What U.S. Hospitals are Doing to Prevent Hospital-Acquired Infection: 2005 to 2009

Background: Hospital-acquired infection (HAI) is common, costly, and potentially life-threatening. 2005 data revealed substantial variability in the use of HAI prevention practices among U.S. hospitals. It is not known, however, whether initiatives to reduce HAI – such as the change in the Centers for Medicare and Medicaid Services (CMS) payment system to not pay hospitals for the costs incurred for certain HAIs – has led to an increase in the use of preventive practices.

Objective: We sought to examine current use of infection prevention practices by hospitals in the U.S. and assess trends in the use of various practices between 2005 and 2009. 

Methods: We surveyed infection preventionists at a national random sample of U.S. hospitals in both 2005 and 2009 and asked about the use of practices to prevent central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI).  We estimated the percent of U.S. hospitals reporting regular use of key prevention practices in 2005 and 2009 and examined changes between 2005 and 2009.

Results: The response rate in both years was approximately 70%.  Between 2005 and 2009 there was a significant increase in the percent of hospitals reporting use of three practices for preventing CLABSI (figure 1): maximum sterile barrier (MSB) use increased from 71% to 90%, chlorhexidine (CHG) for site antisepsis increased from 69% to 95% and use of an antimicrobial dressing with chlorhexidine increased from 25% to 55%.  58% of hospitals reported a moderate or large increase in CLABSI prevention as a priority due to the CMS payment changes. Significant changes for preventing VAP included an increase in the percent of hospitals reporting use of semi-recumbent positioning (82% to 95%), antimicrobial mouth rinse (41% to 58%), and subglottic secretion drainage (21% to 42%) with 54% of hospitals indicating that payment changes had a moderate to large effect on preventing VAP as a priority.  Although 65% of hospitals reported a moderate to large increase in prevention of CAUTI as a priority due to payment changes, use of most practices to prevent CAUTI remained relatively low.  Significant increases were observed, however, in the percent using portable bladder ultrasound (29% to 39%), catheter reminders or stop orders (9% to 20%), and silver alloy urinary catheters (29% to 45%). 

Conclusions: Since 2005, there have been significant increases in the percentage of U.S. hospitals reporting use of several key practices to prevent CLABSI, VAP, and CAUTI.  While over 60% of hospitals report a moderate or large increase in CAUTI prevention as a facility priority related to the CMS payment changes, the percent of hospitals using specific practices to prevent CAUTI remains low compared to CLABSI and VAP.