Health care-associated infections in hospitals continue to decline

Major Finding: Since 2008, central line-associated bloodstream infections in facilities from all 50 states and the District of Columbia have declined 41% and surgical site infections have declined 17%, with catheter-associated urinary tract infections showing a decline of 7% since 2009.

Data Source: The data come from 3,472 facilities’ reports for central line-associated bloodstream infections, 1,807 facilities’ reports for catheter-associated urinary tract infections and 2,130 facilities’ reports for surgical site infections, which occurred during the 2011 calendar year, included in reports submitted up through Sept. 4, 2012.

Disclosures: The study was funded by the U.S. Centers for Disease Control and Prevention. No disclosures were noted.

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Implementing best practices will continue to boost improvements

The CDC report on health care–associated infections is great news. It shows that we have been making significant and substantial progress in the often preventable infections that occur in our hospitals. Reductions of 41% (CLABSI) are very impressive. This is a significant number of patients who did not get infected, receive otherwise unnecessary antibiotics and remain in the hospital longer than necessary. This also represents a significant cost savings. As we strive for improved value for our patients – higher quality care at lower costs – improvements like this are amazing.

One interesting finding is that, while there are reductions in CAUTIs and SSIs, they are not as significant as those with CLABSI. I think part of this has to do with the research into CLABSI and the fact that it lent itself well to the use of protocols and checklists, which are easily adopted by institutions. Peter Pronovost’s 2006 New England Journal of Medicine study detailed the 66% reduction in CLABSI throughout Michigan ICUs via the use of a simple checklist. SSIs also lend themselves to "protocol-ization." CAUTIs are slightly more difficult because a different human factor is introduced – the convenience and wishes of the patient. We need to continue educating our patients about CAUTIs and developing protocols that make the early removal of catheters the norm rather than the exception.

Physicians should be proud of their efforts in reducing health care–associated infections. We need to continue working hard to sustain these gains and identify other areas where similar interventions will yield positive outcomes. Sustained education and intervention will get us close to the HHS goals by the end of 2013, if not achieve them outright. One simple method of preventing health care–associated infections is to (a) implement a standardized checklist of proven steps to reduce said infections, and (b) empower members of the health care team to stop the provider when those steps are not being followed. A team approach, both in the development and implementation of these protocols, is essential to initial and sustained success.

Dr. Michael Pistoria is an internal medicine specialist and hospitalist at Allentown Hospital and Bethlehem Hospital in New Jersey. He is a senior fellow of the Society of Hospital Medicine and served as lead editor of the publication "Core Competencies in Hospital Medicine," which defined hospitalists’ roles. He made these comments in an e-mail interview with this news organization.


The rates of three major types of health care–associated infections have continued to decrease in U.S. hospitals, according to a new report from the Centers for Disease Control and Prevention.

The rate of central line–associated bloodstream infections (CLABSI) is down nationally by 41%, catheter-associated urinary tract infections (CAUTI) are down by 7%, and surgical site infections (SSI) for a combined 10 surgical procedures are down by 17%.

These declines are measured against the 2008 baseline rates of CLABSIs, CAUTIs and SSIs reported when the U.S. Department of Health and Human Services established its 5-year goals for reducing health care–associated infections by the end of 2013. The HHS goals include reducing CLABSIs by 50%, CAUTIs by 25%, and SSIs by 25%. The American College of Surgeons and the CDC have partnered to develop the means to report, measure, and prevent health care–associated infections, and the ACS has been instrumental in collecting and submitting standard SSI measure data and other data to the CDC’s National Healthcare Safety Network (NHSN) and the ACS’s National Surgical Quality Improvement Program (NSQIP).

“One thing these numbers show us is the complexity of achieving im­ provement,” said Dr. Clifford Y. Ko, MD, MS, FACS, Director of the American College of Surgeons (ACS) Division of Research and Optimal Patient Care. “The College’s recent effort with the Joint Commission Center for Transforming Healthcare to reduce SSI has shown us that SSIs are very multifactorial, and not every provider or facility has the same is­ sues to address.

“Similarly, even the measurement and analytical techniques used in this study can be improved upon,” Dr. Ko added. “While better than they used to be, we know through ACS NSQIP®[the College’s National Surgical Quality Improvement Program] that we can measure and feedback risk-adjusted infection rates on all procedures, not just 10. This is important for gaining traction with all providers because it will likely require the effort of all providers to achieve system- wide, sustained improvement.”

Paul J. Malpiedi and associates at the CDC reported the findings in the 2011 National and State Healthcare-Associated Infections Standard Infection Ratio Report. Mr. Malpiedi’s team compared the standard infection ratios (SIRs) between 2010 and 2011 to determine progress in preventing health care–associated infections.

Standard infection ratios developed at the national, state, and facility levels compare the number of infections that actually occurred to the number that would be expected based on the referent years: 2008 for CLABSIs and SSIs, and 2009 for CAUTIs. The standard infection ratios were adjusted to account for hospital type, hospital size (based on bed number), and hospital affiliation with a medical school.

Mr. Malpiedi’s team analyzed the data reported for the 2011 calendar year to the NHSN from 3,472 facilities for CLABSIs, 1,807 facilities for CAUTIs and 2,130 facilities for SSIs, based on reports submitted through Sept. 4, 2012. Non–acute care hospitals, outpatient dialysis facilities, inpatient dialysis wards, long-term care facilities, and outpatient surgical settings were excluded from the analysis.

A total of 18,113 CLABSIs were reported during 2011, compared with 30,617 that were predicted to occur based on the 2008 referent population, for an SIR of 0.592. This 41% reduction is an improvement over the 2010 reduction of 32%. With a median SIR of 0.469, half the reporting facilities in 2011 had reduced their CLABSIs by 53%. The lowest rate of CLABSIs was reported in ICUs, where the infections had declined 44% since 2008.

The number of facilities reporting infection data increased from 2010 to 2011. The 3,472 facilities in 50 states and the District of Columbia that reported data for CLABSIs represented a 55% increase from those reporting in 2010. The 2011 data came from 12,122 patient care locations, which included 5,722 ICUs (47%), 5,436 wards (45%) and 946 NICUs (8%).

The overall reduction in CAUTIs was less substantial, with no significant overall change since 2010. The 7% reduction in CAUTIs, with an SIR of 0.93, came from 14,315 reported CAUTIs, compared to the 15,398 predicted infections based on the 2009 referent population. Specifically, CAUTIs in wards declined about 15% while the infection rates in ICUs remained unchanged.

When only the 550 facilities that reported in both 2010 and 2011 were included in the analysis, the reduction since 2010 was statistically significant. A total of 1,807 facilities in 50 states and the District of Columbia reported CAUTI data, an 84% increase from the 2010 number of 981 reporting facilities. The 6,402 patient care locations included in the CAUTI data came from 2,633 ICUs (41%) and 3,769 wards (59%).

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