hospital-wide surveillance of overall hai 1143
table 2. Overall Incidences of Healthcare-Associated Infections (HAIs) by Specific Infection Site in UNC Hospitals, 2003–2012 Incidencea
Infection Type 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 BSI
2.07 2.00 1.67 1.37 1.12 1.06 0.84 0.84 0.61 0.67 RTI
Pneumonia VAP
Non-VAP LRTI
UTI SSI
CLABSI …… …… 2.63 2.31 2.07 1.82 1.26 1.37 Non-CLABSI 0.37 0.30 0.35 0.20 0.19 0.21 0.12 0.19 0.16 0.18 1.32 1.28 1.25 1.02 0.82 1.15 1.00 0.94 0.95 0.74 0.84 0.81 0.82 0.65 0.53 0.66 0.53 0.45 0.40 0.38 … 6.57 5.78 4.09 3.63 4.67 3.04 2.31 2.22 1.80 0.36 0.41 0.30 0.25 0.22 0.27 0.29 0.28 0.22 0.25 0.46 0.45 0.42 0.33 0.27 0.46 0.43 0.48 0.49 0.33 2.30 2.23 2.37 1.99 2.17 1.54 1.11 1.30 1.13 0.96
Other CDI CVS
EENT GI
CNS
REPR SST SYS
All HAIs
CAUTI …… … 5.02 5.71 3.86 2.98 3.15 2.58 2.36 Non-CAUTI …… … 0.55 0.59 0.41 0.32 0.49 0.51 0.42 …… 1.23 1.25 1.22 1.31 1.39 1.17 0.99 0.94 0.11 0.11 0.31 0.32 0.37 0.32 0.28 0.55 0.79 0.81
Other non-CDI 0.83 0.80 0.54 0.61 0.45 0.35 0.34 0.33 0.29 0.23 BJ
0 0 0.01 0 0 0.01 0 0 0.01 0
0.20 0.20 0.12 0.12 0.05 0.09 0.07 0.05 0.01 0.01 0.05 0.05 0.03 0.06 0.04 0.02 0.04 0.03 0.04 0.02 0.28 0.27 0.41 0.42 0.47 0.37 0.33 0.60 0.83 0.85 0.05 0.05 0.02 0.02 0.04 0.03 0.01 0.01 0.01 0.02 0
0
0.32 0.31 0.24 0.31 0.19 0.14 0.13 0.18 0.16 0.13 0.02 0.02
0.01 0
0.01 0.01
0 0
0.03 0.01 0.02 0.01 0.01
0 0 0 7.90 7.64 7.33 6.55 6.19 5.99 5.11 5.40 5.05 4.59 0 0
Incidence Rate −
− − −
Difference −
−1.53 −1.39 −0.2
−0.48 −0.5
−4.52 −0.12
0.005
−1.55 −3.2 −0.1
−0.28 0.66
−0.6 0.003
−0.19 −0.02 −0.53 0.03 0.02 0.2
0.02 3.39
P Value <.001
.001 .004 .004
<.001 <.001 .028 .929
<.001 .005 .379 .078
<.001 <.001 .53
<.001 .059 .003 .018 .155
<.001 .016
<.001
NOTE. BSI, bloodstream infection; CLABSI, central-line–associated bloodstream infection; RTI, respiratory tract infection; Pneumonia, pneu- monia; VAP, ventilator-associated pneumonia; LRTI, lower respiratory tract infection; UTI, urinary tract infection; CAUTI, catheter-associated urinary tract infection; SSI, surgical site infection; CDI, Clostridium difficile infection, BJ, bone and joint infection; CVS, cardiovascular system infection; EENT, eye, ear, nose, throat, or mouth infection; GI, gastrointestinal infection; CNS, central nervous system infection; REPR,
reproductive tract infection; SST, skin and soft-tissue infection; SYS, systemic infection. aIncidences of device-associated infections (CLABSI, VAP, and CAUTI) and SSI were calculated as infections per 1,000 device days and infections per 100 procedures, respectively. Incidences of HAI except those device-associated infections and SSI were calculated as the number of infections per 1,000 patient days. The data (…) were not available.
SSI), butrecentdataonhospital-wide HAIs, including
non-ICU patients, are scarce. Hospital-wide HAIs may be underestimated by targeted surveillance because such surveil- lance detectsHAIs only in high-risk areas (eg, ICUs), on specific units, associated with certain services, or at specific infection sites (eg, device-associated HAIs). Our previous study showed that targeted surveillancemissed approximately 50%ofHAIs that are not included in published NHSN reports, compared with com- prehensive hospital-wide surveillance (ie, all hospital units, all HAIs).12 Other studies that focused only on CLABSI have described the burden of these infections outside the ICUs.13–15 As a result of comprehensive hospital-wide surveillance and
infection control measures over the last decade, the outcomes at UNC Hospitals during the study period were estimated as 700 overall HAIs prevented, 40 lives saved, and cost savings of more than $10 million. Our hospital-wide surveillance was conducted by 2.4 professional full-time equivalents (FTEs) and 5 infection preventionist FTEs in the UNC Hospital system (860 beds: 171 ICU beds and 689 non-ICU beds). Staff chan- ged occasionally. According to a survey to members of the
Society for Healthcare Epidemiology of America,16 the median numbers of physician FTEs and infection control practitioner FTEs in facilities larger than 600 beds were 1.00 (range, 0–10) and 3.9 (range, 0.13–6.1), respectively. Staff allocation to implement surveillance in our hospital was likely to be affordable and within the range of the survey results. Although there was concern regarding the incremental workload cost of HAI surveillance, our labor costs corresponded to less than half the annual cost saved based on physician earnings ($151,000–$200,000) and infection preventionist earnings ($69,339–$99,024) by region.16,17 The frequencies of other types of HAI due to CDI and non-
CDI doubled in 2012. We previously described “other” types of HAI and pathogens causing such infections.18 This study pro- vides further details regarding incidences of 8 specific “other” types of HAI in both ICU and non-ICU settings at UNC Hos- pitals over the last decade. For CDI, an additional 20 other HAI types were associated with costs ofmore than $100,000 per year. Gastrointestinal infections are now increasing, and C. difficile was our most common healthcare-associated pathogen atUNC
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140