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Highest Prevalence of Nosocomial Infection

Nosocomial (hospital-acquired) infections are increasingly known as HAIs, or healthcare associated infections, because they also affect nursing homes, dialysis clinics, health centers, and other medical settings. Estimates in 2002 from the Centers for Disease Control (CDC) indicated that 1.7 million patients annually contract an HAI unrelated to (or even in the incubation stage of) the disease or condition that originally caused them to seek medical care.

  1. Background

    • The CDC began monitoring HAIs in the early 1970s through the National Nosocomial Infections Surveillance (NNIS) system. By 2002, estimates were 98,059 hospital deaths per year from HAI, with an approximate annual treatment cost by 2009 of between $28.4 and $33.8 billion. These figures, supplemented by other hospital data, were however based on voluntary reporting by hospitals only. To increase surveillance efficiency and prevention efforts, the CDC in 2005 introduced the upgraded National Healthcare Safety Network Surveillance Initiative (NHSN) which taps a variety of national electronic reporting systems.

    HAI Pathogens

    • The 10 most common infection-causing pathogens, accounting for 84% of HAIs, are negative staphylococci (15%), Staphylococcus aureus (15%), Enterococcus species (12%), Candida species (11%), Escherichia coli (10%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (6%), Enterobacter species (5%), Acinetobacter baumannii (3%) and Klebsiella oxytoca (2%). The resulting infections in 2002 affected the urinary tract (32%), surgical sites (22%), respiratory systems through pneumonia (15%) and bloodstream (14%). However the global growth of antibiotic resistance, including Methicillin-resistant staphylococcus aureus (MRSA), complicates the treatment of HAI.

    Prevalence of HAI

    • In hospitals, the most common locations harboring HAI pathogens are intensive care units (ICUs), with high-risk and well-baby nurseries reporting significant numbers of HAI infections and deaths. Discrepancies in reporting the total number of ICU infections from surgical sites are widespread because many infections emerge only after discharge. At first, NNIS statistics were given for hospitals overall rather than by location of care within the hospital, further clouding the accuracy of data.

    Ongoing Efforts

    • Among the conditions blamed for the increase in HAIs are urbanization, pollution, demographics (growing numbers of elderly persons needing medical care), resurgence of diseases such as tuberculosis and increased global travel. An increasing number of hospitals and medical facilities have instituted infection control programs that target both physical plant and personnel practices, some as economical as hand hygiene and glove-wearing. The CDC has implemented an MRSA initiative.

    Progress

    • By 2009, although many organizations, government bodies, state agencies, foundations and academic institutions had developed plans and programs to fight HAI, there was no nationwide mandate to require reporting or to implement infection control measures. There are, however, encouraging signs of progress. Pennsylvania has mandated a statewide reporting program; New York state requires all medical personnel to undergo infection control training. The Institute for Healthcare Improvement's "100,000 Lives" program has been successful in test sites. North Carolina is building infection control into continuing education programs. There are many participants committed to reducing the prevalence of HAIs.

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