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Healthcare-Associated Infections (HAIs) and Antimicrobial Use Prevalence Survey

Purpose

Healthcare-associated infections (HAIs) are a major public health problem in U.S. hospitals.  The purpose of the prevalence survey is to provide critical information on the burden and types of HAIs affecting patients in U.S. hospitals as well as the prescribing quality of antimicrobial drugs.

Goals and Objectives

  • Estimate HAI prevalence in a large sample of U.S. acute care inpatients.
  • Determine the distribution of HAI by pathogen (including antimicrobial-resistant pathogens) and major infection site.
  • Estimate the prevalence and describe the indications for antimicrobial use in a large sample of U.S. acute care inpatients.
  • Identify changes in HAI and antimicrobial use prevalence, burden and epidemiology over time.
  • Estimate the burden of HAIs and antimicrobial use in the United States.
  • Describe the quality of antimicrobial drug prescribing in selected clinical circumstances. 

Activities

In 2009, the Centers for Disease Control and Prevention (CDC) conducted a single city pilot point prevalence survey. The New York EIP participated in a (phase 2) limited roll-out survey conducted at 3 area hospitals in 2010. A full-scale survey (phase 3) was conducted in 2011 at 183 hospitals in the United States; 23 of which were in New York. The CDC’s goal is to conduct the survey every 4-5 years. The phase 4 point prevalence survey was conducted again in 2015, featuring a more robust data collection with the intent to compare results to previous surveys, future surveys and to surveys conducted in Europe. Over 200 hospitals in ten states were captured in phase 4, including 22 hospitals in western and central New York. 

In 2013-14, the NYEIP was one of four states to participate in a pilot Nursing Home Prevalence Survey (NHPS). With the changing delivery of healthcare in the U.S. from hospitals to non-hospital settings, additional efforts to effectively measure and prevent HAIs in non-acute care hospital settings have been initiated. Nursing homes and skilled nursing facilities have been identified by the US Department of Health and Human Services as a priority area for monitoring the occurrence of HAIs and implementing programs to reduce HAIs, (www.hhs.gov/ash/initiatives/hai/actionplan/index.html#Phase3:Long-TermCareFacilities). There was no reliable estimate of the national burden of HAI in skilled nursing facilities, as previous estimates were based on studies conducted in the 1970s, 1980s and 1990s in a limited number of facilities.   

The primary objectives of the prevalence survey effort are to: 1) Implement revised HAI definitions designed for use in residents of certified nursing facilities; 2) Evaluate the feasibility of using prevalence survey methods to perform surveillance and the usability of data collection instruments in certified nursing facilities 3) Identify changes to methods and instruments, and necessary training or education needs for certified nursing facility staff related to conducting a prevalence survey in certified nursing facilities. This effort will also determine if the implementation, methods, instruments and operational procedures developed are suitable for scale-up. Publications featuring information garnered from the NHPS are listed below, and the NYEIP is currently gearing up for a full scale NHPS to be conducted in 12-20 facilities in a seven-county region in 2017.

Publications

  • Epstein L, Stone ND, LaPlace L, Harper J, Lynfield R, Warnke L, Whitten T, Maloney M, Melchreit R, Rodriguez R, Quinlan G, Concannon C, Dumyati G, Thompson DL, Thompson N.  Comparison of Data Collection for Healthcare-Associated Infection Surveillance in Nursing Homes, Infect Control Hosp Epidemiol. 2016 Oct 3:1-6. Article Link
  • Nicola D. Thompson, Lisa LaPlace, Lauren Epstein, Deborah Thompson, Ghinwa Dumyati, Cathleen Concannon, Gail Quinlan, Tory Witten, Linn Warnke, Ruth Lynfield, Meghan Maloney, Richard Melchreit, Nimalie D. Stone. Prevalence of Antimicrobial Use and Opportunities to Improve Prescribing Practices in U.S. Nursing Homes, Journal of the American Medical Directors Association, Available online 14 October 2016. Article Link
  • Magill SS, Edwards JR, Beldavs ZG, Dumyati G, Janelle SJ, Kainer MA, Lynfield R, Nadle J, Neuhauser MM, Ray SM, Richards K, Rodriguez R, Thompson DL, Fridkin SK,. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA. 2014 Oct 8; 312(14):1438-46. Article Link
  • Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson DL, Wilson LE, Fridkin SK, . Multistate point-prevalence survey of healthcare-associated infections. The New England journal of medicine. 2014 Mar 27; 370(13):1198-208. Article Link
  • Fridkin S, Baggs J, Fagan R, Magill S, Pollack LA, Malpiedi P, Slayton R, Khader K, Rubin MA, Jones M, Samore MH, Dumyati G, Dodds-Ashley E, Meek J, Yousey-Hindes K, Jernigan J, Shehab N, Herrera R, McDonald CL, Schneider A, Srinivasan A, . Vital signs: improving antibiotic use among hospitalized patients. MMWR. Morbidity and mortality weekly report. 2014 Mar 7; 63(9):194-200. Article Link