CDC report: CAUTIs difficult to prevent

The good news: A 41% cut in CLABSIs

Hospitals in the U.S. continue to make progress in the fight against central line-associated bloodstream infections and some surgical site infections, but are struggling to reduce catheter-associated urinary tract infections (CAUTI), according to a new report issued by the Centers for Disease Control and Prevention.1

The CDC reported a 7% reduction in CAUTIs since 2009, which is the same percentage of reduction that was reported in 2010. While there were modest reductions in infections among patients in general wards, there was essentially no reduction in CAUTI infections reported in critical care locations, the CDC reported.

“The slower progress in reducing catheter-associated urinary tract infections among ICU patients is concerning because these infections drive antibiotic use. While antibiotics are critical for treating bacterial infections, they also put patients at risk for complications including a deadly diarrhea caused by the bacteria Clostridium difficile,” the CDC reported.

The lack of significant reductions in CAUTIs may be due to an inability to substantially decrease catheter days in critical care areas (as can be done more easily in wards), the CDC reported. However, Michigan reported a 25% reduction in CAUTI using a device-day rate based standardized infection ratio (SIR) after implementing a series of prevention initiatives. “This suggests that with continued prevention efforts, we should expect continued reductions in both critical care and ward-specific CAUTI SIRs using a device-day methodology,” the CDC noted.

The report looked at data submitted to the National Healthcare Safety Network (NHSN), CDC’s infection tracking system, which receives data from more than 11,500 healthcare facilities nationwide. Healthcare facilities using NHSN have real-time access to their data for local improvement efforts. The CDC report provides analysis of national and state-level healthcare-associated infection data to help identify gaps in prevention.

The CDC uses an SIR summary measure used to track HAIs at a national, state, or facility level over time. The SIR adjusts for the fact that each healthcare facility treats different types of patients. For example, the experience with HAIs at a hospital with a large burn unit cannot be directly compared to a facility without a burn unit. In HAI data analysis, the SIR compares the actual number of HAIs in a facility or state with the baseline U.S. experience (i.e., standard population), adjusting for several risk factors that have been found to be most associated with differences in infection rates. If the SIR is 1, then the number of infections reported to NHSN is the same as the number of predicted infections. If the SIR is less than 1, then there were fewer infections reported in 2011 than what would have predicted given the baseline data. If the SIR is greater than 1, then there were more infections reported in 2011 than what would have predicted given the baseline data.

Other findings in the CDC report include:

— A 41 % reduction in central line-associated bloodstream infections since 2008, up from the 32% reported in 2010. Progress in preventing these infections was seen in ICUs, wards, and neonatal ICUs in all reporting facilities. The CDC estimated that 12,400 central line-associated bloodstream infections occurred in 2011, costing one payer, the Centers for Medicare & Medicaid Services (CMS), approximately $26,000 per infection.

— A 17% reduction in surgical site infections since 2008, up from the 7% reduction reported in 2010. This improvement was not evident for all procedure types, and there is still substantial opportunity for improvement across a range of operative procedures, the CDC concluded.

Problem facilities will be contacted

The CDC report is the first to provide some perspective on the potential improvements that can occur with facility-specific engagement. For each major location group and procedure category, roughly 2% to 9% of the facilities reported SIRs greater than 1.0, meaning significantly more infections were observed than predicted. These include:

  • 54 facilities that had SIRs significantly higher than 1.0 for central line-associated bloodstream infections
  • 133 facilities that had SIRs significantly higher than 1.0 for catheter-associated urinary tract infections
  • 25 facilities that had SIRs significantly higher than 1.0 for surgical site infections associated with hip arthroplasty
  • 30 facilities who had SIRs significantly higher than 1.0 for surgical site infections associated with knee arthroplasty
  • 20 facilities that had SIRs significantly higher than 1.0 for surgical site infections associated with colon surgery
  • 15 facilities that had SIRs significantly higher than 1.0 for surgical site infections associated with abdominal hysterectomy

“These are relatively small numbers of facilities compared to the total number of facilities reporting in 2011 (e.g., 3,468 reporting CLABSI, 1,802 reporting CAUTI, 2,130 reporting SSIs),” the CDC concluded. “However, focusing efforts on these facilities may be one strategy to ensure that prevention resources are utilized most wisely in coming years.“

The CDC is contacting the facilities that have significantly high SIRs and connecting them with existing prevention initiatives including:

  • State health department collaboratives
  • CUSP initiatives funded by the Agency for Healthcare Research and Quality
  • Partnership for Patients initiative
  • CMS Quality Improvement Organizations

“By moving these hospitals towards more prevention, we hope to see even greater reductions next year,” the CDC report concludes.

Reference

  1. CDC. 2011 National and State Healthcare-associated Infections Standardized Infection Ratio Report. Available at: http://www.cdc.gov/hai/national-annual-sir/index.html