HAI and Antibiotic Use Prevalence Survey

This project examines the numbers and types of 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 1 in 25 hospital patients gets 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

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

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. Phase 4 is currently underway.

Benefits

The results of this survey will 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.

Publication

• Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida.

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.

Abstract

• Preliminary Results of a Healthcare-Associated Infection and Antimicrobial Use Prevalence Survey in 22 U.S. Acute Care Hospitals

Phase 3 (2011)

A full-scale, one-day survey was conducted in 183 acute care hospitals in 10 EIP states.

Abstracts

• Point Prevalence Survey of Antimicrobial Use in U.S. Acute Care Hospitals.
• Epidemiology of Pediatric Healthcare-Associated Infections and Antimicrobial Use in U.S. Acute Care Hospitals.

Publications

• Multistate Point-Prevalence Survey of Health Care-Associated Infections
• Prevalence of Antimicrobial Use in US Acute Care Hospitals, May-September 2011.

Phase 4 (2015-2016)

Data collection for this survey was expanded to be able to describe the quality of antimicrobial drug prescribing. About 200 acute care hospitals in 10 EIP states participated. Hospital survey dates occurred between May and September 2015. Initial results are expected in 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 using a stratified random sample based on hospital bed size. Hospital participation was voluntary. The goal was to have 25 participating hospitals in each EIP state. Non-federal general and children’s acute care hospitals were included. 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, including information on infections and antimicrobial drug use.

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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 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.

Publications

• Comparison of data collection for healthcare-associated infection surveillance in nursing homes. L Epstein, L La Place, D Thompson et al. Infection Control and Hospital Epidemiology, 2016
• Prevalence of antimicrobial use and opportunities to improve prescribing practices in U.S. nursing homes. ND Thompson, L LaPlace, L Epstein et al. Journal of the American Medical Directors Association, 2016

Abstracts

• Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents. T Eure, N Thompson, N Stone, et al. Abstract 7716. SHEA Spring 2016 Conference.

Phase 2 (2017)

A full-scale survey will include about 200 nursing homes in 10 EIP states (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN). This survey will gather 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 will be randomly selected for participation. Nursing home participation is voluntary. The goal is to recruit up to 20 nursing homes in each EIP state. Each nursing home will selected a single survey day between April and September 2017. Resident’s medical records will be reviewed to collected demographic data, and for evidence of HAIs and antimicrobial use. Medical record reviews will be performed by EIP staff members, and in some cases with assistance from nursing home staff members. Residents newly admitted to the nursing home will not be included.

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