Over 30 years ago, Dr. Robert Haley, now a professor of medicine at UT Southwestern in Dallas, led the CDC in pioneering work to apply epidemiology methods to hospital infection control. The Study on the Efficacy of Nosocomial Infection Control Project (SENIC), published in 1985, found that hospitals with active infection control programs had 32% lower incidence of nosocomial infections. SENIC was the cornerstone of efforts to monitor, control and prevent infections in health care settings. A study published this week in NEJM shows the work is still vital and needed.
The article by Dr. Shelley MacGill and colleagues in 10 geographically diverse states is a prevalence study estimating 4% of patients had a hospital-acquired infection (HAI) during 2011. Such prevalence surveys have been used in other countries to describe the scope of HAIs. The current work by CDC and 183 U.S. hospitals included 11,282 patients and found the Clostridium difficile was the most common pathogen, causing 12.1% of HAIs. The No. 2 pathogen was Staph aureus. The most common types of infections were pneumonia (21.8%), surgical site infections (21.8%) and gastrointestinal infections (17.1%).
The investigators also reported device-related infections caused by central lines, catheters and ventilators and other devices, caused 25.6% of HAIs. However, infections not associated with devices or operative procedures caused about half of all HAIs reported in the study. The authors suggested that more work is needed to define the risks for those HAIs and development of effective prevention measures. Currently most hospitals limit their reporting to device-related HAIs, surgical site infections and infections caused by C. difficile and methicillin-resistant S. aureus. The current study is important because it provides a more complete modern picture on the overall HAI burden and its distribution across a spectrum of patient types.
A limitation of the study is that it focused on hospitals, not other health care facilities such as skilled-nursing facilities and other long-term care facilities. Further work is needed in those areas since hospital stays have become shorter and many patients are now cared for in rehabilitation and chronic facilities.
Clearly the work that Dr. Haley started in health-care infections has taken root and may need expansion beyond the acute-care setting.