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Healthcare Associated Infection and Antibiotic Use Prevalence Surveys


On any given day 1 in 31 U.S. hospital patients has at least one Healthcare Associated Infection.1
Healthcare Associated Infection (HAI) and Antibiotic Use (AU) Prevalence Surveys are conducted in all 10 Emerging Infections Program (EIP) sites in the United States. HAIs are an important public health problem because of their devastating effects on the wellbeing of patients, in addition to the billions of dollars in unnecessary expense they add to the healthcare system. Research suggests that a growing number of HAIs are caused by organisms that have developed resistance to standard antimicrobial drugs. Understanding AU in hospital and nursing home settings is an important part of identifying the connections between improper AU and development of HAI. The purpose of the survey project is to examine the number and type of HAIs and AU in hospitals and nursing homes and to identify the reasons antimicrobial drugs are used in these settings. This information will help create policies and procedures to make healthcare safer for patients in U.S. healthcare facilities.

Goals and Objectives

1. Estimate HAI number and frequency
2. Identify HAIs by
a. pathogen (including antimicrobial-resistant pathogens)
b. major infection site
3. Describe the indications for antimicrobial use
4. Identify changes in HAI and antimicrobial use prevalence, burden and epidemiology over time
5. Describe the quality of antimicrobial drug prescribing in selected clinical circumstance


Hospital Survey
The EIP Hospital Survey gathers data on all types of HAIs across all acute care inpatients in hospitals, including those HAIs not routinely tracked by the National Healthcare Safety Network (such as infections that are not associated with a medical device or procedure). The most recent hospital survey was conducted in 2015. To maintain continuity, hospitals that had participated in the 2011 survey were targeted for enrollment followed by recruitment of additional hospitals, up to 25 per site, using a stratified random sample based on hospital bed size. A total of 199 hospitals voluntarily participated in the 2015 survey. Each hospital selected a single survey day between May and September 2015. The number of patients in each hospital who were included in the survey was determined based on the size of the hospital, and the patient sample was randomly selected from the inpatient census on the survey day. Medical records were reviewed by EIP staff members, and in some cases by hospital staff members, to collect demographic and clinical data. Detailed information on HAIs and AU use were collected by trained EIP staff members. The next hospital prevalence survey is scheduled to begin in 2020.

Nursing Home Survey
The EIP Nursing Home Survey gathers data on all types of HAIs in nursing homes. For this survey, infections were defined using the revised McGeer definitions for infections in Long-Term Care Facilities. The most recent nursing home survey was conducted in 2017. Nursing homes were randomly selected for recruitment in each EIP site, participation was voluntary. Each participating nursing home selected a single survey day between April and October 2017. Medical record reviews were performed by EIP staff members and in some cases with assistance from nursing home staff members to collect demographic data, evidence of HAIs and AU. Residents newly admitted to the nursing home were not included. The next nursing home prevalence survey is scheduled to begin in 2022.

Recent Hospital Survey Publications

Magill SS, O’Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, Wilson LE, Kainer MA, Lynfield R, Greissman S, Ray SM, Beldavs Z, Gross C, Bamberg W, Sievers M, Concannon C, Buhr N, Warnke L, Maloney M, Ocampo V, Brooks J, Oyewumi T, Sharmin S, Richards K, Rainbow J, Samper M, Hancock EB, Leaptrot D, Scalise E, Badrun F, Phelps R, Edwards JR; Emerging Infections Program Hospital Prevalence Survey Team. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Eng J Med. 2018 Nov 1;379(18):1732-1744. doi: 10.1056/NEJMoa1801550.

Magill SS, Edwards JR, Beldavs ZG, Dumyati G, Janelle SJ, Kainer MA, Lynfield R, Nadle J, Neuhauser MM, Ray SM, Richards K, Rodriguez R, Thompson DL, Fridkin SK; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Prevalence of antimicrobial use in US acute care hospitals, May-September, 2011. JAMA. 2014 Oct 8;312(14):1438-46. doi: 10.1001/jama.2014.12923.

Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson DL, Wilson LE, Fridkin SK; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014 Mar 27;370(13):1198-208. doi: 10.1056/NEJMoa1306801.

Magill SS, Hellinger W, Cohen J, Kay R, Bailey C, Boland B, Carey D, de Guzman J, Dominguez K, Edwards J, Goraczewski L, Horan T, Miller M, Phelps M, Saltford R, Seibert J, Smith B, Starling P, Viergutz B, Walsh K, Rathore M, Guzman N, Fridkin S. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol. 2012 Mar;33(3):283-91. doi: 10.1086/664048. Epub 2012 Jan 12.

Recent Nursing Home Survey Publications

Epstein L, Stone ND, LaPlace L, Harper J, Lynfield R, Warnke L, Whitten T, Maloney M, Melchreit R, Rodriguez R, Quinlan G, Concannon C, Dumyati G, Thompson DL, Thompson N. Comparison of Data Collection for Healthcare-Associated Infection Surveillance in Nursing Homes. Infect Control Hosp Epidemiol. 2016 Dec;37(12):1440-1445. Epub 2016 Oct 3.

Thompson ND, LaPlace L, Epstein L, Thompson D, Dumyati G, Concannon C, Quinlan G, Witten T, Warnke L, Lynfield R, Maloney M, Melchreit R, Stone ND. Prevalence of Antimicrobial Use and Opportunities to Improve Prescribing Practices in U.S. Nursing Homes. J Am Med Dir Assoc. 2016 Dec 1;17(12):1151-1153. doi: 10.1016/j.jamda.2016.08.013. Epub 2016 Oct 14.

Eure T, LaPlace LL, Melchreit R, Maloney M, Lynfield R, Whitten T, Warnke L, Dumyati G, Quinlan G, Concannon C, Thompson D, Stone ND, Thompson ND. Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents. Infect Control Hosp Epidemiol. 2017 Aug;38(8):998-1001. doi: 10.1017/ice.2017.96. Epub 2017 May 31.

Project Contact

Paula Clogher, MPH
Program Manager, HAI
Connecticut Emerging Infections Program
One Church Street, 7th floor
New Haven, CT 06510

1 HAI and Antibiotic Use Prevalence Survey