Healthcare-Associated Infections (HAIs) and Antimicrobial Use Prevalence Survey

Purpose

Healthcare-associated infections are a major public health problem in U.S. hospitals and are becoming more prevalent in non-acute care settings such as nursing homes. Prevalence surveys provide critical information on the burden and types of HAIs affecting patients in these settings as well as the prescribing quality of antimicrobial drugs.

Goals and Objectives

• Estimate HAI prevalence in a large sample of U.S. acute care inpatients and nursing home residents.
• Determine the distribution of HAI by pathogen (including antimicrobial-resistant pathogens) and major infection site.
• Estimate the prevalence and describe the indications for antimicrobial use in a large sample of U.S. acute care inpatients and nursing home residents.
• Identify changes in HAI and antimicrobial use prevalence, burden and epidemiology over time.
• Describe the quality of antimicrobial drug prescribing in selected clinical circumstances. 

Activities

In 2009, the Centers for Disease Control and Prevention (CDC) conducted a single city pilot point prevalence survey. The Rochester/New York State EIP participated in a limited roll-out survey conducted at three area hospitals in 2010. A full-scale survey was conducted in 2011 in 23 hospitals in the Western NY region and repeated in 2015 in 22 hospitals.

In 2013-2014, Rochester/New York State EIP participated in a pilot study using similar methods in three nursing homes. With the changing delivery of health care in the U.S. from hospitals to non-hospital settings, additional efforts to effectively measure and prevent HAIs in non-acute care hospital settings were initiated. Nursing homes and skilled nursing facilities have been identified by the U.S. Department of Health and Human Services as a priority area for monitoring the occurrence of HAIs and implementing programs to reduce HAIs. In 2017, a full-scale survey was conducted in nursing homes. The goal of this survey was to provide reliable estimates of the national burden of HAI and antibiotic use among nursing home residents.

More information about the survey can be found on the CDC's website.

Publications

• Thompson ND, Stone ND, Brown CJ, Dumyati G, Felsen CB, et al. Antimicrobial Use in a Cohort of US Nursing Homes, 2017. JAMA. 2021;325(13):1286–1295. doi:10.1001/jama.2021.2900 
• Magill SS, O’Leary E, Ray SM, Dumyat G et al. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals.  JAMA 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; Nadie J; Thompson DL; Sharmin S; Pierce R; Zhang AY; Ocampo V; Maloney M; Greissman S; Wilson LE; Dumyati G; Edwards JR; Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011. Clinical infectious diseases 2020; Epub 2020 Jun 10.  

• Penna AR, Sancken CL, Stone ND, Eure TR, Bamberg W, Barney G, Barter D, Carswell S, Clogher P, Dumyati G, Felsen CB, Frank L, Godine D, Johnston H, Kainer MA, Li L, Lynfield R, Mahoehney JP, Nadle J, Pierce R, Ray SM, Davis SS, 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 criteria. Infect. Control Hosp Epidemiol. 2020 April 28; 1-3. doi: 10:1017/ice.2020.77. Online ahead of print.

• S.S. Magill, E. O’Leary, S.J. Janelle, D.L. Thompson, G. Dumyati, J. Nadle, L.E. Wilson, M.A. Kainer, R. Lynfield, S. Greissman, S.M. Ray, Z. Beldavs, C. Gross, W. Bamberg, M. Sievers, C. Concannon, N. Buhr, L. Warnke, M. Maloney, V. Ocampo, J. Brooks, T. Oyewumi, S. Sharmin, K. Richards, J. Rainbow, M. Samper, E.B. Hancock, D. Leaptrot, E. Scalise, F. Badrun, R. Phelps, and J.R. Edwards. Changes in Prevalence of Health Care - Associated Infections in U.S. Hospitals. 2018 Oct.;N Engl. J. Med.; 379:1732-44.
• 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 Residents. Infect. Control Hosp Epidemiol. 2017 Aug;38(8):998-1001. doi: 10.1017/ice.2017.96.
• 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 Homes. Infect Control Hosp Epidemiol. 2016 Oct 3:1-6.
• Nicola D. Thompson, Lisa LaPlace, Lauren Epstein, Deborah Thompson, Ghinwa Dumyati, Cathleen Concannon, Gail Quinlan, Tory Witten, Linn Warnke, Ruth Lynfield, Meghan Maloney, Richard Melchreit, Nimalie D. Stone. Prevalence of Antimicrobial Use and Opportunities to Improve Prescribing Practices in U.S. Nursing Homes. Journal of the American Medical Directors Association, Available online 14 October 2016.
• 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,. Prevalence of antimicrobial use in US acute care hospitals. May-September 2011. JAMA. 2014 Oct 8; 312(14):1438-46.
• 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, . Multistate point-prevalence survey of healthcare-associated infections. The New England Journal of Medicine. 2014 Mar 27; 370(13):1198-208.
• Fridkin S, Baggs J, Fagan R, Magill S, Pollack LA, Malpiedi P, Slayton R, Khader K, Rubin MA, Jones M, Samore MH, Dumyati G, Dodds-Ashley E, Meek J, Yousey-Hindes K, Jernigan J, Shehab N, Herrera R, McDonald CL, Schneider A, Srinivasan A. Vital signs: improving antibiotic use among hospitalized patients. MMWR. Morbidity and mortality weekly report. 2014 Mar 7; 63(9):194-200.