Preventing Hospital-Acquired Infections: A National Survey of Practices Reported by U.S. Hospitals in 2005 and 2009
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Hospital-acquired infection (HAI) is common, costly, and potentially lethal. Whether initiatives to reduce HAI—such as the Centers for Medicare and Medicaid Services (CMS) no payment rule—have increased the use of preventive practices is not known.
To examine the use of infection prevention practices by U.S. hospitals and trends in use between 2005 and 2009.
DESIGN, SETTING, AND PARTICIPANTS
Surveys of infection preventionists at non-federal general medical/surgical hospitals and Department of Veterans Affairs (VA) hospitals, which are not subject to the CMS no payment rule, in 2005 and 2009.
Percent of hospitals using practices to prevent central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI).
Survey response was approximately 70%. More than 1/2 of non-federal hospitals reported a moderate or large increase in CLABSI, VAP and CAUTI prevention as a facility priority due to the non-payment rule; over 60% of VA hospitals reported no change in priority. However, both non-federal and VA hospitals reported significant increases in use of most practices to prevent CLABSI, VAP and CAUTI from 2005 to 2009, with 90% or more using certain practices to prevent CLABSI and VAP in 2009. In contrast, only one CAUTI prevention practice was used by at least 50% of hospitals.
Since 2005, use of key practices to prevent CLABSI, VAP and CAUTI has increased in non-federal and VA hospitals, suggesting that despite its perceived importance, the non-payment rule may not be the primary driver. Moreover, while 65% of non-federal hospitals reported a moderate or large increase in preventing CAUTI as a facility priority, prevention practice use remains low.
- Klevens, RM, Edwards, JR, Richards, CL (2007) Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Rep 122: pp. 160-167
- Wenzel, RP, Edmond, MB (2006) Team-based prevention of catheter-related infections. New Engl J Med 355: pp. 2781-2783 CrossRef
- Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP (1999) Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 27: pp. 887-892 CrossRef
- Burke, JP (2003) Patient safety: infection control - a problem for patient safety. New Engl J Med 348: pp. 651-656 CrossRef
- Scott RD. (Division of Healthcare Quality Promotion National Center for Preparedness, Detection, and Control of Infectious Diseases Coordinating Center for Infectious Diseases Centers for Disease Control and Prevention). The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. 2009.
- Harbarth, S, Sax, H, Gastmeier, P (2003) The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 54: pp. 258-266 CrossRef
- Pronovost, P, Needham, D, Berenholtz, S (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. New Engl J Med 355: pp. 2725-2732 CrossRef
- O'Grady, NP, Alexander, M, Dellinger, EP (2002) Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23: pp. 759-769 CrossRef
- Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R (2004) Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 53: pp. 1-36
- Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA (2010) Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 31: pp. 319-326 CrossRef
- Yokoe, DS, Mermel, LA, Anderson, DJ (2008) A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 29: pp. S12-S21 CrossRef
- Krein, SL, Hofer, TP, Kowalski, CP (2007) Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clin Proc 82: pp. 672-678
- Krein, SL, Kowalski, CP, Damschroder, L, Forman, J, Kaufman, SR, Saint, S (2008) Preventing ventilator-associated pneumonia in the United States: a multicenter mixed-methods study. Infect Control Hosp Epidemiol 29: pp. 933-940 CrossRef
- Saint, S, Kowalski, CP, Kaufman, SR (2008) Preventing hospital-acquired urinary tract infection in the United States: A national study. Clin Infect Dis 46: pp. 243-250 CrossRef
- Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates. Vol. 73: Federal Register; 2008:48471–91.
- Saint, S, Meddings, JA, Calfee, D, Kowalski, CP, Krein, SL (2009) Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med 150: pp. 877-884
- Berwick, DM, Calkins, DR, McCannon, CJ, Hackbarth, AD (2006) The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 295: pp. 324-327 CrossRef
- Meier, BM, Stone, PW, Gebbie, KM (2008) Public health law for the collection and reporting of health care-associated infections. Am J Infect Control 36: pp. 537-551 CrossRef
- Dillman D. Mail and Internet Surveys: the tailored design method New York: J. Wiley; 2000.
- Lo, E, Nicolle, L, Classen, D (2008) Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol 29: pp. S41-S50 CrossRef
- Coffin, SE, Klompas, M, Classen, D (2008) Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 29: pp. S31-S40 CrossRef
- Marschall, J, Mermel, LA, Classen, D (2008) Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 29: pp. S22-S30 CrossRef
- Kollef, MH, Afessa, B, Anzueto, A (2008) Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 300: pp. 805-813 CrossRef
- HHS Action Plan to Prevent Healthcare-Associated Infections: Prevention - Targets and Metrics. 2010: U.S. Department of Health and Human Services. Available at: http://www.hhs.gov/ash/initiatives/hai/actionplan/hhs_hai_action_plan_final_06222009.pdf. Accessed October 18, 2011.
- Allegranzi, B, Pittet, D (2008) Preventing infections acquired during health-care delivery. Lancet 372: pp. 1719-1720 CrossRef
- Dougherty, D, Conway, PH (2008) The "3 T's" road map to transform US health care: the "how" of high-quality care. JAMA 299: pp. 2319-2321 CrossRef
- Pronovost, PJ, Goeschel, CA, Wachter, RM (2008) The wisdom and justice of not paying for "preventable complications". JAMA 299: pp. 2197-2199 CrossRef
- Meddings, J, Rogers, MA, Macy, M, Saint, S (2010) Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 51: pp. 550-560 CrossRef
- Hooton, TM, Bradley, SF, Cardenas, DD (2010) Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50: pp. 625-663 CrossRef
- Edwards, JR, Peterson, KD, Mu, Y (2009) National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 37: pp. 783-805 CrossRef
- System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32: pp. 470-485 CrossRef
- McCarthy D, Chase D. Advancing patient safety in the U.S. Department of Veterans Affairs. Commonwealth Fund pub. 1477, vol. 9 March 2011. Available at http://www.commonwealthfund.org/Content/Publications/Case-Studies/2011/Mar/Advancing-Patient-Safety.aspx. Accessed October 18, 2011.
- Preventing Hospital-Acquired Infections: A National Survey of Practices Reported by U.S. Hospitals in 2005 and 2009
Journal of General Internal Medicine
Volume 27, Issue 7 , pp 773-779
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- infection prevention
- patient safety
- Industry Sectors
- Author Affiliations
- 1. VA Ann Arbor Healthcare System, VA Ann Arbor Center for Clinical Management Research and the Hospital Outcomes Program of Excellence (HOPE), PO Box 130170, Ann Arbor, MI, USA
- 2. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- 3. VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA