25% reduction in sampled U.S. hospitals in 2015 versus 2011
by Michael Smith, North American Correspondent, MedPage Today October 08, 2017

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• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

SAN DIEGO — Hospitals appear to be doing better at preventing healthcare-associated infections (HAIs), a researcher said here.
A 2015 update of a 2011 point-prevalence survey showed a significant drop in HAIs over time, suggesting that national efforts to prevent the infections are having an effect, according to Shelley Magill, MD, PhD, of the CDC’s Emerging Infections Program (EIP) in Atlanta.
The decline was driven by sharp drops in skin and soft tissue infections and urinary tract infections (UTI), Magill said at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).
But some important conditions, notably pneumonia and Clostridium difficile infection, did not change significantly, suggesting there’s more work to be done, Magill said.
The 2011 survey, based on data from hospitals in the CDC’s eight EIP areas, showed that on any given day, one in 25 patients had at least one HAI, Magill said. To see if there had been changes, her group asked the same hospitals to supply 1 day’s worth of data in the same manner they had for the earlier analysis.
All told, 148 hospitals took part in both surveys. In both, they were asked to pick a day from May through September and to identify a random patient sample from the morning census. In 2011, 9,283 patients were in the sample compared with 9,169 in 2015.
In both surveys, the investigators screened for patients getting antimicrobials and found about the same proportion in each year, about 51%. About 38.6% of the patients in 2011 and 37.8% in 2915 meet a screening criterion that triggered chart review to identify an HAI, a significant decline.
The analysis also showed that more patients were being treated in large hospitals (22.8% versus 24%), but fewer had either a urinary catheter or a central line on the survey date (23.3% versus 18.8% and 19% versus 17.6%, respectively).
Overall, about one patient in 31 had an HAI in 2015 — 297 of the 9,169 patients in the survey, which was significantly better than the one-in-25 rate in 2011.
The investigators also found that:
• 1% of patients had a skin and soft tissue infection in 2011, which fell to 0.59% in 2015.
• 0.55% had a UTI, which fell to 0.35%.
• There were no significant changes in C. difficile infections, other gastrointestinal infections, or bloodstream infections.
Magill cautioned that the findings are based on a small number of hospitals and doesn’t take into account changes in diagnostics that might have led to an overestimated of C. difficile infection in 2015.
The findings are a mix of good news and bad news, commented Thomas Talbot, MD, of Vanderbilt University in Nashville, co-moderator of the IDWeek session.
On the positive side,the numbers suggest about a 25% reduction in the prevalence of HAIs, he told MedPage Today, adding that he’s encouraged to see the use of devices fall but “less encouraged” that the use of antibiotics remains at about the same level.
That difference might be a function of how the HAI problem was tackled. “The focus was on device use,” he said, “and now we’re starting to see an increased focus on antibiotic stewardship. It will be interesting to look again in another years to see what happens” with antibiotic use.
While the study really only applies to the hospitals it surveyed, Thomas said there’s good diversity geographically and in size and type of institutions, so the findings might reflect larger-scale changes.
Magill and co-authors disclosed no relevant relationships with industry.
• Primary Source
IDWeek
Source Reference: Magill SS, et al “Reduction in the prevalence of healthcare-associated infections in U.S. acute care hospitals, 2015 versus 2011” IDWeek; Abstract 1768.