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1146 infection control & hospital epidemiology october 2015, vol. 36, no. 10


device-associated infections,3–5,26 and currently, device- associated infections account for only 26% of HAIs in the United States.11 Importantly, the incidence of non-device infections, which are not currently assessed by NHSN, is not changing.26 Furthermore, our study showed that the incidence of SSI in hospital-wide settings remained unchanged (24% reduction only), and most SSIs occurred in non-ICU units after surgical procedures. Our data on SSI may not have included all SSIs after discharge and in outpatient clinics because follow-up of SSI is difficult, and no standard validated surveillance method exists. A survey in Washington State reported that 95% of acute care hospitals conducted post-discharge SSI surveillance by various methods without consistency among hospitals.27 In the United States, the most common types of HAI were SSI (21.8%) and pneumonia.11 Owens et al28 reported that 90% of visits for SSIs after ambu- latory surgery procedures involved treatment in the inpatient setting. Therefore, our data regarding HAI incidence over the last decade also highlight the importance of healthcare epide- miology and infection control for SSIs and non-device- associated infections including BSIs, RTIs, and UTIs. In summary, we demonstrated the substantial reductions in


hospital, rigorous and continuous bundled approaches of prevention strategies allow significant reduction of device- associated infections, which ultimately led to a reduction in overall HAIs over the last decade. Detailed descriptions of intervention strategies to control HAIs, including improved compliance with hand hygiene, new devices (eg, chlorhexidine patch for central IV sites), and new methods of terminal room disinfection (eg, UV light), are beyond the scope of this study. Several studies have described the decreasing trend of the


HAIs, lives saved, and cost savings related to comprehensive hospital-wide HAI surveillance and infection control measures over the last decade. Point-prevalence surveys of HAIs at multiple centers have several limitations regarding representa- tiveness and validation for data collection and the use of formula of prevalence to incidence conversions.11,29 Thus, this study, even at single tertiary care facility, has the strength of longitudinal data regarding all HAIs through comprehensive hospital-wide sur- veillance, including HAIs that could not be detected by targeted surveillance. Our study also provides new insight regarding HAIs outsideICUsaswellas “other” HAIs, suggesting the necessity of further infection prevention and control efforts.


acknowledgments


The authors thank Judie Bringhurst, Sherie Goldbach, Maria Gergen at Hospital Epidemiology, University of North Carolina Health Care, andAmy Powell, Kirk Huslage at Statewide Programfor Infection Control and Epidemiology (SPICE), University of North Carolina, for their efforts and contributions. Financial support. This study was supported by internal funding from UNC


Health Care. H.K. received financial support necessary for studying abroad from the


Naito Foundation and the Kanae Foundation for the Promotion of Medical Science.


Potential conflicts of interest. All authors report no conflicts of interest


relevant to this article. Address correspondence to Hajime Kanamori, MD, PhD, MPH, Hospital


Epidemiology, UNC Health Care, 1001 West Wing CB #7600, 101 Manning Drive, Chapel Hill, NC 27514 (kanamori@med.unc.edu).


supplementary material


To view supplementary material for this article, please visit http://dx.doi.org/10.1017/ice.2015.142


references


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3. Yokoe DS, Mermel LA, Anderson DJ, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29:S12–S21.


4. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.


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6. Centers for Disease Control and Prevention; National Healthcare Safety Network. Surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_ current.pdf. Accessed August 30, 2014.


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9. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mor- tality and costs. Infect Control Hosp Epidemiol 2011;32:101–114.


10. Scott RD II. The direct medical costs of healthcare-associated infections in US hospitals and benefits of prevention. Centers for Disease Control and Prevention website. http://www.cdc.gov/hai/ pdfs/hai/scott_costpaper.pdf. Published 2009. Accessed 30 August 2014.


11. Magill SS, Edwards JR, Bamberg W, et al. Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections.NEnglJMed 2014;370:1198–1208.


12. Weber DJ, Sickbert-Bennett EE, Brown V, Rutala WA. Completeness of surveillance data reported by the national


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