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URMC / Center for Community Health & Prevention / Surveillance & Prevention / Emerging Infections Program / Healthcare-Associated Infections (HAI) and Antimicrobial Use Prevalence Surveys

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


Healthcare-associated infections (HAIs) are a major public health problem in U.S. hospitals and are becoming more prevalent in non-acute care settings such as nursing homes. Prevalence surveys provide critical information on the burden and types of HAIs affecting patients in these settings 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 and nursing home residents.
  • 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 and nursing home residents.
  • Identify changes in HAI and antimicrobial use prevalence, burden and epidemiology over time.
  • Estimate the burden of HAIs and antimicrobial use in the U.S.
  • Describe the quality of antimicrobial drug prescribing in selected clinical circumstances. 


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 limited roll-out survey conducted at 3 area hospitals in 2010. A full-scale survey was conducted in 2011 in 23 hospitals in the Western NY region and again in 2015 in 22 hospitals.

In 2013-4, Rochester EIP participated in a pilot study using similar methods in three nursing homes. 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, ( In 2017, a full-scale survey was conducted in nursing homes. The goal of this survey was to provide reliable estimates of the national burden of HAI among nursing home residents.


  • S.S. Magill, E. O’Leary, S.J. Janelle, D.L. Thompson, G. Dumyati, J. Nadle, L.E. Wilson,
    M.A. Kainer, R. Lynfield, S. Greissman, S.M. Ray, Z. Beldavs, C. Gross, W. Bamberg,
    M. Sievers, C. Concannon, N. Buhr, L. Warnke, M. Maloney, V. Ocampo,
    J. Brooks, T. Oyewumi, S. Sharmin, K. Richards, J. Rainbow, M. Samper,
    E.B. Hancock, D. Leaptrot, E. Scalise, F. Badrun, R. Phelps, and J.R. Edwards. Changes in Prevalence of Health Care - Associated Infections in U.S. Hospitals. 2018 Oct.;N Engl. J. Med.; 379:1732-44. Article Link
  • 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