HAI: A Patient’s Worst Nightmare July 22, 2015 Peg Gilbert, RN, MS, CIC Outline • Background • Impact • National and state HAI incidence • Mandatory reporting • Measurement • Surveillance • Key terms • Definitions, CLABSI, CAUTI, CDI • HAI prevention strategies • Guidelines • Emerging issues - infection prevention . The Impact of HAIs • One in 25 U.S. patients/day contracts an HAI during the course of their hospital care • Steps can be taken to control and prevent HAI in a variety of settings • Research shows that when healthcare teams take specific steps to prevent them, rates can decrease by more than 70 percent CDC HAI Prevalence Survey Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care– Associated Infections. N Engl J Med 2014;370:1198-208 Major Site of Infection Estimated No. Pneumonia 157,500 Gastrointestinal Illness 123,100 Urinary Tract Infections 93,300 Primary Bloodstream Infections 71,900 Surgical site infections from any inpatient surgery 157,500 Other types of infections 118,500 Estimated total number of infections in hospitals 721,800 Estimates of HAIs Occurring in Acute Care Hospitals in the United States, 2011 Healthcare Facility HAI Reporting to CMS via NHSN – Current and Proposed Requirements HAI Event Facility Type Reporting Start Date CLABSI Acute Care Hospitals (IPPS only) Adult, Pediatric, and Neonatal ICUs Select Medical and Surgical Ward Locations January 2011 January 2015 CAUTI Acute Care Hospitals (IPPS only) Adult and Pediatric ICUs Select Medical and Surgical Ward Locations January 2012 January 2015 SSI Acute Care Hospitals (IPPS only) Colon and abdominal hysterectomy January 2012 I.V. antimicrobial start, Dialysis Facilities January 2012 Positive blood culture Dialysis Facilities January 2012 Signs of vascular access infection Dialysis Facilities January 2012 CLABSI, CAUTI Long Term Care Hospitals October 2012 CAUTI Inpatient Rehabilitation Facilities October 2012 MRSA Bacteremia LabID Event Acute Care Hospitals (IPPS only) Long Term Care Hospitals January 2013 January 2015 C. difficile LabID Event Acute Care Hospitals (IPPS only) Long Term Care Hospitals January 2013 January 2015 HCW Influenza Vaccination Acute Care Hospitals (IPPS only) Long Term Care Hospitals & IRF January 2013 October 2014 HCW Influenza Vaccination ASCs October 2015 CLABSI, CAUTI PPS Cancer Facilities, all special care locations January, 2013 Overall National Incidence Trend • 46 percent decrease in CLABSI between 2008 and 2013 • 19 percent decrease in SSI related to the 10 select procedures tracked in the report between 2008 and 2013 • 6 percent increase in CAUTI between 2009 and 2013 • 8 percent decrease in MRSA bacteremia between 2011 and 2013 • 10 percent decrease in C.difficile infections between 2011 and 2013 Centers for Disease Control and Prevention.2013 National and State Healthcare-Associated Infections Progress Report. Published January 14, 2015.Available at www.cdc.gov/hai/progress-report/index.html