State of infection prevention in US hospitals enrolled in the National Health and Safety Network
This report provides a national cross-sectional snapshot of infection prevention and control programs and clinician compliance with the implementation of processes to prevent health care–associated infections (HAIs) in intensive care units (ICUs).
All hospitals, except Veterans Affairs hospitals, enrolled in the National Healthcare Safety Network (NHSN) were eligible to participate. Participation involved completing a survey assessing the presence of evidence-based prevention policies and clinician adherence and joining our NHSN research group. Descriptive statistics were computed. Facility characteristics and HAI rates by ICU type were compared between respondents and nonrespondents.
Of the 3,374 eligible hospitals, 975 provided data (29% response rate) on 1,653 ICUs, and there were complete data on the presence of policies in 1,534 ICUs. The average number of infection preventionists (IPs) per 100 beds was 1.2. Certification of IP staff varied across institutions, and the average hours per week devoted to data management and secretarial support were generally low. There was variation in the presence of policies and clinician adherence to these policies. There were no differences in HAI rates between respondents and nonrespondents.
Guidelines for IP staffing in acute care hospitals need to be updated. In future work, we will analyze the associations between HAI rates and infection prevention and control program characteristics, as well as the inplementation of and clinician adherence to evidence-based policies.
[Show abstract] [Hide abstract]
ABSTRACT: Knowing the temporal trend central line-associated bloodstream infection (CLABSI) rates among U.S. pediatric intensive care units (PICUs), the current extent of central line bundle compliance, and the impact of compliance on rates is necessary to understand what has been accomplished and can be improved in CLABSI prevention. This is a longitudinal study of PICUs in National Healthcare Safety Network hospitals and a cross-sectional survey of directors and managers of infection prevention and control departments regarding PICU CLABSI prevention practices, including self-reported compliance with elements of central line bundles. Associations between 2011-2012 PICU CLABSI rates and infection prevention practices were examined. Reported CLABSI rates decreased during the study period, from 5.8 per 1,000 line days in 2006 to 1.4 in 2011-2012 (P < .001). Although 73% of PICUs had policies for all central line prevention practices, only 35% of those with policies reported ≥95% compliance. PICUs with ≥95% compliance with central line infection prevention policies had lower reported CLABSI rates, but this association was statistically insignificant. There was a nonsignificant trend in decreasing CLABSI rates as PICUs improved bundle policy compliance. Given that few PICUs reported full compliance with these policies, PICUs increasing their efforts to comply with these policies may help reduce CLABSI rates. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.American journal of infection control 05/2015; 43(5):489-93. DOI:10.1016/j.ajic.2015.01.006 · 2.33 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Health care-associated infection (HAI) rates have fallen with the development of multifaceted infection prevention programs. These programs require ongoing investments, however. Our objective was to examine the cost-effectiveness of hospitals' ongoing investments in HAI prevention in intensive care units (ICUs). Five years of Medicare data were combined with HAI rates and cost and quality of life estimates drawn from the literature. Life-years (LYs), quality-adjusted LYs (QALYs), and health care expenditures with and without central line-associated bloodstream infection (CLABSI) and/or ventilator-associated pneumonia (VAP), as well as incremental cost-effectiveness ratios (ICERs) of multifaceted HAI prevention programs, were modeled. Total LYs and QALYs gained per ICU due to infection prevention programs were 15.55 LY and 9.61 QALY for CLABSI and 10.84 LY and 6.55 QALY for VAP. Reductions in index admission ICU costs were $174,713.09 for CLABSI and $163,090.54 for VAP. The ICERs were $14,250.74 per LY gained and $23,277.86 per QALY gained. Multifaceted HAI prevention programs are cost-effective. Our results underscore the importance of maintaining ongoing investments in HAI prevention. The welfare benefits implied by the advantageous ICERs would be lost if the investments were suspended. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.American Journal of Infection Control 01/2015; 43(1):4-9. DOI:10.1016/j.ajic.2014.07.014 · 2.33 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE To describe the use of antimicrobial stewardship policies and to investigate factors associated with implementation in a national sample of acute care hospitals. DESIGN Cross-sectional survey. PARTICIPANTS Infection Control Directors from acute care hospitals participating in the National Healthcare Safety Network (NHSN). METHODS An online survey was conducted in the Fall of 2011. A subset of hospitals also provided access to their 2011 NHSN annual survey data. RESULTS Responses were received from 1,015 hospitals (30% response rate). The majority of hospitals (64%) reported the presence of a policy; use of antibiograms and antimicrobial restriction policies were most frequently utilized (83% and 65%, respectively). Respondents from larger, urban, teaching hospitals and those that are part of a system that shares resources were more likely to report a policy in place (P<.01). Hospitals located in California were more likely to have policy in place than in hospitals located in other states (P=.014). CONCLUSION This study provides a snapshot of the implementation of antimicrobial stewardship policies in place in U.S. hospitals and suggests that statewide efforts in California are achieving their intended effect. Further research is needed to identify factors that foster the adoption of these policies. Infect Control Hosp Epidemiol 2014;00(0): 1-4.Infection Control and Hospital Epidemiology 03/2015; 36(3):261-4. DOI:10.1017/ice.2014.50 · 3.94 Impact Factor