Burden estimates to support prioritization of public health problems

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Burden estimates to support prioritization of
public health problems
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Challenges to National Estimates of
Healthcare-Associated Infections in U.S. Hospitals

• No single source of representative data available
  to estimate burden in the United States
• In 2002, available data were
• National Nosocomial Infections Surveillance
  System
• American Hospital Association Survey
• National Hospital Discharge Survey

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Calculation of estimates of healthcare-associated
infections in U.S. hospitals among adults and
children outside of intensive care units, 2002
HRN high risk newbornsWBN - well-baby
nurseriesICU intensive care unitSSI
surgical site infectionsBSI bloodstream
infectionsUTI urinary infectionsPNEU
pneumonia
Klevens, Edwards, Richards, et al. Pub Health Rep
2007122160-6
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Rates of Healthcare-Associated Infections in
Newborns, Adults, and Children by Site of
Infection, National Nosocomial Infections
Surveillance (NNIS) System
Well-baby nurserya High-risk nurseryb Intensive
care unitb (adults and children)Patient-days
c 7,436,520 4,835,702 30,236,811Major site of
infection Rate of infection per 1,000
patient-days Urinary tract 0.19 0.5
3.38 Bloodstream 0.76 3.06
2.71 Pneumonia 0.24 0.91 3.33 Surgical
site 0.003 0.2 0.95 Other 1.37 2.21
2.67 Total 2.56 6.88 13.04aFrom NNIS
hospital-wide surveillance, 1990-1995bFrom NNIS
surveillance 2002, high-risk nursery and ICU
componentcFrom the National Hospital Discharge
Survey (NHDS) for the U.S. population in
non-federal hospitals
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Estimated Number of Healthcare-Associated
Infections in U.S. Hospitals by Subpopulation and
Major Site of Infection, United States, 2002
Outside of Intensive care intensive
careMajor site Well-baby High-risk unit
(adults units (adults Unadjusted Adjustedof
infection nursery nursery and children) and
children)a total totalb PercentageUrinary
tract 1,413 2,418 102,200 424,060
530,091 561,667 32Bloodstream
5,652 14,797 81,942 133,368 235,759
248,678 14Pneumonia 1,785 4,400 100,689
129,519 236,393 250,205 15Surgical site
21 967 28,725 244,385 274,098
290,485 22Other 10,188 10,687 80,732
263,810 365,417 386,090
17Total 19,059 33,269 394,288 1,195,142 1,641,758
1,737,125 100aSee proportions applied from
description in Figure.bAdjusted for inclusion of
federal hospitals by multiplying non-newborn
values by 1.06
Klevens, Edwards, Richards, et al. Pub Health Rep
2007122160-6
6
Burden of Healthcare-Associated Infections in the
United States, 2002

• 1.7 million infections in hospitals
• Most (1.3 million) were outside of ICUs
• 9.3 infections per 1,000 patient-days
• 4.5 per 100 admissions
• 99,000 deaths associated with infections
• 36,000 pneumonia
• 31,000 bloodstream infections

Klevens, Edwards, Richards, et al. Pub Health Rep
2007122160-6