Journal of General Internal Medicine

, Volume 27, Issue 7, pp 773–779 | Cite as

Preventing Hospital-Acquired Infections: A National Survey of Practices Reported by U.S. Hospitals in 2005 and 2009

  • Sarah L. Krein
  • Christine P. Kowalski
  • Timothy P. Hofer
  • Sanjay Saint
Original Research



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.


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.


infection prevention hospitals patient safety 


  1. 1.
    Klevens RM, Edwards JR, Richards CL, et al. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Rep. 2007;122:160–7.PubMedGoogle Scholar
  2. 2.
    Wenzel RP, Edmond MB. Team-based prevention of catheter-related infections. New Engl J Med. 2006;355(26):2781–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med. 1999;27(5):887–92.PubMedCrossRefGoogle Scholar
  4. 4.
    Burke JP. Patient safety: infection control - a problem for patient safety. New Engl J Med. 2003;348(7):651–6.PubMedCrossRefGoogle Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    Harbarth S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect. 2003;54(4):258–66.PubMedCrossRefGoogle Scholar
  7. 7.
    Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New Engl J Med. 2006;355(26):2725–32.PubMedCrossRefGoogle Scholar
  8. 8.
    O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol. 2002;23(12):759–69.PubMedCrossRefGoogle Scholar
  9. 9.
    Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53(RR-3):1–36.PubMedGoogle Scholar
  10. 10.
    Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31(4):319–26.PubMedCrossRefGoogle Scholar
  11. 11.
    Yokoe DS, Mermel LA, Anderson DJ, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(Suppl 1):S12–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Krein SL, Hofer TP, Kowalski CP, et al. Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clin Proc. 2007;82(6):672–8.PubMedGoogle Scholar
  13. 13.
    Krein SL, Kowalski CP, Damschroder L, Forman J, Kaufman SR, Saint S. Preventing ventilator-associated pneumonia in the United States: a multicenter mixed-methods study. Infect Control Hosp Epidemiol. 2008;29(10):933–40.PubMedCrossRefGoogle Scholar
  14. 14.
    Saint S, Kowalski CP, Kaufman SR, et al. Preventing hospital-acquired urinary tract infection in the United States: A national study. Clin Infect Dis. 2008;46:243–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates. Vol. 73: Federal Register; 2008:48471–91.Google Scholar
  16. 16.
    Saint S, Meddings JA, Calfee D, Kowalski CP, Krein SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med. 2009;150(12):877–84.PubMedGoogle Scholar
  17. 17.
    Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA. 2006;295(3):324–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Meier BM, Stone PW, Gebbie KM. Public health law for the collection and reporting of health care-associated infections. Am J Infect Control. 2008;36(8):537–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Dillman D. Mail and Internet Surveys: the tailored design method New York: J. Wiley; 2000.Google Scholar
  20. 20.
    Lo E, Nicolle L, Classen D, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(Suppl 1):S41–50.PubMedCrossRefGoogle Scholar
  21. 21.
    Coffin SE, Klompas M, Classen D, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(Suppl 1):S31–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(Suppl 1):S22–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Kollef MH, Afessa B, Anzueto A, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;300(7):805–13.PubMedCrossRefGoogle Scholar
  24. 24.
    HHS Action Plan to Prevent Healthcare-Associated Infections: Prevention - Targets and Metrics. 2010: U.S. Department of Health and Human Services. Available at: Accessed October 18, 2011.
  25. 25.
    Allegranzi B, Pittet D. Preventing infections acquired during health-care delivery. Lancet. 2008;372(9651):1719–20.PubMedCrossRefGoogle Scholar
  26. 26.
    Dougherty D, Conway PH. The "3 T's" road map to transform US health care: the "how" of high-quality care. JAMA. 2008;299(19):2319–21.PubMedCrossRefGoogle Scholar
  27. 27.
    Pronovost PJ, Goeschel CA, Wachter RM. The wisdom and justice of not paying for "preventable complications". JAMA. 2008;299(18):2197–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Meddings J, Rogers MA, Macy M, Saint S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis. 2010;51(5):550–60.PubMedCrossRefGoogle Scholar
  29. 29.
    Hooton TM, Bradley SF, Cardenas DD, et al. 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. 2010;50(5):625–63.PubMedCrossRefGoogle Scholar
  30. 30.
    Edwards JR, Peterson KD, Mu Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37(10):783–805.PubMedCrossRefGoogle Scholar
  31. 31.
    National Nosocomial Infections Surveillance (NNIS). System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32(8):470–85.CrossRefGoogle Scholar
  32. 32.
    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 Accessed October 18, 2011.

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Sarah L. Krein
    • 1
    • 2
    • 3
  • Christine P. Kowalski
    • 1
    • 3
  • Timothy P. Hofer
    • 1
    • 2
    • 3
  • Sanjay Saint
    • 1
    • 2
    • 3
  1. 1.VA Ann Arbor Healthcare SystemVA Ann Arbor Center for Clinical Management Research and the Hospital Outcomes Program of Excellence (HOPE)Ann ArborUSA
  2. 2.Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.VA/UM Patient Safety Enhancement ProgramAnn ArborUSA

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