HAI and Antibiotic Use Prevalence Survey
As part of the Emerging Infections Program’s (EIP) Healthcare-Associated Infections Community Interface (HAIC) this project examines the numbers and types of healthcare-associated infections (HAIs), the types of antimicrobial medications (such as antibiotics), and the reasons antimicrobial medications are used in hospitals and nursing homes. This information will help create policies and procedures to make healthcare safer for patients in U.S. healthcare facilities.
CDC estimates that on any given day, 1 in 31 hospital patients and 1 in 43 nursing home residents has an HAI (an infection while being treated in a medical facility). In addition, CDC estimates that on any given day, about half of hospital patients and 1 in 12 nursing home residents receive an antimicrobial medication.
HAIs can have devastating effects on physical, mental/emotional, and financial health. In addition, they cost billions of dollars in added expenses to the healthcare system.
Research suggests that a growing number of HAIs are caused by pathogens (germs) that are outsmarting the antimicrobial medications typically used to fight them. These are known as antibiotic-resistant germs. Inappropriate or unnecessary use of antimicrobial medications contributes to the development of antibiotic resistance.
Improving Patient Safety
A data collection tool used to identify the number of people with a disease or condition at a specific point in time.
To prevent HAIs and improve antimicrobial medication prescribing in healthcare facilities, we must understand:
- The number of HAIs
- The type of HAIs, including those resistant to antimicrobial medications
- How antimicrobial medications are prescribed in healthcare facilities
- The most common antimicrobial medications prescribed and why
The EIP HAI and Antimicrobial Use Prevalence Survey examines the problem of HAIs and how antimicrobial medications are used in hospitals and nursing homes.
A type of medication used to treat infections caused by germs such as
Improper use of these medications causes germs to become resistant so that the medications no longer work.
Hospital Survey Overview
This EIP Hospital Survey gathers data on all types of HAIs across all acute care inpatients in hospitals, including those HAIs not routinely tracked by the National Healthcare Safety Network (such as infections that are not associated with a medical device or procedure).
The survey is done in hospitals in the EIP states. Each participating hospital picks a day to do the survey. A sample of patients in the hospital on that day is included, and data collectors review medical records to gather information on infections and antimicrobial medication use. For selected patients, additional information is gathered to evaluate the quality of antimicrobial medication prescribing. The most recent hospital survey was conducted in 2015.
The results of the hospital surveys help to
- Improve methods to collect data on HAIs
- Create policies and procedures to reduce HAIs
- Support appropriate use of antimicrobial drugs
Phase 1 (2009)
A pilot survey was conducted in 9 acute care hospitals in Jacksonville, Florida. The main objective was to test the survey design and data collection.
Phase 2 (2010)
A limited roll-out survey was conducted in 22 acute care hospitals in 10 EIP states. This helped improve the design of the full-scale survey conducted in Phase 3.
Phase 3 (2011)
A full-scale survey was conducted in 183 acute care hospitals in 10 EIP states.
Phase 4 (2015-2016)
Data collection for this survey was expanded to be able to describe the quality of antimicrobial medication prescribing. Overall, 12,299 patients in 199 acute care hospitals in 10 EIP states were included in the survey. Hospital survey dates occurred between May and September 2015, and data collection took place during 2015–2017.
- Estimate HAI number and frequency
- Identify HAIs by
- germs (including antimicrobial-resistant pathogens)
- major infection site
- Describe the indications for antimicrobial use
- Identify changes in HAI and antimicrobial use prevalence, burden and epidemiology over time
- Describe the quality of antimicrobial medication prescribing in selected clinical circumstances
In each site, hospitals were selected for participation if they had previously participated in the 2011 survey. The goal was to include up to 25 hospitals in each EIP site. After recruiting hospitals that had participated in the 2011 survey, EIP sites recruited additional hospitals, up to a total of 25, using a stratified random sample based on hospital bed size. Hospital participation was voluntary. Each hospital selected a single survey day between May and September 2015. The number of patients in each hospital who were included in the survey was determined based on the size of the hospital, and the patient sample was randomly selected from the inpatient census on the survey day. Medical records were reviewed by EIP staff members, and in some cases by hospital staff members, to collect demographic and clinical data. Detailed information on infections and antimicrobial drug use was collected by trained EIP staff members.
Hospital Survey Publications
Magill SS, O’Leary E, Ray SM, Kainer M, Evans C, Bamberg W, Johnston H, Janelle S, Oyewumi, T, Lynfield R, Rainbow J, Warnke L, Nadle J, Thompson D, Sharmin S, Pierce R, Zhang A, Ocampo V, Maloney M, Greissman S, Wilson L, Dumyati G, Edwards J, Chea N, Neuhauser M, Emerging Infections Program Hospital Prevalence Survey Team. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals. external iconJAMA Netw Open. 2021;4(3):e212007. doi:10.1001/jamanetworkopen.2021.2007
Magill SS, O’Leary E, Ray SM, Kainer MA, Evans C, Bamberg WM, Johnston H, Janelle SJ, Oyewumi T, Lynfield R, Rainbow J, Warnke L, Nadle J, Thompson DL, Sharmin S, Pierce R, Zhang AY, Ocampo V, Maloney M, Greissman S, Wilson LE, Dumyati G, Edwards JR; Emerging Infections Program Hospital Prevalence Survey Team. Antimicrobial Use in US Hospitals: Comparison of Results from Emerging Infections Program Prevalence Surveys, 2015 and 2011.external icon Clin Infect Dis 2020 Jun 10;ciaa373. doi: 10.1093/cid/ciaa373.
Magill SS, O’Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, Wilson LE, Kainer MA, Lynfield R, Greissman S, Ray SM, Beldavs Z, Gross C, Bamberg W, Sievers M, Concannon C, Buhr N, Warnke L, Maloney M, Ocampo V, Brooks J, Oyewumi T, Sharmin S, Richards K, Rainbow J, Samper M, Hancock EB, Leaptrot D, Scalise E, Badrun F, Phelps R, Edwards JR; Emerging Infections Program Hospital Prevalence Survey Team. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals.external icon N Eng J Med. 2018 Nov 1;379(18):1732-1744. doi: 10.1056/NEJMoa1801550.
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; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Prevalence of antimicrobial use in US acute care hospitals, May-September, 2011external icon. JAMA. 2014 Oct 8;312(14):1438-46. doi: 10.1001/jama.2014.12923.
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; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infectionsexternal icon. N Engl J Med. 2014 Mar 27;370(13):1198-208. doi: 10.1056/NEJMoa1306801.
Magill SS, Hellinger W, Cohen J, Kay R, Bailey C, Boland B, Carey D, de Guzman J, Dominguez K, Edwards J, Goraczewski L, Horan T, Miller M, Phelps M, Saltford R, Seibert J, Smith B, Starling P, Viergutz B, Walsh K, Rathore M, Guzman N, Fridkin S. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Floridaexternal icon. Infect Control Hosp Epidemiol. 2012 Mar;33(3):283-91. doi: 10.1086/664048. Epub 2012 Jan 12.
Hospital Survey Abstracts
Magill SS, Wilson LE, Thompson DL, Ray SM, Nadle J, Lynfield R, Janelle SJ, Kainer MA, Greissman S, Dumyati G, Beldavs Z, Edwards JR. Reduction in the prevalence of healthcare-associated infections in U.S. acute care hospitals, 2015 versus 2011.external icon
Magill SS, Mcallister LM, Allen-Bridson K, Bamberg W, Baumbach J, Beldavs Z, Concannon C, Crist MB, Dumyati G, Duran J, Edwards J, Godine D, Harper JE, Henry K, Horan T, Kainer MA, Lawson P, Lynfield R, Makvandi M, Melchreit R, Morrell G, Nadle J, Neuhauser M, Perry L, Rainbow J, Ray SM, Reingold A, Rodriguez R, Smith R, Srinivasan A, Thomas A, Thompson D, White N, Wilson L, Fridkin SK. Preliminary Results of a Healthcare-Associated Infection and Antimicrobial Use Prevalence Survey in 22 U.S. Acute Care Hospitalsexternal icon.
Magill SS, McAllister L, Neuhauser M, Beldavs ZG, Dumyati G, Duran J, Edwards J, Kainer MA, Lynfield R, Melchreit R, Nadle J, Ray SM, Thompson D, Wilson L, Fridkin S. Point Prevalence Survey of Antimicrobial Use in U.S. Acute Care Hospitalsexternal icon.
Hocevar SN, Fridkin S, Edwards JR, Nadle J, Janelle SJ, Rodriguez R, Ray SM, Richards K, Lynfield R, Thompson D, Dumyati G, Beldavs ZG, Kainer MA, Magill SS. Epidemiology of Pediatric Healthcare-Associated Infections and Antimicrobial Use in U.S. Acute Care Hospitalsexternal icon
Nursing Home Survey
Stone N, et al. Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infect Control Hosp Epi 2012;33:965-977.
Nursing Home Survey Overview
This EIP Nursing Home Survey gathers data on all types of HAIs in nursing homes. For this survey, infections are defined using the revised McGeer definitions for infections in Long-Term Care Facilities.
In addition to providing data on the number and type of HAIs and antimicrobial medications in nursing homes, the survey will:
- Discover the risk factors for getting HAIs
- Identify the types of antimicrobial medications used and which are most common
- Discover the situations in which antimicrobials are prescribed that may be contributing to resistance
This information can be used to
- Create new local or national policies to reduce HAIs
- Improve future HAI research and tracking efforts
- Improve proper use of antimicrobial medications
Phase 1 (2013-2014)
A pilot survey was conducted in 9 nursing homes in 4 EIP states (Connecticut, Minnesota, New Mexico, and New York). The main objective was to test the survey design and data collection procedures.
Phase 2 (2017)
The first full-scale survey was in 2017 and included 161 nursing homes in 10 EIP states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee). This survey gathered additional data on antimicrobial prescribing for urinary tract infections.
- Estimate the number and type of HAIs
- Describe the types and reasons for antimicrobial use.
- Describe the quality of antimicrobial drug prescribing in selected clinical circumstances.
In each site, nursing homes were randomly selected for participation. Nursing home participation was voluntary. The goal was to recruit up to 20 nursing homes in each EIP state. Each nursing home selected a single survey day between April and September 2017. Residents medical records were reviewed to collect data and information on antimicrobials and infections. Medical record reviews were performed by EIP staff members, and in some cases with assistance from nursing home staff members. Residents newly admitted to the nursing home were not included.
Nursing Home Survey Publications
Thompson N, Stone N, Brown C, Penna A, Eure T, Bamberg W, Barney G, Barter D, Clogher P, DeSilva M, Dumyati G, Frank L, Felsen C, Godine D, Irizarry L, Kainer M, Li L, Lynfield R, Mahoehney JP, Maloney M, Nadle J, Ocampo V, Pierce R, Ray S, Shrum Davis S, Sievers M, Srinivasan K, Wilson L, Zhang A, Magill SS, Antimicrobial Use in a Cohort of US Nursing Homes, 2017.external icon 2021;325(13):1286–1295. doi:10.1001/jama.2021.2900
Penna A, Sancken CL, Stone ND, Eure TR, Bamberg W, Barney G, Barter D, Carswell S, Clogher P, Dumyati G, Epson E, Felsen CB, Frank L, Godine D, Irizarry L, Johnston H, Kainer M, Li L, Lynfield R, Mahoehney JP, Nadle N, Pierce R, Ray SM, Shrum Davis S, Sievers M,, Wilson LE, Zhang AY, Magill SS, Thompson ND. Documentation of Acute Change in Mental Status in Nursing Homes Highlights Opportunity to Augment Infection Surveillance Criteriaexternal icon. Infect Control Hosp Epidemiol. 2020;41:848–850.
Thompson ND, Penna A, Eure T, Bamberg W, Barney G, Barter D, Clogher P, DeSilva M, Dumyati G, Epson E, Frank L, Godine D, Irizarry L,, Kainer MA, Li L, Lynfield R, Mahoehney JP, Nadle J, Ocampo V, Perry L, Ray S, Shrum S, Sievers M, Wilson LE, Zhang AY, Stone ND, Magill SS. Use of Antibiotics for Urinary Tract Infection in U.S. Nursing Home Residents.external icon J Am Med Dir Assoc. 2020; 21(1):91-96.
Eure T, LaPlace LL, Melchreit R, Maloney M, Lynfield R, Whitten T, Warnke L, Dumyati G, Quinlan G, Concannon C, Thompson D, Stone ND, Thompson ND. Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residentsexternal icon. Infect Control Hosp Epidemiol. 2017; 8:998-1001.
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 ND. Comparison of Data Collection for Healthcare-Associated Infection Surveillance in Nursing Homesexternal icon. Infect Control Hosp Epidemiol. 2016 Dec;37(12):1440-1445. Epub 2016 Oct 3.
Thompson ND, LaPlace L, Epstein L, Thompson D, Dumyati G, Concannon C, Quinlan G, Witten T, Warnke L, Lynfield R, Maloney M, Melchreit R, Stone ND. Prevalence of Antimicrobial Use and Opportunities to Improve Prescribing Practices in U.S. Nursing Homesexternal icon. J Am Med Dir Assoc. 2016 Dec 1;17(12):1151-1153. doi: 10.1016/j.jamda.2016.08.013. Epub 2016 Oct 14.
ND Thompson, ND Stone, C Brown, A Penna, TR Eure, G Barney, D Barter, P Clogher, G Dumyati, E Epson, CB Felsen, L Frank, D Godine, L Irizarry, H Johnston, MA Kainer, L Li, R Lynfield, JP Mahoehney, J Nadle, VLS Ocampo, SM Ray, M Samper, S Shrum Davis, M Sievers, K Srinivasan, L Wilson, A Zhang, SS Magill. Prevalence and Epidemiology of Healthcare-Associated Infections (HAI) in US Nursing Homes (NH), 2017 | Infection Control & Hospital Epidemiology | Cambridge Coreexternal icon Infection Control and Hospital Epidemiology, 2020;41(S1); S45-S46.
Eure TR, Thompson ND, Penna A, Bamberg WM, Barney G, Barter D, Clogher P, DeSilva M, Dumyati G, Epson E, Felsen CB, Frank L, Godine D, Irizarry L, Johnston H, Kainer MA, Li L, Lynfield R, Mahoehney JP, Nadle J, Ocampo VLS, Ray S, Samper ME, Shrum Davis S, Sievers M, Srinivasan K,, Wilson LE, Zhang AY, Magill SS, Stone ND. Appropriateness of Initiating Antibiotics for Urinary Tract Infection among Nursing Home Residents. Poster Presentation. 6th Decennial International Conference on Healthcare-Associated Infections. Atlanta, GA. March 28th, 2020
Thompson ND, Brown CJ, Eure T, Penna A, Bamberg W, Barney G, Barter D, Clogher P, Desilva M, Dumyati G, Epson E, Frank L, Godine D, Irizarry L, Kainer M, Lynfield R, Mahoehney JP, Maloney M, Morabit S, Nadle J, Ocampo V, Pierce R, Ray SM, Shrum S, Sievers M, Wilson LE, Stone, ND Magill SS. Prevalence and epidemiology of antimicrobial use in US nursing homes. ID Week 2018. Joint Meeting of IDSA, SHEA, HIVMA, and PIDS. San Francisco. October 6, 2018