Despite progress in reducing rates of intestinal, chest, and urinary tract infections transmitted to hospitalized patients, nearly three quarters of a million patients each year end up with healthcare-associated infections, says the CDC.
Hospitals have greatly improved their ability to avoid transmitting infections to patients during acute care stays, according to two reports issued Wednesday by the Centers for Disease Control and Prevention. But officials say there's a lot more work to do, especially in protecting patients from C. difficile, bacterialpneumonia, and catheter-associated urinary tract infections.
The first report, published in the New England Journal of Medicine, surveyed a sample of 11,282 patients treated at 183 hospitals in 10 states in 2011. It found that at any point in time, 4% had at least one infection transmitted within the acute care setting; they did not get infected while outside of a hospital.
Researchers extrapolating to the general hospital population in the U.S., estimated that 648,000 inpatients fought 721,800 infections in 2011. The rate has fallen considerably since 2007, when the figure was estimated to be 1.7 million. And the CDC's research in the 1970s suggested an even higher rate—2.1 million infections.
The reports show that "as a nation, we're moving in the right direction, but there's a great deal of work still to be done," Michael Bell, MD, deputy director of the CDC's division of healthcare quality promotion, said during a news conference. He cautioned, however, that "Despite the progress we've seen, three quarters of a million patients every year end up with healthcare-associated infections."
In a telephone interview Tuesday, CDC medical epidemiologist Shelley Magill, MD, senior author of the journal report, explained that the study was particularly important because it categorizes with greater detail than ever which parts of the body hospital-acquired infections affect. This information helps hospitals pay more attention to those areas where improvements are needed.
For example, surgical site infections and pneumonia tied for first place, with nearly 22% of all infections each. They were followed by gastrointestinal infections, mainly caused by C.diff. An unexpected finding was that a large portion of patients who had a healthcare-associated pneumonia did not have a mechanical ventilator, which is a common risk factor for lung infections. Of the 10,748 patients tracked who were not on mechanical ventilators, 357 acquired pneumonia that was unrelated to a mechanical device.
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"Ventilator-associated pneumonia is still important, and I think quite challenging from a number of perspectives; we need to know more about prevention in that area. But what we didn't realize is that there is this large proportion of pneumonia happening in patients not on ventilators," Magill said. "I think we'd like to have a better handle on why those are happening."
Magill speculated that aspiration pneumonia may be the typical culprit behind non ventilator-associated pneumonias because it "can happen in patients who are sedated, don't have normal mental status while they are in the hospital, or are less able to protect their airway from secretions getting down into the lung." This is something that hospitals and the CDC "need to get a better handle on," she said.
"Our nation is making progress in preventing healthcare-associated infections through three main mechanisms: financial incentives to improve quality, performance measures and public reporting to improve transparency, and the spreading and scaling of effective interventions," Patrick Conway, MD, Deputy Administrator for Innovation and Quality for Centers for Medicare & Medicaid Services and CMS chief medical officer said in a statement.
"This progress represents thousands of lives saved, prevented patient harm, and the associated reduction in costs across our nation."
The second report includes data reported to the CDC's National Healthcare Safety Network or NHSN for six kinds of infections and compared rates over time.
It found the following trends in infections acquired within the hospital:
- Central line-associated bloodstream infections (CLABSI) dropped 44% between 2008 and 2012.
- Surgical site infections associated with colon procedures dropped 20% between 2008 and 2012.
- Infections with methicillin-resistant staphylococcus aureus (MRSA) dropped 4% between 2011 and 2012.
- C. diff infections dropped 2% between 2011 and 2012.
- Only catheter-associated urinary tract infections increased, with 3% more infections reported in 2012 than in 2011.
Paul Malpiedi, health scientist with the CDC's NHSN, said during a telephone interview Tuesday that the NHSN data represents infections that hospitals are incentivized to report through the Centers for Medicare & Medicaid quality reporting programs.
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Asked to which programs he thinks are responsible for the success, Malpiedi replied, "We're aware of prevention success throughout the country due to a variety of efforts led by the CDC as well as the U.S. Department of Health and Human Services. Light has been shined on the problem of healthcare-associated infections, and I think that as facilities start reporting data and are able to see where they have problems, they can implement interventions in different parts of their hospitals."
He credited national collaborative programs such as CUSP (Comprehensive Unit-based Safety Program), and bundles and checklists for prevention protocols, "which have demonstrated the ability to make serious progress and I think we're seeing some spillover from that."
In a statement Wednesday, American Hospital Association President Rich Umbdenstock called the CDC reports a reminder for hospitals and clinicians "that our work is not done. The quality journey is a marathon, not a sprint… Hospitals have worked hard to achieve these results, but will not be satisfied until we reach zero infections."
He credited the CUSP program and the federal Hospital Engagement Networks or HENs, for helping hospitals make quality and safety improvements, especially in central line-associated bloodstream infections."
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Daniel Diekema, MD, president, Society for Healthcare Epidemiology of America said in a statement, "This progress is the direct result of the ongoing efforts of healthcare workers across the country who are dedicated to improving patient care and outcomes." He emphasized that more funding for HAI prevention research "is essential" for further improvements.