Chapter 2 Introduction

Since Act 52 requirements took effect in February 2008, DOH has published a comprehensive yearly report on the number and rates of HAIs in Pennsylvania hospitals. The current report, the ninth in this series, is a significant update from previous reports. DOH, in consultation with the statewide HAI Advisory Committee, modified this report in two significant ways.

First, the format of the report has changed so it is now accessible through an interactive webpage. Readers of the report (e.g., patients, providers, payors and local health departments) can view tables tailored for their particular needs. The data tables can be filtered and sorted to identify an individual hospital, or hospitals of similar type or in a specific county.

Second, this report is the first DOH HAI report to adopt CDC’s calculations of HAI performance measures. This change is well-timed and coincides with several recent changes made by CDC and is described in detail in the methods section of this report. HAI measures in previous reports are not comparable to measures in this report; however, the measures in this report will be comparable to CDC published measures in future state and national reports.

As in the past, this report includes the core benchmarked HAIs. They are catheter-associated urinary tract infections (CAUTIs), central line-associated blood stream infections (CLABSIs) and seven distinct types of surgical site infections (SSIs). They were selected by DOH in collaboration with a statewide HAI Advisory Committee established by Act 52 based on the volume of infections, their human and economic toll, and preventability. The DOH will periodically publish supplements to the annual report addressing special topics, including C. difficile, MRSA, VAP, CRE and health care personnel influenza vaccination rates.

Urinary tract infections (UTIs) are the fourth most common type of healthcare-associated infection, with an estimated 93,300 UTIs in acute care hospitals in 2011. UTIs account for more than 12 percent of infections reported by acute care hospitals (Magill et al. 2014). Each year, UTIs contribute to an estimated 13,000 deaths (Klevens et al. 2007). Many of these deaths are preventable. Virtually all healthcare-associated UTIs are caused by instrumentation of the urinary tract (Centers for Disease Control and Prevention 2018). Approximately 23.6 percent of adult hospitalized patients have an indwelling urinary catheter at some time during their hospitalization (Magill et al. 2014), and each day the indwelling urinary catheter remains, a patient has a 3-7 percent increased risk of developing a CAUTI (McGuckin 2012). Strategies to prevent CAUTIs are discusssed in CDC’s Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) document, Guideline for Prevention of Catheter-associated Urinary Tract Infection (Gould et al. 2010).

Central line-associated bloodstream infections (CLABSIs) are serious preventable blood stream infections. CLABSIs are associated with longer and more expensive hospital stays and increased risk of death (Warren et al. 2006; Climo et al. 2003). Although CLABSI rates decreased 46 percent from 2008–2013 (Centers for Disease Control and Prevention 2016a), an estimated 30,100 CLABSIs still occur in U.S. hospitals each year. CLABSIs can be prevented through proper insertion techniques and diligent management of the central line after insertion. These techniques are addressed in the CDC/HIPAC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011 (O’Grady 2011).

SSIs are costlier than those from CLABSI, CAUTI, and C. difficile infections (Zimlichman et al. 2013; Anderson et al. 2013) and lengthen hospital stays by 9.7 days (Ban KA 2016). An estimated 157,500 to 274,098 surgical site infections occurred in the United States in 2002 and 2011, respectively (Klevens et al. 2007; Magill et al. 2014). They are the most common HAI (Lewis et al. 2013; Magill et al. 2014) among hospitalized patients, accounting for 20-24 percent of all HAIs (Magill et al. 2014). Significant progress has occurred in decreasing the rate of SSIs since tracking began. Between 2006 and 2008, the SSI rate from all procedure types in 39 states was 1.9 percent (Mu Y and S.K. 2011). Similar data from 2010-2012 determined the SSI rate to be 0.82 percent (Lewis et al. 2013). By 2015 the national SSI rate dropped to 0.77 percent (Lewis et al. 2013). Similarly, the combined national SSI SIR (containing 10 procedures) fell from 0.92 in 2010 to 0.83 in 2014 (Centers for Disease Control and Prevention 2018).