HAI and Antibiotic Use Prevalence Survey

This project examines the numbers and types of Healthcare-Associated Infections (HAIs), the types of antimicrobial drugs (such as antibiotics), and the reasons antimicrobial drugs 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.

Overview

CDC estimates that on any given day, 1 in 31 hospital patients has an HAI (an infection while being treated in a medical facility).

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.

Another concern is super germs. Research suggests that a growing number of HAIs are caused by pathogens (germs) that are outsmarting the antimicrobial drugs typically used to fight them. These are known as antibiotic resistant germs.

Improving Patient Safety

What’s a Point Prevalence Survey?

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, we must understand:

  • The number of HAIs
  • The type of HAIs, including those resistant to antimicrobial drugs
  • How antimicrobial drugs are prescribed in healthcare facilities
  • The most common antimicrobial drugs prescribed and why

The EIP HAI and Antimicrobial Use Prevalence Survey examines the problem of HAIs in hospitals and nursing homes.

Hospital Survey

A type of drug used to treat infections caused by germs such as

  • Bacteria
  • Fungi
  • Viruses

Improper use of these drugs causes germs to become resistant so that the drugs no longer work.

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 (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN). 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 drug use. The most recent hospital survey was conducted in 2015.

Benefits

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, FL. 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, one-day 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 drug 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.

Objectives
  • Estimate HAI number and frequency
  • Identify HAIs by
    • pathogen (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 drug prescribing in selected clinical circumstances
Methods

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 were collected by trained EIP staff members.

Hospital Survey Publications

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

Related Publication

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.

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 in nursing homes, the survey will:

  • Discover the risk factors for getting HAIs
  • Identify the types of antimicrobial drugs used and which are most common
  • Discover the situations in which antimicrobials are prescribed that may be contributing to resistance

Benefits

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 drugs

Phase 1 (2013-2014)

A pilot survey was conducted in 9 nursing homes in 4 EIP states (CT, MN, NM, and NY). The main objective was to test the survey design and data collection procedures.

Phase 2 (2017)

A full-scale survey was conducted in 161 nursing homes in 10 EIP states (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN). This survey gathered additional data on antimicrobial prescribing for urinary tract infections. Preliminary results are expected in 2018.

Objectives
  • Estimate the number and type of HAIs
  • Describe the reasons for antimicrobial use.
  • Describe the quality of antimicrobial drug prescribing in selected clinical circumstances.
Methods

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 demographic data, and for evidence of HAIs and antimicrobial use. 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

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 N. 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.

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 Aug;38(8):998-1001. doi: 10.1017/ice.2017.96. Epub 2017 May 31.