412 The Long Term Impact of an Infection Control (IC) Network on the Rates of Healthcare-Associated Infections (HAI) in Community Hospitals: An Ounce of Prevention is Worth a Pound of Cure

Saturday, March 20, 2010: 11:45 AM
Regency VI-VII (Hyatt Regency Atlanta)
Becky A. Miller, MD , Duke University Medical Center, Durham, NC
Luke F. Chen, MBBS, FRACP , Duke University Medical Center, Durham, NC
Daniel J. Sexton, MD, FACP , Duke University Medical Center, Durham, NC
Deverick J. Anderson, MD, MPH , Duke University Medical Center, Durham, NC

Background:   Community hospitals often lack the necessary resources required for effective IC programs.  While membership in an IC network of community hospitals has been associated with short-term decreases in rates of HAIs, the long term impact of this type of network has not been evaluated.


Objective:   To describe the long term impact of membership in an IC network on rates of HAI and occupational exposures to blood borne pathogens (OEBBP) in community hospitals.

Methods:   We conducted a prospective cohort study of rates of HAIs and OEBBP in hospitals that participated in the Duke Infection Control Outreach Network (DICON) for a minimum of 5 years.  DICON provides IC expertise, education, data feedback, and best practices for member hospitals.  Data pertaining to Central Line-Associated Bloodstream Infection (CLABSI), Ventilator-Associated Pneumonia (VAP), Catheter-Associated Urinary Tract Infection (CAUTI), Surgical Site Infection (SSI), employee and physician OEBBP, and infection due to methicillin-resistant Staphylococcus aureus (MRSA) were prospectively collected from standardized surveillance databases that use CDC definitions.  Standard descriptive statistics and Poisson regression were performed to analyze data and determine the change in rates of these infections/exposures over time. 


Results:   25 hospitals participated in the DICON network for 5 years or longer, accumulating a total of 6,175,233 patient days.  Statistically significant improvements in the rates of the following infections/exposures were seen as follows: employee OEBBP decreased by 16% (p=0.04); CLABSI decreased by 42% (p=0.0007); VAP decreased by 50% (p=0.001); CAUTI decreased by 41% (p=0.002); and infections due to MRSA decreased by 35% (p=0.002) (Figure).  Rates of SSI and physician OEBBP did not significantly change.       


Conclusions:   Participation in an IC network of community hospitals was associated with long-term reductions in the rates of most HAIs.  Strategies incorporating the use of standardized surveillance, data analysis, regular feedback to member hospitals, and education contributed to the sustained success of this infection control program.  In keeping with National Patient Safety Goals, application of the DICON model of infection control to more community hospitals in the US may help reduce mortality and attributable costs associated with HAIs.

Figure:  Annual rates of Healthcare-associated Infections and Bloodborne Pathogen Exposures in 25 hospitals during 5 years of DICON membership.  EOEBBP=employee OEBBP and POEBBP=physician OEBBP.  See text for definitions of other abbreviations.