May 27, 2010 (CIDRAP News) – Reports from 17 states show that one major type of healthcare-associated infection (HAI) dropped 18% in the first half of 2009, suggesting that the healthcare system is making progress in the battle against infections in hospitals, national health officials announced today.
The Centers for Disease Control and Prevention (CDC) said central line–associated bloodstream infections (CLABSIs) were down 18% compared with a baseline period of 2006 through 2008. The data come from 17 states that require healthcare facilities to report their HAI data to the CDC's National Healthcare Safety Network.
The reduction is consistent with other recent reports and suggests that the healthcare system has made a good start toward a national goal of reducing CLABSIs by 50% by the end of 2013, CDC officials said at a press conference today.
"This report gives us a snapshot of where the country stands in our efforts to prevent central line–associated bloodstream infections," said Arjun Srinavasan, MD, associate director for HAI prevention programs in the CDC's Division of Healthcare Quality Promotion. He said the findings will serve as a baseline that states can use to measure their future progress toward eliminating CLABSIs.
"The bottom line here is that this 18% shows that care in hospitals is getting safer, but there's more work to be done," Srinavasan said.
Central lines are catheters threaded into large blood vessels in the neck to administer medication and fluids. CLABSIs are among the four most common types of HAIs in acute-care hospitals, accounting for about 14% of the total, according to the Department of Health and Human Services (HHS).
The agency says that 1.7 million HAIs led to 99,000 deaths in 2002 and that such infections cost the nation $28 billion to $33 billion per year. CLABSIs are estimated to cause about 30,000 deaths a year, the Association for Professionals in Infection Control and Epidemiology (APIC) said in a statement today.
The new CDC document, titled "First State-Specific Healthcare-Associated Infections Summary Data Report," says that 4,615 CLABSIs were reported by 1,538 facilities in the 17 states. This signals a "standard infection rate," or SIR, of 0.82 (95% confidence interval, 0.80 to 0.85), or 18% fewer than predicted from the 3-year baseline data.
HHS Secretary Kathleen Sebelius said in a statement, "This reflects the hard work and dedication of those working toward CLABSI prevention. And we hope that all states and healthcare facilities will be motivated to continue and strengthen efforts for preventing CLABSIs."
Eleven of the 17 states covered in the report showed a significant reduction in CLABSIs compared with the preceding 3 years, while two had increases and the other four stayed about the same.
Maryland had the largest increase in CLABSIs relative to the baseline, and Vermont had the biggest decrease. But health officials cautioned against comparing states, because the number of infections identified may depend in part on how hard states work to validate hospital data.
"It would not be surprising to find that states with strong validation programs show higher infection rates," said Rachel Stricof, MPH, CIC, an infection preventionist in the New York State Department of Health and representative of the Council of State and Territorial Epidemiologists.
The report itself cautions against reading too much into the findings. "These are encouraging results, but they are not definitive assessments of healthcare facility performance in any state, and they are limited to an initial 6-month reporting period," it states.
The CDC plans to report in the future on other types of HAI and those occurring in facilities other than acute-care hospitals, which should lead to a fuller understanding of HAI prevention opportunities, the report says. For example, reports on infections in ambulatory surgery centers and dialysis centers will be released this summer, said Don Wright, MD, MPH, deputy assistant secretary for healthcare quality at HHS.
Dr. Neil Fishman, president of the Society for Healthcare Epidemiology of America, said an important strength of the report is that it is based on the use of standard definitions and data-collection methods, which are crucial for getting accurate information.
Stricof commented, "This report is the first to provide a transparent view of one type of healthcare-associated infection by state." Previous reports have relied on administrative data that were gathered for other purposes or were derived from a relatively small and not very representative sample of hospitals, she said.
More and more states are requiring healthcare facilities to report HAI data, Wright said in response to a question. The number has grown from 13 to 27 over the last 2 years, and "we expect that trend to continue," he said.
The report was hailed as a "landmark" by Russell Olmsted, MPH, CIC, president-elect of APIC. He said the findings demonstrate that HAIs can be prevented, adding, "We feel that this report furthers our goal of greater transparency within healthcare and ultimately will lead us toward elimination of HAIs."
As noted in the document, the report is a product of a federal-state cooperative agreement program to improve surveillance and prevention of HAIs, with funding from the American Recovery and Reinvestment Act of 2009.
See also:
Full text of CDC's "First state-specific healthcare-associated infections summary data report"
http://www.cdc.gov/hai/pdfs/stateplans/SIR_05_25_2010.pdf
May 27 Sebelius statement
http://www.hhs.gov/news/press/2010pres/05/20100527a.html
HHS backgrounder page on HAIs
http://www.hhs.gov/ophs/initiatives/hai/
