Burden estimates to support prioritization of public health problems

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

Calculation of estimates of healthcare-associated infections in U.S. hospitals among adults and children outside of intensive care units, 2002 HRN = high risk newborns WBN -= well-baby nurseries ICU = intensive care unit SSI = surgical site infections BSI – bloodstream infections UTI = urinary infections PNEU = pneumonia SSI 20% BSI 11% UTI 36% PNEU 11% Other 22% 133, , , , , , ,385 TOTAL HRN WBN Non-newborn ICU = SSI Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6

Rates of Healthcare-Associated Infections in Newborns, Adults, and Children by Site of Infection, National Nosocomial Infections Surveillance (NNIS) System Well-baby nursery a High-risk nursery b Intensive care unit b (adults and children) Patient-days c 7,436,5204,835,70230,236,811 Major site of infection Rate of infection per 1,000 patient-days Urinary tract Bloodstream Pneumonia Surgical site Other Total a From NNIS hospital-wide surveillance, b From NNIS surveillance 2002, high-risk nursery and ICU component c From the National Hospital Discharge Survey (NHDS) for the U.S. population in non-federal hospitals

Estimated Number of Healthcare-Associated Infections in U.S. Hospitals by Subpopulation and Major Site of Infection, United States, 2002 Outside of Intensive careintensive care Major siteWell-babyHigh-riskunit (adultsunits (adultsUnadjustedAdjusted of infectionnurserynurseryand children)and children) a totaltotal b Percentage Urinary tract 1,413 2,418102, , , , Bloodstream 5,65214,797 81, , , , Pneumonia 1,785 4,400100, , , , Surgical site , , , , Other 10,18810,687 80, , , , Total 19,05933,269394,2881,195,1421,641,7581,737, a See proportions applied from description in Figure. b Adjusted for inclusion of federal hospitals by multiplying non-newborn values by 1.06 Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6

Burden of Healthcare-Associated Infections in the United States, 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 2007;122:160-6