidence rate difference for BSI was 1.53 infections per 1,000
patient days (P<.001); for pneumonia the incidence rate dif- ference was
per 1,000 patient days (P<.001). However, the incidence rates of LRTI, SSI, and other types of HAI remained unchanged. In other types of HAI, the incidence rate differences for cardio- vascular system infections, gastrointestinal infections, and skin and soft-tissue infections were (P=.003), and
and for UTI the incidence rate difference was −
0.19 (P<.001), +0.53 0.20 (P<.001) per 1,000 patient days,
respectively. The incidences of bone and joint infection, eye, ear, nose, throat, or mouth infections, central nervous system infection, reproductive tract infection, and systemic infection in overall UNC Hospitals were <0.1 infections per 1,000 patient days. The incidence rate differences for CLABSI, VAP, and CAUTI were days,
− − −
1.39 (P=.001) infections per 1,000 central-line 4.52 (P<.001) infections per 1,000 ventilator days, and 3.20 (P=.005) infections per 1,000 catheter days, respectively.
Thus, there was a striking reduction in such device-associated infections. Importantly, the incidence of CDI increased sig- nificantly from 0.11 in 2003 to 0.81 in 2012 per 1,000 patient days throughoutUNC Hospitals (ie, a 636%increase, incidence
0.50 infections per 1,000 patient days (P<.001); −
1.55 infections
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