Hospital Acquired Infections: Still Room for Improvement

MedicalResearch.com Interview with:
Shelley S. Magill, M.D., Ph.D.
From the Centers for Disease Control and Prevention
Emory University School of Medicine
Atlanta, Georgia

MedicalResearch.com: What are the main findings of the study?

Dr. Magill: The results of this survey show that healthcare-associated infections continue to be a threat to patient safety in U.S. acute care hospitals. Among the more than 11,000 patients included in the survey, approximately 4% (or 1 in 25) had at least one healthcare-associated infection at the time of the survey. We used these results to develop national estimates of healthcare-associated infections. We estimated that in 2011, there were approximately 721,800 healthcare-associated infections in U.S. acute care hospitals. The most common types of infections were surgical site infections (SSIs), pneumonias, and gastrointestinal infections.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Magill: One surprise was the number of pneumonias detected in patients who were not on mechanical ventilators. When we think about pneumonia occurring in hospital patients, many times we think of ventilator-associated pneumonia affecting patients in the intensive care unit. In this survey, we found that fewer than half (39%) of the pneumonias detected in the survey were in patients on mechanical ventilators. That means that a relatively large proportion of all healthcare-associated infections (about 13%) were these non-ventilator-associated pneumonias. We are currently working to learn more about these events, their clinical significance, and how to prevent them.

There were two other findings that were somewhat unexpected. Overall, the device-associated infections, such as central line-associated bloodstream infections, which have been a focus of successful prevention efforts, accounted for just about 26% of all the healthcare-associated infections detected in the survey. Another important finding was that more than half of the non-procedure-associated healthcare-associated infections had their onset outside of the intensive care unit.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Magill: I think it’s important to know that while there has been good progress made in preventing certain types of healthcare-associated infections, such as central line-associated bloodstream infections, we in public health and the healthcare community have a lot of work to do. Every provider can play a role in preventing healthcare-associated infections and making healthcare safer.

Doctors, nurses, and other healthcare providers can remove temporary medical devices from patients as soon as possible, practice good hand hygiene in caring for patients, and prescribe antibiotics wisely.

There are several things patients can do to protect themselves, such as insisting that everyone washes their hands before they provide care, and taking antibiotics only as prescribed (http://www.cdc.gov/HAI/patientSafety/patient-safety.html).

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Magill: As I’ve already mentioned, we really want to know more about the non-ventilator-associated pneumonias that are occurring in hospital patients. In addition to that, ventilator-associated pneumonias remain a real challenge, both from the standpoint of surveillance and prevention. CDC has recently changed its approach to surveillance for ventilator-associated pneumonia, and we are eager to know more about preventing those events that are being detected and reported using this new surveillance approach.

Citation:

Multistate Point-Prevalence Survey of Health Care–Associated Infections

Shelley S. Magill, M.D., Ph.D., Jonathan R. Edwards, M.Stat., Wendy Bamberg, M.D., Zintars G. Beldavs, M.S., Ghinwa Dumyati, M.D., Marion A. Kainer, M.B., B.S., M.P.H., Ruth Lynfield, M.D., Meghan Maloney, M.P.H., Laura McAllister-Hollod, M.P.H., Joelle Nadle, M.P.H., Susan M. Ray, M.D., Deborah L. Thompson, M.D., M.S.P.H., Lucy E. Wilson, M.D., and Scott K. Fridkin, M.D. for the Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team

N Engl J Med 2014; 370:1198-1208
March 27, 2014DOI: 10.1056/NEJMoa1306801

 

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