Device-Associated Infection Rates, Device Utilization, and Antimicrobial Resistance in Long-Term Acute Care Hospitals Reporting to the National Healthcare Safely Network, 2010

2012 ◽  
Vol 33 (10) ◽  
pp. 993-1000 ◽  
Author(s):  
Amit S. Chitnis ◽  
Jonathan R. Edwards ◽  
Phillip M. Ricks ◽  
Dawn M. Sievert ◽  
Scott K. Fridkin ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Acute Care ◽  
Methicillin Resistance ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
Central Line ◽  
Surgical Intensive Care ◽  
National Healthcare ◽  
Tract Infections

Objective.To evaluate national data on healthcare-associated infections (HAIs), device utilization, and antimicrobial resistance in long-term acute care hospitals (LTACHs).Design and Setting.Comparison of data from LTACHs and from medical and medical-surgical intensive care units (ICUs) in short-stay acute care hospitals reporting to the National Healthcare Safety Network (NHSN) during 2010.Methods.Rates of central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and ventilator-associated pneumonia (VAP) as well as device utilization ratios were calculated. For each HAI, pathogen profiles and antimicrobial resistance prevalence were evaluated. Comparisons were made using Poisson regression and the Mood median and x2 tests.Results.In 2010, 104 LTACHs reported CLABSIs and 57 reported CAUTIs and VAP to the NHSN. Median CLABSI rates in LTACHs (1.25 events per 1,000 device-days reported; range, 0.0-5.96) were comparable to rates in major teaching ICUs and were higher than those in other ICUs. CAUTI rates in LTACHs (median, 2.61; range, 0.0-9.92) were higher and VAP rates (median, 0.0; range, 0.0-3.29) were generally lower than those in ICUs. Central line utilization in LTACHs was higher than that in ICUs, whereas urinary catheter and ventilator utilization was lower. Methicillin resistance among Staphylococcus aureus CLABSIs (83%) and vancomycin resistance among Enterococcus faecalis CAUTIs (44%) were higher in LTACHs than in ICUs. Multidrug resistance among Pseudomonas aeruginosa CAUTIs (25%) was higher in LTACHs than in most ICUs.Conclusions.CLABSIs and CAUTIs associated with multidrug-resistant organisms present a challenge in LTACHs. Continued HAI surveillance with pathogen-level data can guide prevention efforts in LTACHs.Infect Control Hosp Epidemiol 2012;33(10):993-1000

scholarly journals Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017

2019 ◽  
Vol 41 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Lindsey M. Weiner-Lastinger ◽  
Sheila Abner ◽  
Jonathan R. Edwards ◽  
Alexander J. Kallen ◽  
Maria Karlsson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Healthcare Associated Infections ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Location Type

AbstractObjective:Describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015–2017 and were reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).Methods:Data from central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical site infections (SSIs) were reported from acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities. This analysis included device-associated HAIs reported from adult location types, and SSIs among patients ≥18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated for each HAI type, location type, surgical category, and surgical wound closure technique.Results:Overall, 5,626 facilities performed adult HAI surveillance during this period, most of which were general acute-care hospitals with <200 beds. Escherichia coli (18%), Staphylococcus aureus (12%), and Klebsiella spp (9%) were the 3 most frequently reported pathogens. Pathogens varied by HAI and location type, with oncology units having a distinct pathogen distribution compared to other settings. The %NS for most pathogens was significantly higher among device-associated HAIs than SSIs. In addition, pathogens from long-term acute-care hospitals had a significantly higher %NS than those from general hospital wards.Conclusions:This report provides an updated national summary of pathogen distributions and antimicrobial resistance among select HAIs and pathogens, stratified by several factors. These data underscore the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.

scholarly journals Incidence Trends of Central-Line–Associated Bloodstream Infections in Acute-Care Hospitals, NHSN, 2009–2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s294-s295
Author(s):  
Allan Nkwata ◽  
Minn Soe ◽  
Qunna Li ◽  
Dominque Godfrey-Johnson ◽  
Jonathan Edwards ◽  
...  
Keyword(s):  
Acute Care ◽  
Negative Binomial ◽  
National Level ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
The United States ◽  
Central Line ◽  
Incidence Trends ◽  
Tract Infections ◽  
Location Type

Background: Central-line–associated bloodstream infections (CLABSIs) are an important cause of healthcare-associated morbidity and mortality in the United States. CLABSI surveillance in the CDC NHSN began in 2005 and has been propelled by state CLABSI reporting requirements, first introduced in 2005, and subsequently by the CMS requirements for intensive care units (ICUs) in 2011 and select ward locations in 2015. Although trend analyses were previously reported, no recent assessment of the NHSN CLABSI incidence rate changes has been performed. In this analysis, we evaluated trends in CLABSI rates in nonneonatal ICUs and all wards reported from acute-care hospitals. Methods: CLABSI rates, including blood stream infections attributed to mucosal barrier injury reported to the NHSN from 2009 to 2018, were analyzed. To evaluate trends in CLABSI incidence and to account for the potential impact of definitional changes in catheter-associated urinary tract infections (CAUTIs) that indirectly impacted CLABSI rates, as well as the CMS mandate for select wards, we conducted an interrupted time-series analysis using negative binomial random-effects modeling with an interruption in 2015. ICUs and ward locations were analyzed separately. Models were adjusted for patient care location type and hospital-level characteristics: hospital type, medical affiliation, teaching status, bed size, number of ICU beds, and average length of inpatient stay. Random intercept and slope models were used to account for differential baseline incidence and trends among reporting hospitals. Results: The overall crude incidence of CLABSI per 1,000 central-line days decreased from 1.6 infections in 2009 to 0.9 infections in 2018, except for an increase in 2015. Similar trends were observed by location type. Among the ICUs, adjusted CLABSI incidence decreased by 10% annually in 2009–2014, increased nearly 29% in 2015, and thereafter decreased at an average of 6.8% per year. Among the wards, adjusted CLABSI incidence decreased at an average of 7.9% annually, except for a 29.3% increase in 2015. Conclusions: Substantial progress has been made in reducing CLABSIs in both ICUs and wards over the last 10 years. Indirect effects of CAUTI definitional changes may explain the immediate increase in ICUs, whereas the CMS mandate may explain the similar increase in wards in 2015. Despite this increase, these findings suggest that policies and practices aimed at prevention of CLABSI have likely been effective on a national level.Funding: NoneDisclosures: None

scholarly journals Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

2020 ◽  
Vol 41 (S1) ◽  
pp. s343-s344
Author(s):  
Margaret A. Dudeck ◽  
Katherine Allen-Bridson ◽  
Jonathan R. Edwards
Keyword(s):  
Acute Care ◽  
National Level ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
Central Line ◽  
Patient Specific ◽  
Healthcare Associated Infections ◽  
Healthcare Associated ◽  
Repeat Infection ◽  
Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

scholarly journals Catheter-Associated Bloodstream Infections in 2 Long-Term Acute Care Hospitals

2007 ◽  
Vol 28 (1) ◽  
pp. 105-106 ◽  
Author(s):  
Linda L. Wolfenden ◽  
Grant Anderson ◽  
Emir Veledar ◽  
Arjun Srinivasan
Keyword(s):  
Acute Care ◽  
Bloodstream Infections ◽  
Acute Care Hospitals

scholarly journals Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI): Descriptive Analysis of Data Reported to National Healthcare Safety Network (NHSN), 2013

2015 ◽  
Vol 37 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Lauren Epstein ◽  
Isaac See ◽  
Jonathan R. Edwards ◽  
Shelley S. Magill ◽  
Nicola D. Thompson
Keyword(s):  
Acute Care ◽  
Descriptive Analysis ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Mucosal Barrier Injury ◽  
The Impact ◽  
Clabsi Rate

OBJECTIVESTo determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line–associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN)DESIGNDescriptive analysis of 2013 NHSN dataSETTINGSelected inpatient locations in acute care hospitalsMETHODSA descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type.RESULTSFrom 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%.CONCLUSIONSAn understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest.Infect. Control Hosp. Epidemiol. 2015;37(1):2–7

scholarly journals Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

2014 ◽  
Vol 35 (S2) ◽  
pp. S89-S107 ◽  
Author(s):  
Jonas Marschall ◽  
Leonard A. Mermel ◽  
Mohamad Fakih ◽  
Lynn Hadaway ◽  
Alexander Kallen ◽  
...  
Keyword(s):  
Acute Care ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
Central Line ◽  
Guidance Document ◽  
American Hospital ◽  
American Hospital Association ◽  
Healthcare Associated ◽  
Healthcare Epidemiology ◽  
Practical Recommendations

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

scholarly journals Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017

2018 ◽  
Vol 23 (46) ◽  
Author(s):  
Carl Suetens ◽  
Katrien Latour ◽  
Tommi Kärki ◽  
Enrico Ricchizzi ◽  
Pete Kinross ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Acute Care ◽  
Long Term Care ◽  
Acute Care Hospitals ◽  
Point Prevalence ◽  
Healthcare Associated Infections ◽  
Term Care ◽  
Care Facilities ◽  
Healthcare Associated

Point prevalence surveys of healthcare-associated infections (HAI) and antimicrobial use in the European Union and European Economic Area (EU/EEA) from 2016 to 2017 included 310,755 patients from 1,209 acute care hospitals (ACH) in 28 countries and 117,138 residents from 2,221 long-term care facilities (LTCF) in 23 countries. After national validation, we estimated that 6.5% (cumulative 95% confidence interval (cCI): 5.4–7.8%) patients in ACH and 3.9% (95% cCI: 2.4–6.0%) residents in LTCF had at least one HAI (country-weighted prevalence). On any given day, 98,166 patients (95% cCI: 81,022–117,484) in ACH and 129,940 (95% cCI: 79,570–197,625) residents in LTCF had an HAI. HAI episodes per year were estimated at 8.9 million (95% cCI: 4.6–15.6 million), including 4.5 million (95% cCI: 2.6–7.6 million) in ACH and 4.4 million (95% cCI: 2.0–8.0 million) in LTCF; 3.8 million (95% cCI: 3.1–4.5 million) patients acquired an HAI each year in ACH. Antimicrobial resistance (AMR) to selected AMR markers was 31.6% in ACH and 28.0% in LTCF. Our study confirmed a high annual number of HAI in healthcare facilities in the EU/EEA and indicated that AMR in HAI in LTCF may have reached the same level as in ACH.

scholarly journals Antibiotic Multidrug Resistance of Escherichia coli Causing Device- and Procedure-related Infections in the United States Reported to the National Healthcare Safety Network, 2013–2017

2020 ◽  
Author(s):  
Athena P Kourtis ◽  
Edward A Sheriff ◽  
Lindsey M Weiner-Lastinger ◽  
Kim Elmore ◽  
Leigh Ellyn Preston ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistance ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
The United States ◽  
E Coli ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Hospital Referral

Abstract Background Escherichia coli is one of the most common causes of healthcare-associated infections (HAIs); multidrug resistance reduces available options for antibiotic treatment. We examined factors associated with the spread of multidrug-resistant E. coli phenotypes responsible for device- and procedure-related HAIs from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities, using isolate and antimicrobial susceptibility data reported to the National Healthcare Safety Network during 2013–2017. Methods We used multivariable logistic regression to examine associations between co-resistant phenotypes, patient and healthcare facility characteristics, and time. We also examined the geographic distribution of co-resistant phenotypes each year by state and by hospital referral region to identify hot spots. Results A total of 96 672 E. coli isolates were included. Patient median age was 62 years, and 60% were female; more than half (54%) were reported from catheter-associated urinary tract infections. From 2013 to 2017, 35% of the isolates were nonsusceptible to fluoroquinolones (FQs), 17% to extended-spectrum cephalosporins (ESCs), and 13% to both ESCs and FQs. The proportion of isolates co-resistant to ESCs and FQs was higher in 2017 (14%) than in 2013 (11%) (P &lt; .0001); overall prevalence and increases were heterogeneously distributed across healthcare referral regions. Co-resistance to FQs and ESCs was independently associated with male sex, central line–associated bloodstream infections, long-term acute care hospitals, and the 2016–2017 (vs 2013–2014) reporting period. Conclusions Multidrug resistance among E. coli causing device- and procedure-related HAIs has increased in the United States. FQ and ESC co-resistant strains appear to be spreading heterogeneously across hospital referral regions.

Mortality and readmission of outcomes after discharge from the surgical intensive care unit to long-term, acute-care hospitals

Surgery ◽  
2017 ◽  
Vol 161 (5) ◽  
pp. 1367-1375 ◽  
Author(s):  
Michelle C. Nguyen ◽  
David S. Strosberg ◽  
Teresa S. Jones ◽  
Ankur Bhakta ◽  
Edward L. Jones ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care
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