CDC Reports Major Progress in Decreasing Healthcare-Associated Infections

Acute care hospitals reduced Clostridium difficile infections by 12%, central line-associated bloodstream infections by 9%, and catheter-associated urinary tract infections by 8% between 2017 and 2018, according to the 2018 National and State Healthcare-Associated Infections (HAI) Progress Report issued today by the US Centers for Disease Control and Prevention (CDC). The report updates 2015 benchmark data, and shows that there has been “significant progress” made across the board.

Still, much more needs to be done the CDC notes, adding that about 1 in 31 US patients get at least 1 infection associated with hospital care every day. About 35,000 Americans die of antibiotic-resistant infections each year, or 1 every 15 minutes.

The “report demonstrates notable progress, yet the threat is still real,” CDC Director Robert Redfield, MD, said at today’s press briefing. 

The CDC used data collected by the agency’s National Healthcare Safety Network (NHSN) that is fed from more than 22,000 hospitals. Investigators also found that methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections decreased by 6%, infections after abdominal hysterectomy by 5%, infection after colon surgery by 7%, and ventilator-associated events by 20%.

Investigators used the standardized infection ratio (SIR) to measure HAIs by dividing the number of observed infections by the number of predicted infections. 

“For example, if 1 hospital only had 5 infections within the course of a year, and yet had 10 HAIs predicted, its SIR would then be .50,” the CDC explains (the prediction is based upon where the hospital is located.) “For this reason, healthcare facilities aim for their SIRs to be as far below 1 as possible.” 

For instance, this was how the 12% reduction in C. difficile was calculated, according to the CDC: “Among the 3,205 [acute-care hospitals] in the United States with enough data to calculate an SIR, 12% had an SIR significantly higher (worse) than 0.71, the value of the national SIR.”

There was a “significant” reduction in C. difficile, with 3,669 hospitals reporting 69,648C. difficile infections in 2018, representing a 29% decrease from 2015. 

Some states still struggle with the problem. 

The 10 states showing the highest (or poor) scores are: Nebraska (0.83), Illinois (0.83), West Virginia (0.84), Colorado (0.88), New Hampshire (0.89), Alaska (0.89), Rhode Island (0.93), New Mexico (0.95), Wyoming (0.90) and North Dakota (0.96). 

The 10 states showing the lowest (or good) scores are: Hawaii (0.53), Montana (0.54), Alabama (0.56), Florida (0.60), Virginia (0.62), Oklahoma (0.63), South Dakota (0.64), Texas (0.64), Maine (0.65), and Kentucky (0.65).

The report categorizes threats as urgent, serious, or concerning.

One of the urgent threats is Candida auris, a fungal infection that seems resistant to antifungal drugs. “It’s a pathogen we didn’t even know about when we put out the last report in 2013,” said Michael Craig, CDC’s senior adviser for antibiotic resistance coordination and strategy. “And since then it has circumnavigated the globe and caused a lot of infections and deaths as it has spread.”

Also on the urgent list: drug-resistant gonorrhea and carbapenem-resistant Enterobacteriaceae, which can fend off carbapenem antibiotics. These bacteria often cause urinary tract infections for which antibiotics are prescribed. 

The release of today’s report heralds the CDC’s US Antibiotic Awareness Week next week. About 30% of antibiotics prescribed in the US are prescribed unnecessarily. The CDC adds that “at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result.”