US officials see decreases in healthcare-linked infections

Apr 19, 2012 (CIDRAP News) – An analysis of data from thousands of US facilities indicates that rates of certain common types of healthcare-associated infections (HAIs) declined in 2010, especially those linked to central intravenous lines, the Centers for Disease Control and Prevention (CDC) reported today.

The analysis shows that the frequency of central line–associated bloodstream infections (CLABSIs) in 2010 was 32% lower than in the CDC's baseline comparison period of 2006 through 2008, the agency said. More modest improvements were reported for catheter-associated urinary tract infections (CAUTIs) and surgical site infections (SSIs).

The report also says that the number of hospitals reporting HAIs to the CDC increased sharply in 2010, which was attributed to federal funding and to requirements for hospitals involved in Medicare's Hospital Inpatient Quality Reporting Program. The report includes breakdowns of HAI numbers by state.

Also today, the US Department of Health and Human Services (HHS) posted an updated version of its National Action Plan to eliminate HAIs and invited public comments on it. The plan sets goals for percentage reductions in nine types of HAIs.

The CDC assessed the frequency of CLABSIs and SSIs by comparing the 2010 numbers with those recorded during the 2006 to 2008 baseline period. For CAUTIs the baseline year was 2009.

The agency adjusted statistically for several risk factors that have been found to be most associated with differences in HAI rates. The report does not include any data on deaths or other outcomes attributed to HAIs.

With 2,389 facilities reporting, the CDC network cited a total of 13,812 CLABSIs in 2010, as compared with a baseline-predicted total of 20,184, a 32% decrease, according to the report. The CDC said 21 states showed decreases in CLABSIs, which contributed to the overall progress and suggests that improvements were not limited to particular regions.

The 32% decrease in CLABSIs in 2010 compares with a 15% decrease in 2009, which indicates that the facilities that reported during both years improved on their success in 2010, the CDC said.

The report shows that 9,995 CAUTIs were reported by 1,086 facilities in 2010, which is about 6% lower than what would have been expected from the 2009 baseline level.

For SSIs, 1,385 facilities reported 4,737 infections related to 529,038 procedures in 2010, which was down about 8% from the baseline prediction, but this decrease was not statistically significant when the comparison was limited to facilities that reported in both 2009 and 2010.

Of 10 types of surgery analyzed, one showed much greater improvement than the rest. Infections linked to coronary artery bypass graft surgeries were 18% lower than the baseline period and were significantly better than in 2009, which was about 4% below the baseline.

"Stable reductions" were observed for just two of the nine other types of surgery: knee arthroplasty, 11%, and colon surgery, 9%, the report says. It adds, "Overall, there appears to be great room for improvement across the variety of operative procedures."

The number of facilities that reported CLABSI numbers to the CDC network increased by about 800 in 2010, while the number reporting SSI data increased by about 400, the CDC reported. The agency said reporting was probably spurred by federal funding to support state-based HAI detection and prevention programs in the second half of 2009 and to the requirements for hospitals participating in the Medicare and Medicaid quality reporting program.

The report also notes that as of December 2011, 22 states required or had plans to require healthcare facilities to use the CDC network for reporting HAIs.

In May 2010 the CDC announced that data from 17 states indicated that CLABSIs in the first half of 2009 were down 18% from the 2006-2008 baseline period. At that point health officials cited a goal of reducing CLABSIs 50% by the end of 2013.

In a press release about the updated HAI action plan today, HHS officials said that every day, about 1 in every 20 patients has an infection related to his or her hospital care. The release notes the reductions cited in the CDC report and also says that methicillin-resistant Staphylococcus aureus infections have decreased about 18% from the baseline period.

However, rates of Clostridium difficile infections remain at historic highs, the release says. While many HAIs declined in the 2000s, hospitalizations linked to C difficile tripled during the decade before leveling off, it states. The pathogen kills about 14,000 Americans annually.

See also:

Apr 19 CDC press release about the HAI report

CDC HAI report homepage

Main results table in the HAI report

HHS National Action Plan to Prevent HAIs

Apr 19 HHS news release on comment period for the above action plan

May 27, 2010, CIDRAP News story on CDC report showing CLABSIs dropped in 2009

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