1. Burden estimates to support prioritization of public health problems

2. 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

3. 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% 133,368 424,060 263,810 129,519 274,098 -967 -21 -28,725 244,385 TOTAL HRN WBN Non-newborn ICU = SSI Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6

4. 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 0.190.5 3.38 Bloodstream 0.76 3.06 2.71 Pneumonia 0.24 0.91 3.33 Surgical site 0.0030.2 0.95 Other 1.37 2.21 2.67 Total 2.56 6.8813.04 a From NNIS hospital-wide surveillance, 1990-1995 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

5. 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 2,418102,200 424,060 530,091 561,667 32 Bloodstream 5,65214,797 81,942 133,368 235,759 248,678 14 Pneumonia 1,785 4,400100,689 129,519 236,393 250,205 15 Surgical site 21 967 28,725 244,385 274,098 290,485 22 Other 10,18810,687 80,732 263,810 365,417 386,090 17 Total 19,05933,269394,2881,195,1421,641,7581,737,125100 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

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 2007;122:160-6