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%).