National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module.
01 Dec 2013-American Journal of Infection Control (NIH Public Access)-Vol. 41, Iss: 12, pp 1148-1166
TL;DR: This work aims to collect data from a sample of health care facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and health care personnel and to provide facilities with risk-adjusted metrics that can be used for inter-facility comparisons and local quality improvement activities.
About: This article is published in American Journal of Infection Control.The article was published on 2013-12-01 and is currently open access. It has received 501 citations till now. The article focuses on the topics: Health care.
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University of Nebraska Medical Center1, University of Connecticut2, Harvard University3, Queen's University4, University of California, San Diego5, Stony Brook University6, University of Michigan7, National Institutes of Health8, Johns Hopkins University9, University of Barcelona10, University at Buffalo11, Summa Health System12, University of Texas Health Science Center at San Antonio13, Royal Brisbane and Women's Hospital14, University of Queensland15, University of Western Australia16, University of Colorado Denver17, McMaster University18
TL;DR: These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia.
Abstract: It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.
2,359 citations
Cites result from "National Healthcare Safety Network ..."
...Although hospital-reported data from the National Healthcare Safety Network suggest that VAP rates have been declining [5, 6], recently published data from a randomly selected national sample demonstrated that approximately 10% of patients who required mechanical ventilation were diagnosed with VAP and that this rate has not declined over the past decade [7]....
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TL;DR: While quality improvement initiatives have decreased HAI incidence and costs, much more remains to be done, as hospitals realize savings from prevention of these complications under payment reforms, they may be more likely to invest in such strategies.
Abstract: $36 286-$44 220), surgical site infections at $20 785 (95% CI, $18 902-$22 667), Clostridium difficile infection at $11 285 (95% CI, $9118-$13 574), and catheter-associated urinary tract infections at $896 (95% CI, $603-$1189). The total annual costs for the 5 major infections were $9.8 billion (95% CI, $8.3-$11.5 billion), with surgical site infections contributing the most to overall costs (33.7% of the total), followed by ventilator-associated pneumonia (31.6%), central line–associated bloodstream infections (18.9%), C difficile infections (15.4%), and catheter-associated urinary tract infections (<1%).
1,387 citations
TL;DR: This report updates previously published DA Module data from the NHSN and provides contemporary comparative rates, including national and state-specific reports of standardized infection ratios for select health care-associated infections (HAIs).
585 citations
TL;DR: Ventilator-associated pneumonia poses grave implications in endotracheally intubated adult patients in ICUs worldwide and leads to increased adverse outcomes and healthcare costs.
Abstract: Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs 48–72 hours or thereafter following endotracheal intubation, characterized by the presence of a new or progressive infiltrate, signs of systemic infection (fever, altered white blood cell count), changes in sputum characteristics, and detection of a causative agent [1]. VAP contributes to approximately half of all cases of hospital-acquired pneumonia [1, 2]. VAP is estimated to occur in 9–27 % of all mechanically ventilated patients, with the highest risk being early in the course of hospitalization [1, 3]. It is the second most common nosocomial infection in the intensive care unit (ICU) and the most common in mechanically ventilated patients [4, 5]. VAP rates range from 1.2 to 8.5 per 1,000 ventilator days and are reliant on the definition used for diagnosis [6]. Risk for VAP is greatest during the first 5 days of mechanical ventilation (3 %) with the mean duration between intubation and development of VAP being 3.3 days [1, 7]. This risk declines to 2 %/day between days 5 to 10 of ventilation, and 1 %/day thereafter [1, 8]. Earlier studies placed the attributable mortality for VAP at between 33–50 %, but this rate is variable and relies heavily on the underlying medical illness [1]. Over the years, the attributable risk of death has decreased and is more recently estimated at 9–13 % [9, 10], largely because of implementation of preventive strategies. Approximately 50 % of all antibiotics administered in ICUs are for treatment of VAP [2, 4]. Early onset VAP is defined as pneumonia that occurs within 4 days and this is usually attributed to antibiotic sensitive pathogens whereas late onset VAP is more likely caused by multidrug resistant (MDR) bacteria and emerges after 4 days of intubation [1, 4]. Thus, VAP poses grave implications in endotracheally intubated adult patients in ICUs worldwide and leads to increased adverse outcomes and healthcare costs. Independent risk factors for development of VAP are male sex, admission for trauma and intermediate underlying disease severity, with odds ratios (OR) of 1.58, 1.75 and 1.47–1.70, respectively [7].
449 citations
TL;DR: The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, whenCatheter use is necessary, to discontinue the catheter as soon as clinically feasible.
Abstract: Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation.
350 citations
References
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TL;DR: In this paper, the NHSN criteria for all healthcare-associated infections (HAIs) are presented, including those for the "Big Four" (surgical site infection [SSI], pneumonia [PNEU], bloodstream infection [BSI] and urinary tract infection [UTI]).
4,927 citations
Journal Article•
TL;DR: In this article, the NHSN criteria for all healthcare-associated infections (HAIs) are presented, including those for the "Big Four" (surgical site infection [SSI], pneumonia [PNEU], bloodstream infection [BSI] and urinary tract infection [UTI]).
4,849 citations
TL;DR: The frequency of selected antimicrobial resistance patterns among pathogens causing device-associated and procedure-associated healthcare-associated infections reported by hospitals in the National Healthcare Safety Network (NHSN) is described.
Abstract: Objective. To describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) during 2009-2010. Methods. Central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections were included. Pooled mean proportions of isolates interpreted as resistant (or, in some cases, nonsusceptible) to selected antimicrobial agents were calculated by type of HAI and compared to historical data. Results. Overall, 2,039 hospitals reported 1 or more HAIs; 1,749 (86%) were general acute care hospitals, and 1,143 (56%) had fewer than 200 beds. There were 69,475 HAIs and 81,139 pathogens reported. Eight pathogen groups accounted for about 80% of reported pathogens: Staphylococcus aureus (16%), Enterococcus spp. (14%), Escherichia coli (12%), coagulase-negative staphylococci (11%), Candida spp. (9%), Klebsiella pneumoniae (and Klebsiella oxytoca; 8%), Pseudomonas aeruginosa (8%), and Enterobacter spp. (5%). The percentage of resistance was similar to that reported in the previous 2-year period, with a slight decrease in the percentage of S. aureus resistant to oxacillins (MRSA). Nearly 20% of pathogens reported from all HAIs were the following multidrug-resistant phenotypes: MRSA (8.5%); vancomycin-resistant Enterococcus (3%); extended-spectrum cephalosporin-resistant K. pneumoniae and K. oxytoca (2%), E. coli (2%), and Enterobacter spp. (2%); and carbapenem-resistant P. aeruginosa (2%), K. pneumoniae/oxytoca (<1%), E, coli (<1%), and Enterobacter spp. (<1%). Among facilities reporting HAIs with 1 of the above gram-negative bacteria, 20%-40% reported at least 1 with the resistant phenotype. Conclusion. While the proportion of resistant isolates did not substantially change from that in the previous 2 years, multidrug-resistant gram-negative phenotypes were reported from a moderate proportion of facilities.
3,470 citations
TL;DR: This report updates previously published DA Module data from the NHSN and provides contemporary comparative rates, including national and state-specific reports of standardized infection ratios for select health care-associated infections (HAIs).
585 citations
"National Healthcare Safety Network ..." refers background in this paper
...2 Step-down NICU (level II) 7 (1) 0 119 0....
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...Medical/surgical 2,048 (1,932) 1,592 1,938,992 0....
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...0 Medical/surgical All other 15 beds 1,690 (1,562) 1,226 1,312,634 0....
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...5 Medical/Surgical 1,825 (1,765) 2,752 2,038,073 1....
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...2 Medical/Surgical All other, 15 beds 1,688 (1,651) 2,521 2,032,215 1....
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TL;DR: In this paper, the authors analyzed data from the National Nosocomial Infections Surveillance System (NOSIS) from October 1986 to December 1990, 79 hospitals reported 2,334 hospital-months of data from 196 hospitals units.
431 citations