Epidemiology of Hospital Acquired Infections By Alena Bosconi, Candice Smith, Dusica Goralewski SUNY Delhi Biol , Infection and Disease Dr. Marsha Stock February 2, 2014

 Epidemiology describes how disease is distributed throughout populations and the factors influencing its distribution  Looks at populations and risk  Determines predisposition or protection from disease  Focus on prevention  Important in communities and hospitals/ healthcare facilities (Gordis, 2009)

 Also known as nosocomial infections  Can be bacterial, viral or fungal  Infections not present or incubating on admission  Found to exist 48 hours after admission or after discharge

 Pathogen and host  Reservoir where pathogen lives  Mode of transmission  Portal of entry  Portal of exit

 2 million cases occur yearly  50% of major hospital complications  40% UTI  20% Surgical site infections  15% Respiratory infections  6% Blood stream infections (Krasner & Shors, 2014)

 Urinary tract (#1 in adults)  Blood stream (#1 in children)  Pneumonia (#2 in children)  Surgical sites (Custodio, 2013)

 Severity of illness  Compromised immune status  Invasive lines and procedures  Increased length of stay  Poor nutrition  Increased antibiotic use fosters resistant strains (70% resistant to at least one antibiotic) (Krasner & Shors, 2014)

 MRSA- number one hospital acquired  Community based  Treatment challenges  Additional resistant pathogens ◦ Acinetobacter baumannii ◦ Clostridium difficile ◦ Klebsiella pneumoniae ◦ Eschericia coli ◦ Enterococcus faecalis (Krasner & Shors, 2014)

 Refers to the state of being diseased or unhealthy  Another term for illness  Incidence tells us about new cases  Prevalence tells us about the affected population at a specific time (Gordis, 2009)

 Refers to the number of people who die within a population  Is another term for death  Data used to measure disease severity and effectiveness of treatment

 Examples of Scoring Systems ◦ Modified Early Warning Score (MEWS) ◦ Percutaneous Coronary Intervention Risk Score (PCI) ◦ Standardized Infection Ratios (SSI risk index)

 CDC- NHSN  WHO  State health departments  Hospitals/ facilities

In July of 2005, Public Health Law 2819 was enacted mandating that NY hospitals report selected HAIS to the NYSDOH. The following indicators must be reported in 2013 to meet NYSDOH requirements  CLABSIs in adult, pediatric and neonatal intensive care units (excluding burn, trauma and respiratory ICUs)  Colon surgical site infections  Coronary artery bypass graft surgical site infections  Hip replacement surgical site infections

Source: New York State Department of Health, Albany, NY September 2012

 The Joint Commission: ◦ 2014 National Patient Safety Goal #7  Centers for Disease Control and Prevention ◦ Healthcare-associated Infections: Prevention Epicenters Program  US Department of Health and Human Services ◦ National Action Plan to Prevent Health Care- Associated Infections: Road Map to Elimination

 Prevent multi-drug resistant infections  Prevent infections of the blood from central lines  Prevent infections after surgery  Prevent urinary tract infections that caused by catheters.

Healthcare-associated Infections: Prevention Epicenters Program:  CDC collaborates with academic investigators to conduct innovative infection control and prevention research.

 MRSA, VRE, and other multidrug-resistant bacterial pathogens  Bloodstream infections  Surgical site infections  Ventilator-associated pneumonia  C.difficile  Catheter associated urinary tract infections.

National Action Plan to Prevent Health Care- Associated Infections: Road Map to Elimination

2011 National and State Healthcare-associated Infections Standardized Infection Ratio Report (CDC,2014) HAIReduction (%)Target (%) Central-line associated bloodstream infections 4150 Surgical site infections 1725 Catheter associated urinary tract infections 725

 HAIs in the US cost approximately $30-$40 billion  Prevention procedures can reduce certain HAIs by 70%  Prevention can save $6-$31 billion dollars (CDC, 2009)

 HAIs a serious problem affecting morbidity and mortality  Increasing numbers of resistant bacteria creating worldwide problem  Financial burden and impact on healthcare

Centers for Disease Control and Prevention (2014) National and State Healthcare- associated Infections Standardized Infection Ratio Report. Retrieved from sir/index.html CDC. (2009). The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Retrieved from aper.pdf

Custodio, H.T. (2013). Hospital-acquired infections clinical presentation. Retrieved from clinical Gordis, L. (2009). Epidemiology (4th ed.). Philadelphia, PA: Saunders-Elsevier The Joint Commission (2014) National Patient Safety Goals. Retrieved from nformation/npsgs.aspx

Krasner, R.I. & Shors, T. (2014). The microbial challenge. A public health perspective (3rd ed.). Burlington, MA: Jones and Bartlett Learning. U.S. Department of Health & Human Services (2014). National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. Retrieved from